Long-term air pollution exposure from industry and traffic and respiratory health in elderly women from the Ruhr Basin [Elektronische Ressource] / vorgelegt von Tamara Schikowski

Ullmann

Sujets

• Gesundheit

Informations

• Publié par: heinrich-heine-universitat_dusseldorf
• Publié le: 01 janvier 2008
• Nombre de lectures: 49
• Langue: Deutsch
• Poids de l'ouvrage: 10 Mo

Extrait

Aus dem Institut für Umweltmedizinische Forschung an der
Heinrich-Heine Universität Düsseldorf
Direktor Prof. Dr. med. Jean Krutmann







Long-term air pollution exposure
from industry and traffic and respiratory health
in elderly women from the Ruhr Basin




Dissertation

zur Erlangung des Doktorgrades in
Gesundheitswissenschaften und Sozialmedizin (Dr.rer.san.)


Der Medizinischen Fakultät der
Heinrich-Heine-Universität Düsseldorf

vorgelegt von

Tamara Schikowski




Düsseldorf, 2008

Als Inauguraldissertation gedruckt mit Genehmigung der Medizinischen Fakultät der
Heinrich-Heine-Universität Düsseldorf


gez: Univ.-Prof. Dr. med. Joachim Windolf
Dekan
Referentin: PD Dr. Ursula Krämer
Koreferent: Univ.-Prof. Dr. Johannes Siegrist















‘A handful of patience is worth more than a bushel of brains’
Dutch Proverb Contents

Contents

CONTENTS.............................................................................................................................................. I
LIST OF PUBLICATIONS .......................................................................................................................... III
LFIGURES AND TABLES ...............................................................................................................IV
ABBREVIATION........V
Chapter 1 Introduction and background.........................................................................1
1.1 DEMOGRAPHIC CHANGES.................................................................................................................. 2
1.2 AIR POLLUTION.2
1.2.1 Definition of air pollutants mainly involved in the exposure and its measurement ................. 2
1.2.2 Particulate matter (PM) ........................................................................................................... 3
1.2.3 Nitrogen dioxides (NO ) .......................................................................................................... 4 2
1.3 MORBIDITY....................................................................................................................................... 4
1.3.1 COPD: chronic bronchitis and emphysema ............................................................................ 5
1.3.2 Chronic Bronchitis ................................................................................................................... 6
1.3.3 Emphysema ................................................................................................................ 6
1.4 LUNG FUNCTION TESTING AND RESPIRATORY SYMPTOMS.................................................................... 7
1.4.1 Spirometry............................................................................................................................... 7
1.4.2 Respiratory symptoms and diagnosis according to questionnaire.......................................... 9
1.5 MORTALITY..... 10
1.6 SOCIAL STATUS .............................................................................................................................. 10
1.7 STATISTICAL ANALYSIS.................................................................................................................... 11
1.8 SALIA STUDY- AN ENVIRONMENTAL HEALTH SURVEY ON RESPIRATORY DISEASES ............................. 13
1.9 AIMS AND OUTLINE OF THE THESIS................................................................................................... 14
REFERENCES....................................................................................................................................... 15
Chapter 2 Long-term air pollution exposure and living close to busy roads are
associated with COPD in women.................................................................20
Chapter 3 Does respiratory health contribute to the effects of long-term air
pollution exposure on cardiovascular mortality? ......................................36
Chapter 4 Contribution of smoking and air pollution exposure in urban areas to
social differences..........................................................................................55
Chapter 5 General Discussion .......................................................................................73
5.1 MAIN FINDINGS 74
5.2 METHODOLOGICAL CONSIDERATIONS .............................................................................................. 75
5.2.1 Data collection....................................................................................................................... 75
5.2.2 Study design............................................................................................................. 76
5.2.3 Validity of assessment of respiratory health outcomes and confounding............................. 76
5.2.4 Assessment of air pollution..... 77
5.2.5 Potential source of bias......................................................................................................... 78
5.2.6 Aspects of effect modification (interactions) in this thesis .................................................... 79
5.3 IMPLICATIONS OF THE STUDY RESULTS FOR PRACTICE AND RESEARCH .............................................. 80
5.4 RECOMMENDATIONS AND FUTURE PUBLIC HEALTH RESEARCH........................................................... 81
5.5 CONCLUSIONS................................................................................................................................82
Summary...............................................................................................................................85
Deutsche Zusammenfassung .............................................................................................89

I Contents

Appendices...........................................................................................................................92

APPENDIX 1 ......................................................................................................................................... 92
STUDY AREA ........................................................................................................................................ 92
APPENDIX 2........... 93
2.3 KEY VARIABLES 1985-86................................................................................................................ 93
2.4 QUESTIONNAIRE ............................................................................................................... 94
2.5 KEY VARIABLES 1990..................................................................................................................... 97
2.6 QUESTIONNAIRE 1990.................................................................................................................... 98
Danksagung...102
Eidesstattliche Erklärung ..................................................................................................103
Curriculum vitae.................................................................................................................104


II List of Publications

List of Publications

1) Schikowski T, Sugiri D, Ranft U, Gehring U, Heinrich J, Wichmann HE, Krämer U.
Long-term air pollution exposure and living close to busy roads are associated with
COPD in women
Respiratory Research 2005, 6:152

2) Schikowski T, Sugiri D, Ranft U, GeKrämer U.
Does respiratory health contribute to the effects of long-term air pollution exposure on
cardiovascular mortality?
Respiratory Research 2007, 8: 20

3) Schikowski T, Sugiri D, Reimann V, Pesch B, Ranft U, Krämer U
Contribution of smoking and air pollution exposure in urban areas to social
differences
BMC Journal of Public Health (accepted May 2008)
III List of Tables and Figues

List of Figures and Tables
Figure 1 Normal spirogram 7
Figure 2 Spirometer of a person with COPD and a person 8
with normal lung function
Table 1 General spirometric classification for the 9
diagnosis of COPD according to the ATS and
ERS
Table 2 Overview on the number of women studied in 64
each area and each year


IV Abbreviations

Abbreviation

ATS: American Thoracic Society
BMI: Body Mass Index
BTS: British Thoracic Society
CI: Confidence interval
COPD: Chronic obstructive pulmonary disease
COLD: Chronic obstructive lung disease
CRP: C-reactive protein
DALYS: Disability-adjusted life’s year
DNA: Desoxyribonucleinacid
EPA: Environmental Protection Agency
ERS: European Respiratory Society
FEV : Forced expiratory volume in one second 1
FVC: Forced vital capacity
GIS: Geographic Information system
GOLD: Global Initiative COLD
IL-8: Interleukin-8
LTB4: Leukotriene B4
MD: Mean difference
NHLBI: National Heart Lung and Blood Institut
NO: Nitrogen dioxide 2
NOtetroxide 3
O: Ozone 3
OR: Odds ratio
PM : Particulate matter of size 10µg diameter 10
P