Rural and urban environmental exposures and the risk of progressive pulmonary fibrosis

SMOKING, ENVIRONMENTAL EXPOSURES, AND CHRONIC LUNG DISEASE AS KEY RISK FACTORS FOR LUNG CANCER IN NORTH SUMATRA.

BACKGROUND Lung cancer remains the leading cause of cancer mortality worldwide, with increasing incidence in many developing countries. Understanding region-specific risk factors is essential for effective prevention strategies. This study aimed to identify major determinants of lung cancer in North Sumatra, Indonesia. MATERIALS AND METHODS A hospital-based observational study with a case-control analytical approach was conducted between August and November 2024 in three referral hospitals in North Sumatra. A total of 240 patients with histologically confirmed lung cancer and 240 controls without malignancy or chronic respiratory disease were included. Participants were comparable by sex and residential area, while age differences between groups were statistically adjusted in the multivariate regression model. RESULTS Smoking exposure differed significantly between cases and controls (p = 0.023). The multivariate analysis identified several independent predictors of lung cancer. Age <45 years increased the risk more than two-fold (OR 2.62; 95% CI 1.10-6.21), whereas age >65 years showed a lower relative risk (OR 0.54; 95% CI 0.33-0.88). The occupational exposure signicantly increased lung cancer risk (OR 1.91; 95% CI 1.13-3.25). Unhealthy indoor environments, characterized by poor ventilation and household pollutant exposure, were also associated with an increased risk (OR 2.53; 95% CI 1.45-4.40). Chronic respiratory diseases, particularly tuberculosis and chronic obstructive pulmonary disease, were more prevalent among cases and contributed to the elevated risk. CONCLUSIONS Smoking exposure, occupational hazards, unhealthy indoor environments, and chronic pulmonary diseases are important determinants of lung cancer in North Sumatra. Public health strategies focusing on tobacco control, improved workplace safety, and reduction of indoor air pollution may substantially reduce lung cancer burden in this region.

Environmental Determinants of Respiratory Diseases: Current Evidence and Preventive Strategies

The deterioration of ambient air quality worldwide has intensified the need to examine the environmental factors associated with the growing burden of respiratory disease. This study aimed to identify broad patterns in the adverse effects of environmental exposures on the respiratory system, while accounting for regional variation and population-specific vulnerability. A systematic literature review was conducted between April and December 2024 using four international databases: PubMed, Web of Science, Scopus, and Google Scholar. Seventy-one relevant publications were included in the final analysis. The findings indicate that, in India, concentrations of particulate matter with aerodynamic diameters of up to 10 μm (PM₁₀) and 2.5 μm (PM₂.₅) exceed recommended limits by a factor of 2.56. In Northern Thailand, reductions of 5.3%–34.3% in particulate matter concentrations were associated with significant declines in hospitalization rates. In China and South Africa, pollutant levels substantially exceed the World Health Organization guideline of 5 μg/m³, while national standards in some settings permit concentrations of up to 40 μg/m³, thereby increasing the risk of chronic inflammatory respiratory conditions. In Bogotá, Colombia, heavy traffic contributes to increased morbidity and mortality from respiratory complications. In Kyrgyzstan, seasonal variation and changes in vegetation patterns have been linked to a rise in allergic reactions, whereas in Slovakia, prolonged pollen seasons are associated with a higher prevalence of bronchial asthma. Children, particularly those under 5 years of age, older adults, and industrial workers were identified as the most vulnerable groups. Climate change further aggravates these risks by intensifying exposure to fine particulate matter and gaseous pollutants. The findings underscore the need for integrated policies focused on emission reduction, environmental monitoring, public awareness, and the harmonization of air-quality standards. The study provides evidence that may support cross-sectoral planning and the development of preventive strategies aimed at reducing the burden of acute and chronic respiratory disease.

Global Asthma Disparities: Deciphering the Multifaceted Environmental Exposome Between Eastern and Western Populations

Urban heat island and risk of rheumatoid arthritis: Insights from genetic predisposition and proteomics.

BACKGROUND Urban heat island (UHI) exposure is an increasingly common consequence of urbanization and climate warming, but its association with rheumatoid arthritis (RA) risk remains unclear. OBJECTIVE To investigate the association between UHI exposure and incident RA, and to further assess the roles of genetic susceptibility and plasma proteomic profiles in this association. METHODS This study included 400,628 urban residents with UHI exposure data and free of RA at baseline. Cox proportional hazards models were used to evaluate the association between UHI exposure and incident RA. Polygenic risk scores were used to assess effect modification by genetic susceptibility. Proteomic analyses identified candidate proteins and enriched pathways underlying the association. Mendelian randomization, colocalization, and mediation analyses assessed causal relevance and mediation. RESULTS Over a median follow-up of 14.05 years, 5397 incident RA cases were documented. Each standard-deviation increase in UHI exposure was associated with a 17% higher risk of RA. This association was more pronounced among older adults and individuals with lower socioeconomic status. An additive interaction was observed between UHI exposure and genetic risk for RA. Proteomic analyses suggested that this association may involve not only canonical immune-inflammatory pathways, but also hypoxia response and protein transport, with CD40, VCAM1, and SUGP1 emerging as potential molecular mediators. CONCLUSIONS UHI exposure may be a modifiable environmental risk factor for RA and provide new insights into the biological mechanisms underlying this association.

Urban environment, health, and equity

Background: Urban residents are exposed to multiple environmental stressors, but robust evidence on inequities in environmental exposure and associated health and well-being outcomes remains limited. Aim: To assess inequities in residential exposure to air pollution (PM2.5, PM10, and NO2), traffic noise (road, railway, and aircraft) and greenness (NDVI within 300 m), and to characterize associations with self-reported symptoms and annoyances. Methods: The study population comprised 46,282 adults (18–84 years) residing in Stockholm County, Sweden, who responded to the Swedish National Environmental Health Survey 2023. Residential exposure (dichotomized) was based on geocoded address coordinates and stratified by socioeconomic status (SES) and building type. Logistic regression estimated adjusted odds ratios (OR) with 95% confidence intervals (95% CI) and tested effect modification via interaction terms. Results: Apartment residents were more often exposed to air pollution and noise and had less surrounding greenness than house residents. SES-stratified analyses revealed exposure-specific patterns, but no consistent overall trends. Air pollution exposure was associated with perceived poor outdoor air quality (NO2: OR = 3.22; 95% CI = 2.75–3.79), traffic noise with, for example, high noise annoyance (road traffic: OR = 4.59; 95% CI = 4.02–5.26), and greenness, for example, with lower perceived indoor heat stress during summer (OR = 0.83; 95% CI = 0.79–0.88). Self-reported health and well-being varied by SES and building type. Conclusions: Our study reveals concentrated environmental stressors in dense residential areas and highlights multidimensional environmental inequities. Environmental exposure was associated with self-perceived health and well-being, underscoring the need for integrated, system-based policies, such as One Health, to promote sustainable urban well-being.

The association of environmental exposures and area-level socioeconomic status with pediatric hydrocephalus outcomes

Previous research has identified an association of socioeconomic status with poor health outcomes related to the treatment of pediatric hydrocephalus. However, the impact of environmental exposures and neighborhood disadvantage remains unexplored. The authors sought to determine how these factors affect hydrocephalus outcomes. This study is an analysis of prospectively collected registry data of pediatric hydrocephalus patients from 2008 to 2023 at a single institution. Geospatial analysis was conducted using the patient’s address at the time of the initial procedure for treatment of hydrocephalus. Socioeconomic status was quantified using the Area Deprivation Index (ADI), and environmental exposure data were obtained from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and satellite-derived ground-level fine particulate matter, linked to patients’ addresses using hospital administrative data. Multivariable Cox regressions with robust standard errors to adjust for clustering of area-level measures were utilized to assess the independent association of neighborhood and environmental factors with shunt revisions and complications. In total, 881 patients who underwent primary shunt insertion for nontraumatic etiologies were included. The median (IQR) ADI percentile was 78 (61–90). The most common hydrocephalus etiology was intraventricular hemorrhage of prematurity (33%), followed by myelomeningocele (12%). At the latest follow-up, 48% of patients had experienced at least one shunt failure. The median (IQR) follow-up duration was 5.6 (1–11) years. In a multivariable Cox proportional hazards model, high ozone exposure areas (HR 1.38, 95% CI 1.05–1.82) and high ADI (HR 1.46, 95% CI 1.15–1.86) were independently associated with an increased risk of failure. High coal exposure was associated with an increased risk of shunt infection (HR 1.92, 95% CI 1.28–2.88). High PM 2.5 (particulate matter with a diameter ≤ 2.5 μm) was also significantly associated with increased all-cause mortality (HR 3.16, 95% CI 1.11–8.99). Exposure to environmental toxins and elevated neighborhood disadvantage are associated with worse outcomes in children with hydrocephalus. Environmental exposure may increase inflammatory pathways in children and reflect poor socioeconomic status. These results highlight social and environmental risk factors that warrant further investigation through biochemical or qualitative means.