Rokho Kim

Environmental burden of disease in Europe : assessing nine risk factors in six countries

Background: Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. Objectives: The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). Methods: Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. Results: About 3–7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 μm; PM2.5) is the leading risk factor associated with 6,000–10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600–1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. Conclusions: With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability. Citation: Hänninen O, Knol AB, Jantunen M, Lim TA, Conrad A, Rappolder M, Carrer P, Fanetti AC, Kim R, Buekers J, Torfs R, Iavarone I, Classen T, Hornberg C, Mekel OC, EBoDE Working Group. 2014. Environmental burden of disease in Europe: assessing nine risk factors in six countries. Environ Health Perspect 122:439–446; http://dx.doi.org/10.1289/ehp.1206154

K X-ray fluorescence measurements of bone lead concentration: the analysis of low-level data

K line x-ray fluorescence (KXRF) measurements of bone lead have emerged as a promising new biological marker of internal lead dose in epidemiological studies. Some disagreements exist, however, over the analysis of data at low levels of bone lead concentration. In this study, we performed 30 serial measurements on each of three phantoms containing spiked amounts of lead. Chemical analysis of these phantoms using an inductively coupled plasma mass spectrometer (ICPMS) indicated that the lead concentrations were 0.30, 5.77, and 11.57 micrograms g-1. Analysis of the data was performed using several definitions of a minimum detectable limit (MDL) to recode data below the MDL, and using all of the continuous point estimates of lead concentration in the phantom (including negative estimates). The results demonstrate that the use of MDLs to recode low-level observations reduces the efficiency of the analysis and the ability to distinguish between the phantoms. Retaining all point estimates of KXRF-measured bone lead concentration provides less bias and greater efficiency in comparing the mean or median levels of bone lead of different populations.

Validation of K x-ray fluorescence bone lead measurements by inductively coupled plasma mass spectrometry in cadaver legs.

K x-ray fluorescence (KXRF) systems are being used in a growing number of epidemiologic studies to measure bone lead levels as a biological marker of accumulated lead exposure. Although validation of the KXRF technique in lead-doped phantoms and bare bone specimens has been repeatedly demonstrated, few studies have compared KXRF to chemical measurements of actual intact cadaver limbs (with skin and soft tissues). In this study, lead levels in eight amputated human legs were measured by KXRF; after dissection, levels in the bare bones were again measured by KXRF and then by inductively coupled plasma mass spectrometry (ICP-MS). We observed close agreement between the KXRF and ICP-MS measurements with correlation coefficients for both the tibia and patella greater than 0.9. In this study we provide further support for the validity of KXRF measurements, particularly with respect to the patella.

Health Impacts of Climate Change in Pacific Island Countries: A Regional Assessment of Vulnerabilities and Adaptation Priorities.

Background: Between 2010 and 2012, the World Health Organization Division of Pacific Technical Support led a regional climate change and health vulnerability assessment and adaptation planning project, in collaboration with health sector partners, in 13 Pacific island countries—Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu. Objective: We assessed the vulnerabilities of Pacific island countries to the health impacts of climate change and planned adaptation strategies to minimize such threats to health. Methods: This assessment involved a combination of quantitative and qualitative techniques. The former included descriptive epidemiology, time series analyses, Poisson regression, and spatial modeling of climate and climate-sensitive disease data, in the few instances where this was possible; the latter included wide stakeholder consultations, iterative consensus building, and expert opinion. Vulnerabilities were ranked using a “likelihood versus impact” matrix, and adaptation strategies were prioritized and planned accordingly. Results: The highest-priority climate-sensitive health risks in Pacific island countries included trauma from extreme weather events, heat-related illnesses, compromised safety and security of water and food, vector-borne diseases, zoonoses, respiratory illnesses, psychosocial ill-health, non-communicable diseases, population pressures, and health system deficiencies. Adaptation strategies relating to these climate change and health risks could be clustered according to categories common to many countries in the Pacific region. Conclusion: Pacific island countries are among the most vulnerable in the world to the health impacts of climate change. This vulnerability is a function of their unique geographic, demographic, and socioeconomic characteristics combined with their exposure to changing weather patterns associated with climate change, the health risks entailed, and the limited capacity of the countries to manage and adapt in the face of such risks. Citation: McIver L, Kim R, Woodward A, Hales S, Spickett J, Katscherian D, Hashizume M, Honda Y, Kim H, Iddings S, Naicker J, Bambrick H, McMichael AJ, Ebi KL. 2016. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 124:1707–1714; http://dx.doi.org/10.1289/ehp.1509756

Fatty marrow conversion of the proximal femoral metaphysis in osteonecrotic hips.

To determine whether fatty marrow conversion of the proximal femoral metaphysis is related to osteonecrosis of the femoral head using a marrow conversion index ([signal intensity of the proximal femoral metaphysis/signal intensity of the greater trochanter] x 100 in T1 weighted magnetic resonance images), a case control study was conducted on 42 osteonecrotic hips in 28 patients. The 28 patients (42 osteonecrotic hips) were matched with 84 control patients (84 normal hips) for gender, age (5-year range), and time of presentation (1-year range). The marrow conversion index was measured in each hip studied. The index was 90.2% (standard deviation, 8.2%) in osteonecrotic hips and 75.1% (standard deviation, 9.1%) in matched controls. By conditional logistic regression, a 5% increase in the index was associated with 3.6 times increase of the odds ratio of osteonecrosis and a 10% increase with a 12.9 times increase of the odds ratio. The marrow conversion index, which reflects the ratio of fatty marrow conversion of the proximal femoral metaphysis to that of the greater trochanter measured on T1 weighted magnetic resonance images, is increased in osteonecrotic hips.

Determinants of Bone and Blood Lead Levels among Minorities Living in the Boston Area

We measured blood and bone lead levels among minority individuals who live in some of Boston’s neighborhoods with high minority representation. Compared with samples of predominantly white subjects we had studied before, the 84 volunteers in this study (33:67 male:female ratio; 31–72 years of age) had similar educational, occupational, and smoking profiles and mean blood, tibia, and patella lead levels (3 μg/dL, 11.9 μg/g, and 14.2 μg/g, respectively) that were also similar. The slopes of the univariate regressions of blood, tibia, and patella lead versus age were 0.10 μg/dL/year (p < 0.001), 0.45 μg/g/year (p < 0.001), and 0.73 μg/g/year (p < 0.001), respectively. Analyses of smoothing curves and regression lines for tibia and patella lead suggested an inflection point at 55 years of age, with slopes for subjects ≥ 55 years of age that were not only steeper than those of younger subjects but also substantially steeper than those observed for individuals > 55 years of age in studies of predominantly white participants. This apparent racial disparity at older ages may be related to differences in historic occupational and/or environmental exposures, or possibly the lower rates of bone turnover that are known to occur in postmenopausal black women. The higher levels of lead accumulation seen in this age group are of concern because such levels have been shown in other studies to predict elevated risks of chronic disease such as hypertension and cognitive dysfunction. Additional research on bone lead levels in minorities and their socioeconomic and racial determinants is needed.

Longitudinal relationship between dentin lead levels in childhood and bone lead levels in young adulthood.

A retrospective cohort study was conducted to examine the relationship between tooth lead in children and bone lead levels in young adults. Members of a cohort of young adults were reassessed 13 y after initial examination at an ambulatory clinical research center. Dentin lead levels were measured by anodic stripping voltammetry during the years 1975-1978, and bone lead levels of the tibia and patella were measured by K-x-ray fluorescence technique during 1989 and 1990. A total of 63 subjects who had no history of chelation or had no missing information on potential confounders were studied. The median follow-up interval was 13.2 y. Dentin lead levels averaged 13.4 micrograms/g (standard deviation [SD] = 10.7 micrograms/g, range = 2.9-51.8 micrograms/g), and bone lead levels averaged 1.3 micrograms/g (SD = 4.4 micrograms/g, range = -9-13 micrograms/g) for tibia and 5.4 micrograms/g (SD = 8.4 micrograms/g, range = -10-25 micrograms/g) for patella. The authors controlled for age, sex, race, and mothers socioeconomic status, and dentin lead levels were predictive of higher tibia, patella, and mean bone lead levels in 32 subjects (follow-up interval of 11.8-13.2 y). A correction for measurement errors in dentin lead measurements was made, and it was determined that a 10-micrograms/g increase in dentin lead levels in childhood was predictive of a 1-microgram/g increase in tibia lead levels, a 5-micrograms/g increase in patella lead levels, and a 3-micrograms/g increase in mean bone lead levels among the young adults. It was concluded, therefore, that lead exposure in early life may be used to predict elevated body burden up to 13 y later.

Workgroup report : developing environmental health indicators for European children: World Health Organization Working Group

A working group coordinated by the World Health Organization developed a set of indicators to protect children’s health from environmental risks and to support current and future European policy needs. On the basis of identified policy needs, the group developed a core set of 29 indicators for implementation plus an extended set of eight additional indicators for future development, focusing on exposure, health effects, and action. As far as possible, the indicators were designed to use existing information and are flexible enough to be developed further to meet the needs of policy makers and changing health priorities. These indicators cover most of the priority topic areas specified in the Children’s Environment and Health Action Plan for Europe (CEHAPE) as adopted in the Fourth Ministerial Conference on Health and Environment in 2004, and will be used to monitor the implementation of CEHAPE. This effort can be viewed as an integral part of the Global Initiative on Children’s Environmental Health Indicators, launched at the World Summit on Sustainable Development in 2002.

Environmental Burden of Disease in European Countries—The EBoDE Project

The experts participating in the Environmental Burden of Disease – European countries project agreed on the specific tasks and timetable. The steering group and specific task groups were established. The first project results should be ready for presentation at the Fifth Ministerial Conference on Environment and Health in March 2010 in Parma, Italy. Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest).