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Association of Ambient and Household Air Pollution With Bone Mineral Content Among Adults in Peri-urban South India.

ABSTRACT: Importance:Air pollution is a major threat to global health. Osteoporosis is responsible for a substantial burden of disease globally and is expected to increase in prevalence because of population aging. Few studies have investigated the association between air pollution and bone health, and their findings were inconclusive. Objective:To quantify the association between ambient and household air pollution and bone mass in a sample of the general population in peri-urban India. Design, Setting, and Participants:This was a population-based cross-sectional analysis of the Andhra Pradesh Children and Parents Study cohort, which recruited participants from 28 villages near Hyderabad, South India, during 2009 to 2012. Separate linear mixed models were fitted with nested random intercepts (household within villages) for each exposure-outcome pair and were sequentially adjusted for potential confounders. Data analysis was conducted between April 2019 and July 2019. Exposures:Annual mean ambient particulate matter air pollution less than 2.5 µm in aerodynamic diameter (PM2.5) and black carbon (BC) levels at the residence estimated by land-use regression and self-reported use of biomass cooking fuel. Main Outcomes and Measures:The primary outcome was bone mineral content (BMC) measured in grams, corrected by bone area at the lumbar spine and left hip, as measured by dual-energy x-ray absorptiometry. The secondary outcome was bone mineral density measured in grams per centimeters squared. Results:A total of 3717 participants were analyzed (mean [SD] age, 35.7 [14.0] years; 1711 [46.0%] women). The annual mean (SD) PM2.5 exposure was 32.8 (2.5) ?g/m3, and the annual mean (SD) BC exposure was 2.5 (0.2) ?g/m3; 57.8% of participants used biomass cooking fuels. In fully adjusted models, PM2.5 was associated with lower BMC in the spine (mean difference, -0.57 g per 3 ?g/m3 increase in PM2.5; 95% CI, -1.06 to -0.07 g per 3 ?g/m3 increase in PM2.5) and hip (mean difference, -0.13 g per 3 ?g/m3 increase in PM2.5; 95% CI, -0.3 to 0.03 g per 3 ?g/m3 increase in PM2.5). After confounder adjustment, exposure to PM2.5 was also associated with lower bone mineral density in the spine (mean difference, -0.011 g/cm2 per 3 ?g/m3 increase in PM2.5; 95% CI, -0.021 to 0 g/cm2 per 3 ?g/m3 increase in PM2.5) and hip (mean difference, -0.004 g/cm2 per 3 ?g/m3 increase in PM2.5; 95% CI, -0.008 to 0.001 g/cm2 per 3 ?g/m3 increase in PM2.5). Exposure to BC was associated with lower BMC in the spine (mean difference, -1.13 g per 1 ?g/m3 increase in BC; 95% CI, -2.81 to 0.54 g per 1 ?g/m3 increase in BC) and hip (mean difference, -0.35 g per 1 ?g/m3 increase in BC; 95% CI, -0.96 to 0.25 g per 1 ?g/m3 increase in BC), although the confidence intervals were wider. There was no association between biomass fuel use and spine BMC (mean difference, 0.12 g; 95% CI, -0.45 to 0.68 g). Conclusions and Relevance:In a cross-sectional analysis of a population-based cohort, ambient air pollution was associated with lower BMC in a young adult population in a peri-urban area of South India.

SUBMITTER: Ranzani OT

PROVIDER: S-EPMC6991311 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Association of Ambient and Household Air Pollution With Bone Mineral Content Among Adults in Peri-urban South India.

Ranzani Otavio T OT Milà Carles C Kulkarni Bharati B Kinra Sanjay S Tonne Cathryn C

JAMA network open 20200103 1

<h4>Importance</h4>Air pollution is a major threat to global health. Osteoporosis is responsible for a substantial burden of disease globally and is expected to increase in prevalence because of population aging. Few studies have investigated the association between air pollution and bone health, and their findings were inconclusive.<h4>Objective</h4>To quantify the association between ambient and household air pollution and bone mass in a sample of the general population in peri-urban India.<h4 ...[more]

PMID: 31899531

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Project description:OBJECTIVE:Air pollution is a leading preventable risk factor for cardiovascular diseases. Previous studies mostly relied on concentrations at residence, which might not represent personal exposure. Personal air pollution exposure has a greater variability compared with levels of ambient air pollution, facilitating evaluation of exposure-response functions and vascular pathophysiology. We aimed to evaluate the association between predicted annual personal exposure to PM2.5 and black carbon (BC) and three vascular damage markers in peri-urban South India. METHODS:We analyzed the third wave of the APCAPS cohort (2010-2012), which recruited participants from 28 villages. We used predicted personal exposure to PM2.5 and BC derived from 610 participant-days of 24 h average gravimetric PM2.5 and BC measurements and predictors related to usual time-activity. Outcomes included carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx). We fit linear mixed models, adjusting for potential confounders and accounting for the clustered data structure. We evaluated nonlinear associations using generalized additive mixed models. RESULTS:Of the 3017 participants (mean age 38 years), 1453 (48%) were women. The average PM2.5 exposure was 51 µg/m3 (range 13-85) for men, and 61 µg/m3 (range 40-120) for women, while the average BC was 4 µg/m3 (range 3-7) for men and 8 µg/m3 (range 3-22) for women. A 10 ?g/m3 increase of PM2.5 was positively associated with CIMT (0.026 mm, 95% CI 0.014, 0.037), cf-PWV (0.069 m/s, 95% CI 0.008, 0.131) and AIx (0.8%, 95% CI 0.3, 1.3) among men. The exposure-response function for PM2.5 and AIx among men showed non-linearity, particularly within the exposure range dominated by tobacco smoking and occupational exposures. Both PM2.5 and BC were positively associated with AIx among women (0.6%, 95% CI 0.2, 1.0, per 10 ?g/m3 PM2.5; 0.5%, 95% CI 0.1, 0.8, per 2 ?g/m3 BC). CONCLUSIONS:Personal exposure to particulate matter was associated with vascular damage in a peri-urban population in South India. Personal exposure to particulate matter appears to have gender-specific effects on the type of vascular damage, potentially reflecting differences in sources of personal exposure by gender.

Project description:BackgroundLimited evidence exists on the effect of particulate air pollution on blood glucose levels. We evaluated the associations of residential and personal levels of fine particulate matter (PM2.5) and black carbon (BC) with blood glucose and diabetic status among residents of 28 peri-urban villages in South India.MethodsWe used cross-sectional data from 5065 adults (?18?years, 54% men) included in the Andhra Pradesh Children and Parents Study. Fasting plasma glucose was measured once in 2010-2012 and prevalent prediabetes and diabetes were defined following the American Diabetes Association criteria. We estimated annual ambient PM2.5 and BC levels at residence using land-use regression models and annual personal exposure to PM2.5 and BC using prediction models based on direct measurements from a subsample of 402 participants. We used linear and logistic nested mixed-effect models to assess the association between exposure metrics and health outcomes. For personal exposures, we stratified analyses by sex.ResultsMean (SD) residential PM2.5 and BC were 32.9 (2.6) ?g/m3 and 2.5 (2.6) ?g/m3, respectively; personal exposures to PM2.5 and BC were 54.5 (11.5) ?g/m3 and 5.8 (2.5) ?g/m3, respectively. Average (SD) fasting blood glucose was 5.3 (1.3) mmol/l, 16% of participants had prediabetes, and 5.5% had diabetes. Residential PM2.5 and BC were not associated with higher blood glucose levels. Personal PM2.5 (20??g/m3 increase) and BC (1??g/m3 increase) were negatively associated with blood glucose levels in women (PM2.5: -1.93, 95%CI: -3.12, -0.73; BC: -0.63, 95%CI: -0.90, -0.37). In men, associations were negative for personal PM2.5 (-1.99, 95%CI: -3.56, -0.39) and positive for personal BC (0.49, 95%CI: -0.44, 1.43). We observed no evidence of associations between any exposure and prevalence of prediabetes/diabetes.ConclusionsOur results do not provide evidence that residential exposures to PM2.5 or BC are associated with blood glucose or prevalence of prediabetes/diabetes in this population. Associations with personal exposure may have been affected by unmeasured confounding, highlighting a challenge in using personal exposure estimates in air pollution epidemiology. These associations should be further examined in longitudinal studies.

Project description:BackgroundMost household air pollution (HAP) interventions in developing countries of sub-Saharan Africa have focused on a single source, such as replacing polluting cooking sources with cleaner burning cooking stoves. Such interventions, however, have resulted in insufficient reductions in HAP levels and respiratory health risks in children. In this study we determined how multiple HAP combustion sources and exposure-mitigation factors in the home environment influence child respiratory health alone and in combination.MethodsWe carried out a case-control study to determine associations between multiple indicators of HAP and persistent cough among children (<15 years of age) seeking care at three primary-care clinics in Kampala, Uganda. HAP indicators included self-report of combustion sources inside the home (e.g., stove type, fuel type, and smoking); housing characteristics and cooking practices that mitigate HAP exposure (e.g., use of windows, location of cooking, location of children during cooking) and perceptions of neighborhood air quality. To explore joint associations between indicators of HAP, we applied a Bayesian clustering technique (Bayesian profile regression) to identify HAP indicator profiles most strongly associated with persistent cough in children.ResultsMost HAP indicators demonstrated significant positive bivariate associations with persistent cough among children, including fuel-type (kerosene), the number of hours burning solid fuels, use of polluting fuels (kerosene or candles) for lighting the home, tobacco smoking indoors, cooking indoors, cooking with children indoors, lack of windows in the cooking area, and not opening windows while cooking. Bayesian cluster analysis revealed 11 clusters of HAP indicator profiles. Compared to a reference cluster that was representative of the underlying study population cough prevalence, three clusters with profiles characterized by highly adverse HAP indicators resulted in ORs of 1.72 (95% credible interval: 1.15, 2.60), 4.74 (2.88, 8.0), and 8.6 (3.9, 23.9). Conversely, at least two clusters of HAP indicator-profiles were protective compared to the reference cluster, despite the fact that these protective HAP indicator profiles used solid fuels for cooking in combination with an unimproved stove (cooking was performed predominantly outdoors in these protective clusters).ConclusionsIn addition to cooking fuel and type of cook stove, multiple HAP indicators were strongly associated with persistent cough in children. Bayesian profile regression revealed that the combination of HAP sources and HAP exposure-mitigating factors was driving risk of adverse cough associations in children, rather than any single HAP source at the home.

Dataset Information

Association of Ambient and Household Air Pollution With Bone Mineral Content Among Adults in Peri-urban South India.

Publications

Association of Ambient and Household Air Pollution With Bone Mineral Content Among Adults in Peri-urban South India.

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