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Health effects of air pollution in Iceland: respiratory health in volcanic environments
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. University of Iceland, Centre of Public Health. (Arcum)
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Air pollution has adverse effects on human health. The respiratory system is the most exposed and short-term changes in air pollution levels have been associated with worsening of asthma symptoms and increased rates of heart attacks and stroke. Air pollution in cities due to traffic is the major concern, as many people are exposed. However, natural sources of air pollution such as natural dust storms and ash from volcanic eruptions can also compromise human health. Exposure to volcanic eruptions and other natural hazards can also threaten mental health. Air pollution has not been extensively studied in Iceland, in spite of the presence of several natural pollution sources and a sizeable car fleet in the capital area.

The aim of this thesis was to determine if there was a measurable effect on health which could be attributed to air pollution in Iceland. This aim was pursued along two paths; time series studies using register data aimed to determine the short-term association between daily variation in air pollution and on one hand daily dispensing of anti-asthma medication or the daily number of emergency room visits and emergency admissions for cardiopulmonary causes and stroke. The other method was to investigate if exposure to the Eyjafjallajökull volcanic eruption was associated with adverse health outcomes, either at the end of the eruption, or 6 months later.

In paper I time series regression was used to investigate the association between the daily number of individuals who were dispensed anti-asthma medication and levels of the air pollutants particle matter with an aerodynamic diameter less than 10 μm (PM10), nitrogen dioxide (NO2), ozone (O3), and hydrogen sulfide (H2S) during the preceding days. For the study period 2006-9, there were significant associations between the daily mean of PM10 and H2S and the sales of anti-asthma medication 3 to 5 days later. Giving the exposure as the highest daily one-hour mean gave more significant results. Air pollution negatively affected the respiratory health of asthma medication users, prompting them to refill their prescriptions before they had originally intended to.

In paper II the main outcome was the number of individuals seeking help at Landspitali University Hospital emergency room for cardiopulmonary disease or stroke. Time series regression was used to identify the lag that gave the best predictive power, and models were run for data for 2003-9 pollutants PM10, NO2, and O3. O3 was significantly associated with the number of emergency hospital visits the same day and two days later in all models, and both for men, women and the elderly. Only emergency hospital visits of the elderly were associated with NO2, and there were no associations with PM10.

In paper III the aim was to investigate if the health effects of PM10 were affected by the addition of volcanic ash from the 2010 eruption of Eyjafjallajökull and 2011 eruption of Grímsvötn to PM10 in the capital area. Time series regression of emergency hospital visits and PM10 before and after the Eyjafjallajökull eruption showed that the effect tended to be higher after the eruption, but the results were not significant. Analysis with a binary indicator for high levels of PM10 from volcanic ash and other sources showed that volcanic ash was associated with increased emergency hospital visits. There were no associations with high levels of PM10 from other sources.

In paper IV, the health of the population exposed to the ongoing eruption of Eyjafjallajökull in 2010 was investigated thoroughly. Lung function in adults was better than in a reference group from the capital area, though many reported sensory organ irritation symptoms and symptoms of stress and mental unhealth, especially those with underlying diseases.

Paper V report the results from a questionnaire study which was carried out six months after the Eyjafjallajökull eruption. The study population comprised a cohort of south Icelanders exposed to the eruption to varying degrees and a reference group from north Iceland. Respiratory and eye symptoms were much more common in south Icelanders than in the reference group, after adjusting for demographic characteristics. Mental unhealth rates had declined considerably.

In the studies, we found that urban air pollution and natural particles have short-term effects on anti-asthma medication dispensing and emergency room visits and hospital admissions. Exposure to natural particles in the form of volcanic dust was associated with increased respiratory symptoms in a very exposed population. There were indications that volcanic ash particles were associated with increased emergency hospital visits in the following days.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2014. , 82 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1659
Keyword [en]
Respiratory health, air pollution, volcanic ash, epidemiology, hydrogen sulfide.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
URN: urn:nbn:se:umu:diva-89153ISBN: 978-91-7601-082-2 (print)OAI: oai:DiVA.org:umu-89153DiVA: diva2:719162
Public defence
2014-06-13, Triple Helix, Samverkanshuset, Umeå Universitet, Umeå, 13:00 (English)
Opponent
Supervisors
Note

Statement of collaboration

This thesis and the work in it have been produced in collaboration between University of Iceland and Umeå University. The thesis was issued and defended at both institutions. Responsible

Available from: 2014-05-23 Created: 2014-05-23 Last updated: 2016-08-17Bibliographically approved
List of papers
1. Health effects following the Eyjafjallajökull volcanic eruption: a cohort study
Open this publication in new window or tab >>Health effects following the Eyjafjallajökull volcanic eruption: a cohort study
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2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 6Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The study aimed to determine whether exposure to a volcanic eruption was associated with increased prevalence of physical and/or mental symptoms.

DESIGN: Cohort, with non-exposed control group.

SETTING: Natural disasters like volcanic eruptions constitute a major public-health threat. The Icelandic volcano Eyjafjallajökull exposed residents in southern Iceland to continuous ash fall for more than 5 weeks in spring 2010. This study was conducted during November 2010-March 2011, 6-9 months after the Eyjafjallajökull eruption.

PARTICIPANTS: Adult (18-80 years of age) eruption-exposed South Icelanders (N=1148) and a control population of residents of Skagafjörður, North Iceland (N=510). The participation rate was 72%.

MAIN OUTCOME MEASURES: Physical symptoms in the previous year (chronic), in the previous month (recent), General Health Questionnaire (GHQ-12) measured psychological morbidity.

RESULTS: The likelihood of having symptoms during the last month was higher in the exposed population, such as; tightness in the chest (OR 2.5; 95% CI 1.1 to 5.8), cough (OR 2.6; 95% CI 1.7 to 3.9), phlegm (OR 2.1; 95% CI 1.3 to 3.2), eye irritation (OR 2.9; 95% CI 2.0 to 4.1) and psychological morbidity symptoms (OR 1.3; 95% CI 1.0 to 1.7). Respiratory symptoms during the last 12 months were also more common in the exposed population; cough (OR 2.2; 95% CI 1.6 to 2.9), dyspnoea (OR 1.6; 95% CI 1.1 to 2.3), although the prevalence of underlying asthma and heart disease was similar. Twice as many in the exposed population had two or more symptoms from nose, eyes or upper-respiratory tract (24% vs 13%, p<0.001); these individuals were also more likely to experience psychological morbidity (OR 4.7; 95% CI 3.4 to 6.5) compared with individuals with no symptoms. Most symptoms exhibited a dose-response pattern within the exposed population, corresponding to low, medium and high exposure to the eruption.

CONCLUSIONS: 6-9 months after the Eyjafjallajökull eruption, residents living in the exposed area, particularly those closest to the volcano, had markedly increased prevalence of various physical symptoms. A portion of the exposed population reported multiple symptoms and may be at risk for long-term physical and psychological morbidity. Studies of long-term consequences are therefore warranted.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2012
Keyword
Epidemiology, Public health, Iceland; ash; hazards; dust; time
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-67368 (URN)10.1136/bmjopen-2012-001851 (DOI)000315081400110 ()23144261 (PubMedID)
Available from: 2013-03-18 Created: 2013-03-18 Last updated: 2017-12-06Bibliographically approved
2. Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavik, Iceland 2003--2009
Open this publication in new window or tab >>Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavik, Iceland 2003--2009
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2013 (English)In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 12, no 1, 28- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Air pollution exposure is associated with hospital admissions and emergency room visits for cardiopulmonary disease and stroke. Iceland's capital area, Reykjavik, has generally low air pollution levels, but traffic and natural sources contribute to pollution levels. The objective of this study was to investigate temporal associations between emergency hospital visits and air pollutants ozone (O3), nitrogen dioxide (NO2), and particulate matter (PM10) in the Icelandic capital area.

METHODS: We constructed a time series of the daily number of adults who visited the emergency room, or were acutely admitted for stroke or cardiorespiratory causes to Landspitali University Hospital 1 January 2003 -- 31 December 2009 from the hospital in-patient register. We used generalized additive models assuming Poisson distribution, to analyze the daily emergency hospital visits as a function of the pollutant levels, and adjusted for meteorological variables, day of week, and time trend with splines.

RESULTS: Daily emergency hospital visits increased 3.9% (95% confidence interval (CI) 1.7-6.1%) per interquartile (IQR) change in average O3 the same and two previous days. For females, the increase was 7.8% (95% CI 3.6-12.1) for elderly (70+), the increase was 3.9% (95% CI 0.6-7.3%) per IQR increase of NO2. There were no associations with PM10.

CONCLUSIONS: We found an increase in daily emergency hospital visits associated with O3, indicating that low-level exposure may trigger cardiopulmonary events or stroke.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keyword
Air pollution; Stroke; Cardiopulmonary; Cardiac; Cardiovascular; Hospital admissions; Emergency room visits
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-68042 (URN)10.1186/1476-069X-12-28 (DOI)000318251500001 ()23566138 (PubMedID)
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2017-12-06Bibliographically approved
3. Effects of PM10 from volcanic ash, natural dust, and other sources on emergency hospital visits in Reykjavík, Iceland
Open this publication in new window or tab >>Effects of PM10 from volcanic ash, natural dust, and other sources on emergency hospital visits in Reykjavík, Iceland
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(English)Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-89163 (URN)
Available from: 2014-05-23 Created: 2014-05-23 Last updated: 2014-05-26Bibliographically approved
4. A survey of early health effects of the Eyjafjallajokull 2010 eruption in Iceland: a population-based study
Open this publication in new window or tab >>A survey of early health effects of the Eyjafjallajokull 2010 eruption in Iceland: a population-based study
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2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 2, e000343- p.Article in journal (Refereed) Published
Abstract [en]

Objective To estimate physical and mental health effects of the Eyjafjallajökull volcanic eruption on nearby residents.

Design Cross-sectional study.

Setting The Icelandic volcano Eyjafjallajökull erupted on 14 April 2010. The eruption lasted for about 6 weeks and was explosive, ejecting some 8 million tons of fine particles into the atmosphere. Due to prevailing winds, the ash spread mostly to the south and south-east, first over the rural region to the south, later over the Atlantic Ocean and Europe, closing European air space for several days.

Participants Residents (n=207) of the most ash-exposed rural area south and east of the volcano.

Methods The study period was from 31 May to 11 June 2010. Participants were examined by a physician. To ascertain respiratory health, standardised spirometry was performed before and after the use of a bronchodilator. All adult participants answered questionnaires about mental and physical health, their children's health and the use of protective equipment.

Results Every other adult participant reported irritation in eyes and upper airway when exposed to volcanic ash. Adults (n=26) and children (n=5) with pre-existing asthma frequently reported worsening of their symptoms. No serious health problems requiring hospitalisation could be attributed to the eruption. The majority of the participants reported no abnormal physical or mental symptoms to the examining physician. Compared to an age- and gender-matched reference group, the ash-exposed participants reported lower smoking rates and were less likely to have ventilation impairment. Less than 10% of the participants reported symptoms of stress, anxiety or depression.

Conclusions Short-term ash exposure was associated with upper airway irritation symptoms and exacerbation of pre-existing asthma but did not contribute to serious health problems. The exposure did not impair respiratory function compared to controls. Outdoor use of protective glasses and face masks was considered protective against irritation in eyes and upper airway.                                  

Place, publisher, year, edition, pages
BMJ Publishing Group, 2012
Keyword
posttraumatic-stress-disorder; volcanic air-pollution; hazards; ash; instrument; validity
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-89158 (URN)10.1136/bmjopen-2011-000343 (DOI)000315042100008 ()
Available from: 2014-05-23 Created: 2014-05-23 Last updated: 2017-12-05Bibliographically approved
5. Hydrogen sulfide and particle matter levels associated with increased dispensing of anti-asthma drugs in Iceland's capital
Open this publication in new window or tab >>Hydrogen sulfide and particle matter levels associated with increased dispensing of anti-asthma drugs in Iceland's capital
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2012 (English)In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 113, 33-39 p.Article in journal (Refereed) Published
Abstract [en]

Background Air pollutants in Iceland's capital area include hydrogen sulfide (H2S) emissions from geothermal power plants, particle pollution (PM10) and traffic-related pollutants. Respiratory health effects of exposure to PM and traffic pollutants are well documented, yet this is one of the first studies to investigate short-term health effects of ambient H2S exposure.

Objectives The aim of this study was to investigate the associations between daily ambient levels of H2S, PM10, nitrogen dioxide (NO2) and ozone (O3), and the use of drugs for obstructive pulmonary diseases in adults in Iceland's capital area.

Methods The study period was 8 March 2006 to 31 December 2009. We used log-linear Poisson generalized additive regression models with cubic splines to estimate relative risks of individually dispensed drugs by air pollution levels. A three-day moving average of the exposure variables gave the best fit to the data. Final models included significant covariates adjusting for climate and influenza epidemics, as well as time-dependent variables.

Results The three-day moving average of H2S and PM10 levels were positively associated with the number of individuals who were dispensed drugs at lag 3–5, corresponding to a 2.0% (95% confidence interval [CI] 0.4, 3.6) and 0.9% (95% CI 0.1, 1.8) per 10&#xa0;μg/m3 pollutant concentration increase, respectively.

Conclusion Our findings indicated that intermittent increases in levels of particle matter from traffic and natural sources and ambient H2S levels were weakly associated with increased dispensing of drugs for obstructive pulmonary disease in Iceland's capital area. These weak associations could be confounded by unevaluated variables hence further studies are needed.

Keyword
Obstructive pulmonary diseases; Pharmaceutical dispensing; Hydrogen sulfide; Particle matter; Traffic pollution
National Category
Environmental Health and Occupational Health
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-89157 (URN)10.1016/j.envres.2011.10.010 (DOI)000301622500005 ()
Available from: 2014-05-23 Created: 2014-05-23 Last updated: 2017-12-05Bibliographically approved

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