title: Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales.
abstract: BACKGROUND
  The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated.
  
  
  METHODS
  A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age.
  
  
  RESULTS
  At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90 to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma.
  
  
  CONCLUSIONS
  No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.
authors.affiliation: The Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Imperial College School of Medicine, St Mary's Campus, Norfolk Place, London W2 1PG, UK. p.aylin@ic.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Aylin
authors.forename: A
authors.initials: A
authors.lastname: Bottle
authors.forename: J
authors.initials: J
authors.lastname: Wakefield
authors.forename: L
authors.initials: L
authors.lastname: Jarup
authors.forename: P
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D003077:Coke / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects*; D019652:Extraction and Processing Industry; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012111:Residence Characteristics; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D017062:Small-Area Analysis; D014852:Wales / Q000453:epidemiology
chemical_list: D003077:Coke