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Air pollution in early life and adult mortality from chronic rheumatic heart disease

Air pollution in early life and adult mortality from chronic rheumatic heart disease
Air pollution in early life and adult mortality from chronic rheumatic heart disease
Background: Chronic rheumatic heart disease (RHD) remains a globally important cause of heart disease. The reasons for the continuing high prevalence of this disease are obscure, but it may have its origins in the poor social and economic conditions with which the disease has been consistently and strongly linked. Mortality studies from the UK have suggested the importance of adverse environmental factors in early life; these studies demonstrated specific geographical associations between high rates of chest infection during infancy and subsequent RHD. They raised the possibility that early air pollution, which is known to be strongly linked with chest infection during infancy, may predispose to RHD.

Methods: We related estimates of air pollution and social conditions developed by Daly in 1951-52 for 78 urban areas in England and Wales to their subsequent RHD mortality rates at ages 35-74 in men and women during 1993-2012.

Results: There were strong relationships between domestic air pollution and RHD [relative risk per standard deviation (SD) increase in pollution 1.168, 95% confidence interval (CI): 1.128 to 1.210, P < 0.001). Inclusion of published data on social class, education, crowding and population density in multiple regression analyses showed that the air pollution association was independent of these; only overcrowding was separately linked with RHD.

Conclusions: We present the first evidence of an association between air pollution in early life and RHD. Although there are several limitations to this study, the strength and consistency of the results, together with their biological plausibility, suggest a causal link. This deserves attention because it may have important consequences for the control of RHD in resource-poor countries where widespread use of biomass fuels and domestic pollution remain a problem.
0300-5771
1107-1114
Phillips, David
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
Williams, Martin L.
1eacfcf3-6c05-48b9-b788-ed7ec01caa17
Jones, Alexander
6db57b28-bd86-40c4-a3ff-d28ea5e286e4
Phillips, David
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
Williams, Martin L.
1eacfcf3-6c05-48b9-b788-ed7ec01caa17
Jones, Alexander
6db57b28-bd86-40c4-a3ff-d28ea5e286e4

Phillips, David, Osmond, Clive, Williams, Martin L. and Jones, Alexander (2017) Air pollution in early life and adult mortality from chronic rheumatic heart disease. International Journal of Epidemiology, 46 (4), 1107-1114. (doi:10.1093/ije/dyw249). (PMID:27773865)

Record type: Article

Abstract

Background: Chronic rheumatic heart disease (RHD) remains a globally important cause of heart disease. The reasons for the continuing high prevalence of this disease are obscure, but it may have its origins in the poor social and economic conditions with which the disease has been consistently and strongly linked. Mortality studies from the UK have suggested the importance of adverse environmental factors in early life; these studies demonstrated specific geographical associations between high rates of chest infection during infancy and subsequent RHD. They raised the possibility that early air pollution, which is known to be strongly linked with chest infection during infancy, may predispose to RHD.

Methods: We related estimates of air pollution and social conditions developed by Daly in 1951-52 for 78 urban areas in England and Wales to their subsequent RHD mortality rates at ages 35-74 in men and women during 1993-2012.

Results: There were strong relationships between domestic air pollution and RHD [relative risk per standard deviation (SD) increase in pollution 1.168, 95% confidence interval (CI): 1.128 to 1.210, P < 0.001). Inclusion of published data on social class, education, crowding and population density in multiple regression analyses showed that the air pollution association was independent of these; only overcrowding was separately linked with RHD.

Conclusions: We present the first evidence of an association between air pollution in early life and RHD. Although there are several limitations to this study, the strength and consistency of the results, together with their biological plausibility, suggest a causal link. This deserves attention because it may have important consequences for the control of RHD in resource-poor countries where widespread use of biomass fuels and domestic pollution remain a problem.

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Accepted/In Press date: 5 August 2016
e-pub ahead of print date: 23 October 2016
Published date: August 2017
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 402077
URI: http://eprints.soton.ac.uk/id/eprint/402077
ISSN: 0300-5771
PURE UUID: 2e15ddd4-d16c-41ab-9f28-5a4c413ba7f3
ORCID for Clive Osmond: ORCID iD orcid.org/0000-0002-9054-4655

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Date deposited: 01 Nov 2016 15:17
Last modified: 18 Feb 2021 16:45

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Contributors

Author: David Phillips
Author: Clive Osmond ORCID iD
Author: Martin L. Williams
Author: Alexander Jones

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