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Associations between blood BTEXS concentrations and hematologic parameters among adult residents of the U.S. Gulf States.

ABSTRACT: Studies of workers exposed to benzene at average air concentrations below one part per million suggest that benzene, a known hematotoxin, causes hematopoietic damage even at low exposure levels. However, evidence of such effects outside of occupational settings and for other volatile organic compounds (VOCs) is limited.To investigate associations between ambient exposures to five VOCs, including benzene, and hematologic parameters among adult residents of the U.S. Gulf Coast.Blood concentrations of selected VOCs were measured in a sample of adult participants in the Gulf Long-term Follow-up Study (GuLF STUDY) during 2012 and 2013. Complete blood counts with differentials were also performed on a subset of participants (n=406). We used these data together with detailed questionnaire data to estimate adjusted associations between blood BTEXS (benzene, toluene, ethylbenzene, o-xylene, m/p-xylene, and styrene) concentrations and hematologic parameters using generalized linear models.We observed inverse associations between blood benzene concentrations and hemoglobin concentration and mean corpuscular hemoglobin concentration, and a positive association with red cell distribution width among tobacco smoke-unexposed participants (n=146). Among tobacco smoke-exposed participants (n=247), we observed positive associations between blood VOC concentrations and several hematologic parameters, including increased white blood cell and platelet counts, suggestive of hematopoietic stimulation typically associated with tobacco smoke exposure. Most associations were stronger for benzene than for the other VOCs.Our results suggest that ambient exposure to BTEXS, particularly benzene, may be associated with hematologic effects, including decreased hemoglobin concentration, mean corpuscular hemoglobin concentration, and increased red cell distribution width.

SUBMITTER: Doherty BT

PROVIDER: S-EPMC5687063 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Associations between blood BTEXS concentrations and hematologic parameters among adult residents of the U.S. Gulf States.

Doherty Brett T BT Kwok Richard K RK Curry Matthew D MD Ekenga Christine C Chambers David D Sandler Dale P DP Engel Lawrence S LS

Environmental research 20170426

<h4>Background</h4>Studies of workers exposed to benzene at average air concentrations below one part per million suggest that benzene, a known hematotoxin, causes hematopoietic damage even at low exposure levels. However, evidence of such effects outside of occupational settings and for other volatile organic compounds (VOCs) is limited.<h4>Objective</h4>To investigate associations between ambient exposures to five VOCs, including benzene, and hematologic parameters among adult residents of the ...[more]

PMID: 28448810

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Project description:BackgroundStyrene is an established neurotoxicant at occupational levels, but effects at levels relevant to the general population have not been studied. We examined the neurologic effects of environmental styrene exposure among U.S. Gulf coast residents.MethodsWe used National Air Toxics Assessment (NATA) 2011 estimates of ambient styrene concentrations to assign exposure levels for 21,962 non-diabetic Gulf state residents, and additionally measured blood styrene concentration in a subset of participants (n = 874). Neurologic symptoms, as well as detailed covariate information, were ascertained via telephone interview. We used log-binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (95% CI) for cross-sectional associations between both ambient and blood styrene levels and self-reported neurologic symptoms. We estimated associations independently for ten unique symptoms, as well as for the presence of any neurologic, central nervous system (CNS), or peripheral nervous system (PNS) symptoms. We also examined heterogeneity of associations with estimated ambient styrene levels by race and sex.ResultsOne-third of participants reported at least one neurologic symptom. The highest quartile of estimated ambient styrene was associated with one or more neurologic (PR, 1.12; 95% CI: 1.07,1.18), CNS (PR, 1.17; 95% CI: 1.11,1.25), and PNS (PR, 1.16; 95% CI: 1.09,1.25) symptom. Results were less consistent for biomarker analyses, but blood styrene level was suggestively associated with nausea (PR, 1.78; 95% CI: 1.04, 3.03). In stratified analyses, we observed the strongest effects among non-White participants.ConclusionsIncreasing estimated ambient styrene concentration was consistently associated with increased prevalence of neurologic symptoms. Associations between blood styrene levels and some neurologic symptoms were suggestive. Environmental styrene exposure levels may be sufficient to elicit symptomatic neurotoxic effects.

Project description:IntroductionExposures to volatile organic compounds and metals have previously been associated with liver diseases including steatohepatitis, although more data are needed. Benzene, toluene, ethylbenzene, xylenes, styrene (BTEXS) and metals were measured in blood samples collected between May 2012-July 2013 from volunteers participating in home visits for the Gulf Long-term Follow-up (GuLF) Study. This cross-sectional analysis evaluates associations of exposure biomarkers with serum liver injury and adipocytokine biomarkers in a sample of 214 men.MethodsAdult nonsmoking men without a history of liver disease or heavy alcohol consumption were included. The serologic disease biomarkers evaluated were the hepatocellular injury biomarker, cytokeratin 18 [whole (CK18 M65) and caspase-cleaved fragment (CK18 M30)]; and adipocytokines. Confounder-adjusted beta coefficients were determined using linear regression models for the overall sample (primary endpoints) and for obesity-classified sub-groups (secondary endpoints). A product interaction term between the exposure of interest and a dichotomized indicator of obesity was included to determine the disease modifying effects of obesity on the biomarker associations.ResultsThe study sample was 57% white and 51% obese. In the overall sample, lead was positively associated with CK18 M30 (β = 21.7 ± 6.0 (SE), p = 0.0004); IL-1β (β = 32.8 ± 5.2, p < 0.0001); IL-6 (β = 72.8 ± 18.3, p = 0.0001); and IL-8 (β = 140.8 ± 42.2, p = 0.001). Cadmium exposures were associated with increased IL-1β (β = 77.8 ± 26.3, p = 0.003) and IL-8 (β = 419.5 ± 201.2, p = 0.04). There were multiple significant interactions between obesity and exposure to lead, cadmium, benzene and toluene in relation to outcome biomarkers. Among obese participants (n = 108), benzene, lead, and cadmium were each positively associated with CK18 M30, IL-1β, IL-6, and IL-8. In obese subjects, lead was also inversely associated with leptin, and toluene was positively associated with IL-1β.ConclusionFor the overall sample, heavy metal exposures were associated with liver injury (lead only) and/or systemic inflammation (lead and cadmium). Obesity modified the associations between BTEXS and heavy metal exposures on several of the outcome variables. In the obesity subgroup, liver injury was positively associated with lead, cadmium and benzene exposures; systemic inflammation was increased with lead, cadmium, benzene, and toluene exposures; and leptin was inversely associated with lead exposures. The cross-sectional design of this study makes it difficult to determine causality, and all results should be interpreted cautiously. Nonetheless, the potential impact of exposures to lead, cadmium, benzene and toluene in steatohepatitis, an obesity-associated inflammatory liver disease, warrants further investigation.

Project description:Medicare utilization and costs for residents of the U.S. Gulf Coast, who are highly vulnerable to natural disasters, may be impacted by their disaster exposure.To estimate differences in healthcare utilization by disaster exposure, we calculated Medicare expenditures among residents of U.S. Gulf States and compared them with expenditures among residents of other regions of the U.S.Panel models were used to calculate changes in overall Medicare expenditures, inpatient expenditures, and home health expenditures for 32,819 Medicare beneficiaries. Individual demographic characteristics were included as predictors of change in expenditures.Medicare beneficiaries with National Health Interview Survey participation were identified and Part A claims were linked. Federal Emergency Management Agency (FEMA) data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with Medicare claims data to create a panel dataset from 2001 to 2007.Medicare Part A claims for the years 2001 to 2007 were merged with FEMA data related to disasters in each U.S. County. Overall Medicare costs, as well as costs for inpatient and home health care for residents of states located along the U.S. Gulf Coast (Texas, Louisiana, Mississippi, Alabama, and Florida) were compared to costs for residents of the rest of the U.S.Expenditures among residents of U.S. Gulf States decreased with increased hazard exposure. Decreases in inpatient expenditures persisted in the years following a disaster.The use of beneficiary-level data highlights the potential for natural hazards to impact health care costs. This study demonstrates the possibility that exposure to more severe disasters may limit access to health care and therefore reduce expenditures. Additional research is needed to determine if there is a substitution of services (e.g., inpatient rehabilitation for home health) in disaster-affected areas during the post-disaster period.

Dataset Information

Associations between blood BTEXS concentrations and hematologic parameters among adult residents of the U.S. Gulf States.

Publications

Associations between blood BTEXS concentrations and hematologic parameters among adult residents of the U.S. Gulf States.

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