title: Respiratory hospital admission risk near large composting facilities.
abstract: Large-scale composting can release bioaerosols in elevated quantities, but there are few studies of health effects on nearby communities.
  
  
  
  A cross-sectional ecological small area design was used to examine risk of respiratory hospital admissions within 2500m of all 148 English large-scale composting facilities in 2008-10. Statistical analyses used a random intercept Poisson regression model at Census Output Area (COA) level (mean population 310). Models were adjusted for age, sex, deprivation and tobacco sales.
  
  
  
  Analysing 34,963 respiratory hospital admissions in 4656 COAs within 250-2500m of a site, there were no significant trends using pre-defined distance bands of >250-750m, >750-1500m and >1500-2500m. Using a continuous measure of distance, there was a small non-statistically significant (p=0.054) association with total respiratory admissions corresponding to a 1.5% (95% CI: 0.0-2.9%) decrease in risk if moving from 251m to 501m. There were no significant associations for subgroups of respiratory infections, asthma or chronic obstructive pulmonary disease.
  
  
  
  This national study does not provide evidence for increased risks of respiratory hospital admissions in those living beyond 250m of an outdoor composting area perimeter. Further work using better measures of exposure and exploring associations with symptoms and disease prevalence, especially in vulnerable groups, is recommended to support regulatory approaches.
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom. Electronic address: p.douglas@imperial.ac.uk.
authors.forename: Philippa
authors.initials: P
authors.lastname: Douglas
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom; Department of Biostatistics, King's College London, London, United Kingdom; Department of Health Services and Population Research, King's College London, London, United Kingdom. Electronic address: ioannis.bakolis@kcl.ac.uk.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bakolis
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom. Electronic address: d.fecht@imperial.ac.uk.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fecht
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom. Electronic address: clare.pearson@kcl.ac.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Pearson
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom. Electronic address: lealsanchezmaria@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Leal Sanchez
authors.affiliation: Environment Agency, Evidence Directorate, Deanery Road, Bristol, United Kingdom. Electronic address: rob.kinnersley@environment-agency.gov.uk.
authors.forename: Rob
authors.initials: R
authors.lastname: Kinnersley
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: c.dehoogh@unibas.ch.
authors.forename: Kees
authors.initials: K
authors.lastname: de Hoogh
authors.affiliation: Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom; Public Health and Primary Care, Imperial College Healthcare NHS Trust, United Kingdom. Electronic address: a.hansell@imperial.ac.uk.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Hansell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D012987:Soil; D018505:Waste Management / Q000379:methods*; D055815:Young Adult
chemical_list: D012987:Soil
keywords: Asthma; Bioaerosol; Chronic obstructive pulmonary disease (COPD); Compost; Hospitalization; Respiratory health