Association between air pollution and chronic respiratory symptom- table 31 . ...... source of indoor air pollution such as fuel, regular exposure to air fresheners, ...
A STUDY TO EVALUATE THE PLAUSIBLE MECHANISM OF AIR POLLUTION EFFECT ON DIABETES
A PHD THESIS SUBMITTED TO THE UNIVERSITY OF PUNE FOR THE AWARD OF
DOCTOR OF PHILOSOPHY (IN HEALTH SCIENCES)
BY KHAFAIE ABDOLLATIF MORTEZA M. SC PUBLIC HEALTH (M.P.H)
UNDER GUIDANCE OF GUIDE: PROF. C.S. YAJNIK CO- GUIDE: DR. S. SALVI CO- GUIDE: DR. A. OJHA
INTERDISCIPLINARY SCHOOL OF HEALTH SCIENCE, SCIENCES FACULTY UNIVERSITY OF PUNE, GANESHKHIND PUNE- 411007, INDIA MAY 2013
Contents List of figure ................................................................................................................................................ iv List of table ................................................................................................................................................. vii Declaration ................................................................................................................................................... ix Certificate of the Guide ................................................................................................................................. x Acknowledgment .......................................................................................................................................... ii Abbreviations ................................................................................................................................................. i Abstract ....................................................................................................................................................... 20 Chapter 1 Introduction ................................................................................................................................ 21 1.
Background and Statement of Problem .......................................................................................... 22
2.
Aim and objectives ......................................................................................................................... 23
3.
Scope and contents of this thesis..................................................................................................... 23
Chapter 2 Literature Review ....................................................................................................................... 25 Overview ................................................................................................................................................. 26 1.
2.
Section 1: ambient air pollution, common term and concepts ........................................................ 27 1.1.
Air pollution ............................................................................................................................ 27
1.2.
Emission inventory ................................................................................................................. 29
1.3.
Concentration .......................................................................................................................... 30
1.3.
Human exposure ..................................................................................................................... 30
1.4.
Dose ........................................................................................................................................ 31
1.5.
Exposure modeling ................................................................................................................. 31
Section 2: air pollution exposure assessment .................................................................................. 32 2.1.
3.
4.
Dispersion model .................................................................................................................... 35
Section 3: study area, Pune ............................................................................................................. 37 3.1.
Metrological issue ................................................................................................................... 38
3.2.
Air quality monitoring station and standards .......................................................................... 38
3.3.
Industries ................................................................................................................................. 39
3.4.
Slum area ................................................................................................................................ 39
3.5.
Source of air pollution in Pune ............................................................................................... 40
Section 4: Air pollution health effect .............................................................................................. 42 4.1.
Historical perspective .............................................................................................................. 42
4.2.
General Review of air pollution Health Effect ....................................................................... 44
4.4.
Mechanism of air pollution health effect ................................................................................ 55
4.5.
Summary and research gaps .................................................................................................... 60
Chapter 3 Methodology .............................................................................................................................. 62 Overview ................................................................................................................................................. 63 1.
2.
3.
Study population and design- table 10 ............................................................................................ 64 1.1.
Part 1 ....................................................................................................................................... 64
1.2.
Part 2 ....................................................................................................................................... 64
Exposure assessment ....................................................................................................................... 67 2.1.
Short- term exposure to air pollution ...................................................................................... 68
2.2.
Long- term exposure to air pollution (dispersion model) ....................................................... 69
Material and methods ...................................................................................................................... 77 3.1.
The Database ........................................................................................................................... 77
3.2.
Participant information ........................................................................................................... 81
4.
Data Management ........................................................................................................................... 93
5.
Outline of Analysis ......................................................................................................................... 94 5.1.
Part 1 ....................................................................................................................................... 95
5.2.
Part 2 ....................................................................................................................................... 97
Chapter 4 Results ...................................................................................................................................... 102 Overview ............................................................................................................................................... 103 1.
2.
Part 1, retrospective study ............................................................................................................. 104 1.1.
Characteristic of the study population- table 14 ................................................................... 104
1.2.
Exposure variable.................................................................................................................. 110
1.3.
Association between temperature and blood biomarker of systemic inflammation ............. 115
1.4.
Association between short-term exposure to air pollution and systemic inflammation ........ 117
1.5.
Association between long-term exposure to PM10 and biomarkers of glycemic control ...... 123
1.6.
Summary of result from retrospective study- part 1 ............................................................. 125
Part 2, prospective study ............................................................................................................... 126 2.1.
Characteristics of study population ....................................................................................... 126
2.4.
Background air pollution during year 2004 and 2010........................................................... 138
2.5.
Association between air pollution and chronic respiratory symptom- table 31 .................... 139
2.6.
Effect of long-term exposure to PM10 on lung function- table 32......................................... 140 Page ii of 222
2.7.
Summary of result from prospective study- part 2................................................................ 143
Chapter 5 Discussions ............................................................................................................................... 145 1.
Measurements of air pollution ...................................................................................................... 146
2.
Daily concentration of air pollution associated with markers of systemic inflammation ............. 148
3.
Meteorological variable are important in the association between air pollution and health outcome 151
4. Long-term exposure to PM10 at diabetic patients location (home) is associated with biomarkers of glycemic control.................................................................................................................................... 153 5.
Biochemical profile (glycemic measures and lipids) is an important indicator of respiratory health 154
6.
Long-term exposure to PM10 (at home and work place) and respiratory parameters ................... 156
Chapter 6 Thesis summary........................................................................................................................ 162 Summary ............................................................................................................................................... 163 1.
Air pollution in Pune ..................................................................................................................... 163
2.
Air pollution health effect ............................................................................................................. 163
Chapter 7 References and Appendices...................................................................................................... 167 References ............................................................................................................................................. 168 Appendices............................................................................................................................................ 191 Appendix A- Questionarie .................................................................................................... 193
I. 195 II.
Appendix B- CRF PFT certificate ........................................................................................ 199
III.
Appendix C- Article in Journal ............................................................................................. 201
IV.
Appendix D- Article in conference proceedings ................................................................... 209
V.
Appendix E- Article in news ................................................................................................. 217
VI.
Appendix F- Scholar awards ................................................................................................. 221
Page iii of 222
List of figure FIGURE 1: AEROSOL SIZE DISTRIBUTION AND MORPHOLOGY ......................................................... 28 FIGURE 2: HUMAN HEALTH EFFECT OF AIR POLLUTION .................................................................. 32 FIGURE 3: A GENERAL SCHEMATIC FOR AIR POLLUTION EXPOSURE ASSESSMENT .......................... 33 FIGURE 4: OVERVIEW OF THE AIR POLLUTION MODELING PROCEDURE........................................... 35 FIGURE 5: TYPE OF MODEL TYPICALLY APPLIED ACCORDING TO THE COMPLEXITY OF THE PROBLEM ............................................................................................................................................... 36 FIGURE 6: PUNE MAP & DECADAL CHANGES IN POPULATION ....................................................... 37 FIGURE 7: WARD WISE STATUS DEMOGRAPHIC OF SLUMS .............................................................. 40 FIGURE 8: MEUSE VALLEY AND DONORA 1948 ............................................................................. 42 FIGURE 9: LONDON FOG ................................................................................................................. 43 FIGURE 10: BHOPAL DISASTER 1984 .............................................................................................. 43 FIGURE 11: AIR POLLUTION HEALTH EFFECT PYRAMID ................................................................... 45 FIGURE 12: US COUNTIES WITH POPULATIONS LARGER THAN 200 000 INCLUDED IN ANALYSIS . 47 FIGURE 13: MECHANISM BY WHICH MAKE OBESE MORE SUSCEPTIBLE TO AIR POLLUTION PULMONARY EFFECT ............................................................................................................... 59
FIGURE 14: SUBJECT RECRUITMENT IN PART 2 OF THE STUDY ........................................................ 66 FIGURE 15: PM10 CONCENTRATION AT KARVE RD., ESTIMATED (MODEL) VS. MEASURED (MONITOR) ............................................................................................................................. 70 FIGURE 16: AERMOD CONTROL PATHWAY .................................................................................. 72 FIGURE 17: AERMOD SOURCE PATHWAY ..................................................................................... 73 FIGURE 18: AERMOD CARTESIAN GRID NETWORK RECEPTOR ..................................................... 74 FIGURE 19: AERMOD DISCRETE RECEPTORS ................................................................................ 74 FIGURE 20: AERMOD METEOROLOGY PATHWAY ......................................................................... 75 FIGURE 21: AERMOD OUTPUT PATHWAY ..................................................................................... 76 FIGURE 22: LOCATION OF AIR POLLUTANT MONITORS, METEOROLOGICAL DEPARTMENT, KEM HOSPITAL, AND DISTRIBUTION OF DIABETIC PATIENTS IN PUNE, INDIA ................................... 80 FIGURE 23: SCHEMATIC OF WORK DONE TO OBTAIN AND USE GEOGRAPHIC LOCATION OF SUBJECT RESIDENCE PLACE ................................................................................................................... 81
FIGURE 24: CLASSIFICATION OF OBSTRUCTIVE OR RESTRICTIVE OR MIXED AIRWAY DISEASE BASED ON FVC AND FEV1 VALUE. .................................................................................................... 91
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FIGURE 25: SPIROMETRY STANDARDIZATION STEPS....................................................................... 92 FIGURE 26: HISTOGRAM OF C - REACTIVE PROTEIN, BEFORE AND AFTER LOGARITHM TRANSFORMATION ................................................................................................................ 106
FIGURE 27: HISTOGRAM OF WHITE BLOOD CELL, BEFORE AND AFTER LOGARITHM TRANSFORMATION ................................................................................................................ 107
FIGURE 28: HISTOGRAM OF FASTING PLASMA GLUCOSE BEFORE AND AFTER LOGARITHM TRANSFORMATION ................................................................................................................ 107
FIGURE 29: HISTOGRAM OF 2HRS POST MEAL PLASMA GLUCOSE CONCENTRATION ..................... 108 FIGURE 30: HISTOGRAM OF HEMOGLOBIN ................................................................................... 109 FIGURE 31: HISTOGRAM OF HBA1C ............................................................................................. 109 FIGURE 32: CONCENTRATION PROFILE OF A) AIR POLLUTANTS (AVERAGED ACROSS THREE CENTRAL MONITORS- KARVE ROAD, NAL STOP, AND SWARGATE) AND B) METEOROLOGICAL VARIABLES IN PUNE, MAY 2005- MARCH 2007 .................................................................... 112
FIGURE 33: PUNE PM10
CONCENTRATION FOR THE YEAR 2004. †INDICATE SUBJECT LOCATION
. 114
FIGURE 34: ASSOCIATION BETWEEN AMBIENT AIR TEMPERATURE AND CRP. ERROR BAR INDICATE 95% CI. BLACK TRIANGLE INDICATE SIGNIFICANT ASSOCIATION (P3 mg/L) and 19% had abnormally raised CRP levels (>10 mg/L). "Higher inflammatory response in newly diagnosed diabetic patients could be attributed to their younger age and therefore possibly more exposure to outdoor air pollution, and because many were not yet started on medication that lowers inflammation," says the team. Given existing evidence that CRP levels are associated with the development and complications of the metabolic syndrome, the findings may have implications for the risk for cardiovascular disease in city-dwelling Indian diabetic patients. In addition, the results "should promote studies on the effect of air pollution on the risk of noncommunicable disease in India," writes the team. Page 217 of 222
Springer Healthcare News November 2012, 1:1662
Air quality in cities linked to inflammatory risk in diabetes About this Article Title: Air quality in cities linked to inflammatory risk in diabetes Journal: Springer Healthcare News 1:1662 Online Date: November 2012 DOI: 10.1007/s40014-012-1662-2 Online ISSN: 2193-0961 Publisher: Springer Healthcare Communications
© Springer, Part of Springer Science+Business Media
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Air pollution bad for type 2 diabetes patients admin
By Jimmy Downs Wednesday April 24, 2013 (foodconsumer.org) -- A new study in Diabetes Care suggests exposure to outdoor air pollution may increase the risk of complications in people with type 2 diabetes mellitus. Chittaranjan S. Yajnik, MD, FRCP from King Edward Memorial Hospital Research Center, Pune, Maharashtra, India and colleagues conducted the study and found the association between ambient air pollutants and serum C-reactive protein concentration in type 2 diabetics in India. Enrolled in the study were 1392 type 2 diabetes patients residing in Pune, India. Data on daily time series of ambient air pollution were obtained from monitoring sites and serum C-reactive protein concentrations were measured in the type 2 diabetic patients participating in the Wellcome Trust Genetic Study between 2005 and 2007. The researchers concluded ambient air pollution can contribute to systemic inflammation in Indian Type 2 diabetes patients and the pollution can cause implications for vascular complications in type 2 diabetes. www.foodconsumer.org/newsite/Non-food/Environment/air_pollution_tyoe_2_diabetes_0424130717.html
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VI. Appendix F- Scholar awards
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