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Central European Study of Air Pollution and Respiratory Health

Does outdoor or indoor air pollution cause more respiratory disease? Evidence from the Central European Study on Air Pollution and Respiratory Health (CESAR Study).

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Central European Study of Air Pollution and Respiratory Health

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  1. Does outdoor or indoor air pollution cause more respiratory disease? Evidence from the Central European Study on Air Pollution and Respiratory Health (CESAR Study). Tony Fletcher, London School of Hygiene and Tropical Medicine, London. UKBrunekreef B, Houthuijs D, Fabianova E, Lebret E, Leonardi G, Gurzau E, Nikiforov B, Rudnai P, Volf J, Zejda J. Central European Study of Air Pollution and Respiratory Health

  2. CESAR National Research Teams Bulgaria: National Centre of Hygiene, Bojidar Nikiforov Czech Republic: Regional Institute of Hygiene Ostrava, Jaroslav Volf Hungary: National Institute of Public Health, Alan Pintér and Peter Rudnai Poland: Institute of Occupational Medicine and Environmental Health, Jan Zejda Romania:Environmental Health Center, Eugen Gurzau Slovakia: Regional Specialized Institute of Public Health Banska Bystrica, Eleonorá Fabiánová United Kingdom: LSHTM, Tony Fletcher,Giovanni Leonardi and Sam Pattenden The Netherlands: WAU, : Bert Brunekreef and Gerard Hoek The Netherlands: RIVM, Erik Lebret, Annelike Dusseldorp and Danny Houthuijs

  3. CESAR - AIMS: Establish comparable base-line data on: children’s respiratory health air pollution, including PM10 and PM2.5 environment and health risk perceptions Investigate effects on respiratory health of: air pollution indoor and other risks factors Capacity building: (epidemiological) research methods introduction of QA/QC methods Central European Study of Air Pollution and Respiratory Health

  4. European Funding for CESAR: 1994-1997 EC - PHARE Programme 1999-2000 EC - INCO Copernicus Central European Study of Air Pollution and Respiratory Health

  5. Study characteristics • Cross-sectional study among children aged 7 - 11 year in 6 countries • Four (five) study areas per country: 25 study areas • Selection of study areas within countries based on differences in air pollution levels and in dominant local sources • Participation of about 1,000 children per study area • Current concentration of PM10 and PM2.5 measured in all study areas • Assessment of respiratory health endpoints and potential confounders at individual level

  6. CESAR Study areas Central European Study of Air Pollution and Respiratory Health

  7. Methods • 24 hour sampling, once every six days, during Nov 1995 - Oct 1996 • background sampling site • Harvard impactors with cut-off points at 2.5 and 10 µm • preparation and analysis in one central laboratory per country • Questionnaire respiratory symptoms and conditions: based on items from WHO, ISAAC and ATS in children 7 - 11 years old • Base-line pulmonary function test (FVC and FEV1) in children age 9 - 11 • Information on risk factors and potential confounders collected by questionnaire

  8. Questionnaire based health endpoints • Cough on most days for at least 3 months consecutively in the last autumn-winter season • Any cough symptom over life time (combination) • Any wheeze symptom in the last 12 months (combination) • Any wheeze symptom over lifetime (combination) • Bronchitis doctor diagnosed, ever • Bronchitis in last 12 months • Asthma doctor diagnosed, ever • Asthma attacks in last 12 months • Medication use for a breathing trouble in last 12 months

  9. Age, sex country current # of smokers in the home use of gas range or oven for heating in winter use of unvented gas, oil or kerosene heater ever moisture stains or mould in the home over lifetime of child Furniture with chipboard Reported frequency of traffic passing the house Consumption of fruit, vegetables and fish education of the mother occupation of the father Parental history of wheeze, asthma, inhalant allergy, eczema or hay fever Risk factors in model

  10. Statistical analyses • Assessment of current annual average concentrations for PM10, PM2.5 and coarse fraction • Two stage regression of area-specific means/logits after adjustment for potential individual confounders • Random effects models at taking into account within country correlations for estimating pollution effect • Attributable fraction: calculation of attributable fractions from logistic regression models

  11. Numbers in study total population: 20271 3470 (1 Country) dropped for lack of PM data 2899 dropped for missing values in one or more variables in the models subjects used in these analyses: 13902

  12. Bulgaria Sofia suburb Thermal power station Sofia centre Traffic Vratza Chemicals, Assenovgrad Metallurgical Czech Republic Ostrava centre Local heating, traffic Ostrava -Vitkovice Iron works, power, coke Ostrava - Poruba No local sources Ostrava - Radvanice Iron works, coke oven Hungary Cegled No local sources Dorog Local heat., power plant, pharmac. Eger Local heat., intense traffic, agric. Tata Local heating, moderate traffic Tatabanya Local heating, coal/ oil power Poland Kedzierzyn - Kozle Chemical plant Kielce Clean, recreational area Pszczyna Clean area Swietochlowice Metallurg., coal, chemical Romania Bucharest Traffic, local heating Ploiesti Petrochemical, chemicals Baja Mare Metallurgical industry Tirgu Mures Chemical industry Slovakia Banska Bystrica suburb No local sources Banska Bystrica centre Traffic, cement plant Zilina Chemical, paper factories Bratislava Traffic, local heating CESAR - 25 Study areas Central European Study of Air Pollution and Respiratory Health

  13. Cough and PM2.5 by study area 60 P P P C C C C P 40 S any cough symptoms ever (%) S S B B B B S 20 H H H H H 0 30 40 50 60 70 PM2.5-concentration (µg/m3)

  14. Wheeze and PM2.5 by study area 50 B B B B 40 30 any wheeze symptoms ever (%) C C C P P H H H C P H P H 20 S S S S 10 30 40 50 60 70 PM2.5-concentration (µg/m3)

  15. Example of some risk factors for Wheeze: Prevalence, Odds ratios and Attributable fractions

  16. Conclusions • attributable fractions are a helpful indicator for interpreting these results and could be used more widely • parental history of respiratory illness and indicators of socioeconomic status are important contributors to symptom prevalence • air pollution is more important for some symptoms than indoor combustion sources, ETS or dampness • the presence of chipboard furniture is very prevalent and appears to be associated with substantial attributable fractions for some symptoms Central European Study of Air Pollution and Respiratory Health

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