title: Chronic disease prevalence in women and air pollution--A 30-year longitudinal cohort study.
abstract: BACKGROUND
  Air pollution, such as fine particulate matter (PM2.5), can increase risk of adverse health events among people with heart disease, diabetes, asthma and chronic obstructive pulmonary disease (COPD) by aggravating these conditions. Identifying the influence of PM2.5 on prevalence of these conditions may help target interventions to reduce disease morbidity among high-risk populations.
  
  
  OBJECTIVE
  The objective of this study is to measure the association of exposure of PM2.5 with prevalence risk of various chronic diseases among a longitudinal cohort of women.
  
  
  METHODS
  Women from Ontario who enrolled in the Canadian National Breast Screening Study (CNBSS) from 1980 to 1985 (n = 29,549) were linked to provincial health administrative data from April 1, 1992 to March 31, 2013 to determine the prevalence of major chronic disease and conditions (heart disease, diabetes, asthma, COPD, acute myocardial infarction, angina, stroke and cancers). Exposure to PM2.5 was measured using satellite data collected from January 1, 1998 to December 31, 2006 and assigned to resident postal-code at time of entry into study. Poisson regression models were used to describe the relationship between exposure to ambient PM2.5 and chronic disease prevalence. Prevalence rate ratios (PRs) were estimated while adjusting for potential confounders: baseline age, smoking, BMI, marital status, education and occupation. Separate models were run for each chronic disease and condition.
  
  
  RESULTS
  Congestive heart failure (PR = 1.31, 95% CI: 1.13, 1.51), diabetes (PR = 1.28, 95% CI: 1.16, 1.41), ischemic heart disease (PR = 1.22, 95% CI: 1.14, 1.30), and stroke (PR = 1.21, 95% CI: 1.09, 1.35) showed over a 20% increase in PRs per 10 μg/m(3) increase in PM2.5 after adjusting for risk factors. Risks were elevated in smokers and those with BMI greater than 30.
  
  
  CONCLUSIONS
  This study estimated significant elevated prevalent rate ratios per unit increase in PM2.5 in nine of the ten chronic diseases studied.
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: teresa.to@sickkids.ca.
authors: Teresa
authors: T
authors: To
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Jingqin
authors: J
authors: Zhu
authors: Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada.
authors: Paul J
authors: PJ
authors: Villeneuve
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Jacqueline
authors: J
authors: Simatovic
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada.
authors: Laura
authors: L
authors: Feldman
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Chenwei
authors: C
authors: Gao
authors: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Devon
authors: D
authors: Williams
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada.
authors: Hong
authors: H
authors: Chen
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors: Scott
authors: S
authors: Weichenthal
authors: Dalla Lana School of Public Health, Toronto, Ontario, Canada.
authors: Claus
authors: C
authors: Wall
authors: Dalla Lana School of Public Health, Toronto, Ontario, Canada.
authors: Anthony B
authors: AB
authors: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000397:Air Pollution / Q000032:analysis* / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis* / Q000633:toxicity; D015995:Prevalence; D012307:Risk Factors
chemical_list: D052638:Particulate Matter
keywords: Air pollution; Chronic disease prevalence; Environmental exposures