Environmental Risk Factors for Pneumocystis Pneumonia Hospitalizations in HIV Patients

Djawe, Kpandja; Levin, Linda; Swartzman, Alexandra; Fong, Serena; Roth, Brenna; Anuradha, S; Grieco, Katherine; Jarlsberg, Leah G.; Miller, R F; Huang, Laurence; Walzer, Peter D.

doi:10.1093/cid/cis841

Cited by 32 publications

(42 citation statements)

References 42 publications

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“…Our results suggest that disproportionate exposures may contribute to LGBT populations experiencing disparate burdens from health conditions such as cancer and asthma (Agénor, 2015; Blosnich et al, 2010, 2013; Boehmer et al, 2012; Cochran and Mays, 2012; Heck and Jacobson, 2006; Landers et al, 2011), which have well-established links to air pollution (Kampa and Castanas, 2008). It is also possible that other health problems with disparate effects on sexual minorities—such as obesity, stress, HIV, and related comorbidities—may be influenced by and/or interact with disproportionate exposures to air pollution in a synergistic manner (Baillie-Hamilton, 2002; Chen et al, 2008; Djawe et al, 2013; Kampa and Castanas, 2008). Clearly, more research that tests for environmental health disparities based on LGBT status is needed.…”

Section: Discussionmentioning

confidence: 99%

“…Other health problems with disparate impacts on sexual minorities—such as obesity, stress, HIV and related comorbidities—may be influenced by and/or interact with environmental exposures (Baillie-Hamilton, 2002; Chen et al, 2008; Djawe et al, 2013; Kampa and Castanas, 2008). However, only one extant study, which focused on one US metro area, has investigated disparities in environmental health risks among sexual minorities (Collins et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Environmental injustice and sexual minority health disparities: A national study of inequitable health risks from air pollution among same-sex partners

Collins

Grineski

Morales

2017

Social Science & Medicine

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Air pollution is deleterious to human health, and numerous studies have documented racial and socioeconomic inequities in air pollution exposures. Despite the marginalized status of lesbian, gay, bisexual, and transgender (LGBT) populations, no national studies have examined if they experience inequitable exposures to air pollution. This cross-sectional study investigated inequities in the exposure of same-sex partner households to hazardous air pollutants (HAPs) in the US. We examined cancer and respiratory risks from HAPs across 71,207 census tracts using National Air Toxics Assessment and US Census data. We calculated population-weighted mean cancer and respiratory risks from HAPs for same-sex male, same-sex female and heterosexual partner households. We used generalized estimating equations (GEEs) to examine multivariate associations between sociodemographics and health risks from HAPs, while focusing on inequities based on the tract composition of same-sex, same-sex male and same-sex female partners. We found that mean cancer and respiratory risks from HAPs for same-sex partners are 12.3% and 23.8% greater, respectively, than for heterosexual partners. GEEs adjusting for racial/ethnic and socioeconomic status, population density, urban location, and geographic clustering show that living in census tracts with high (vs. low) proportions of same-sex partners is associated with significantly greater cancer and respiratory risks from HAPs, and that living in same-sex male partner enclaves is associated with greater risks than living in same-sex female partner enclaves. Results suggest that some health disparities experienced by LGBT populations (e.g. cancer, asthma) may be compounded by environmental exposures. Findings highlight the need to extend the conceptual framework for explaining LGBT health disparities beyond psycho-behavioral mechanisms translating social stress into illness to include environmental mechanisms. Because psycho-behavioral and environmental factors may together exacerbate health disparities, we call for a shift toward interdisciplinary research on LGBT health that takes into account cumulative risks, including the role of environmental exposures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Environmental injustice and sexual minority health disparities: A national study of inequitable health risks from air pollution among same-sex partners

Collins

Grineski

Morales

2017

Social Science & Medicine

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“…Although there is little direct evidence for the interaction between HIV infection and HAP, a 2013 meta-analysis of 14 observational studies showed that tobacco smoking increases the risk of bacterial pneumonia in patients with HIV, and that smoking cessation is effective to decrease that risk 110. Two studies of the effects of outdoor air pollution on pneumocystis pneumonia showed that exposure to higher temperatures and sulphur dioxide were associated with increased risk of hospital admissions due to pneumocystis pneumonia,111 and that the serological immune response to pneumocystis pneumonia was attenuated by both ambient PM (PM 10 ) and cigarette smoking 112…”

Section: Respiratory Infectionsmentioning

confidence: 99%

Respiratory risks from household air pollution in low and middle income countries

Gordon¹,

Bruce²,

Grigg³

et al. 2014

The Lancet Respiratory Medicine

777

592

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A third of the world’s population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5–4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.

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“…Pneumocystis genotypes and virulence factors [9]); and 3) environmental factors (e.g. climatological factors and air pollutants [10,11]).…”

Section: Introductionmentioning

confidence: 99%

“…The role that specific environmental factors may play in the development of PCP in HIV-positive patients has piqued scientific interest in recent years [11–13], because climatological factors and air pollution levels have been shown to have an impact on the progression of several pulmonary diseases [14]. However, published data on environmental factors in relation to PCP disease are somewhat inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis pneumonia in HIV‐positive patients in Spain: epidemiology and environmental risk factors

Álvaro-Meca¹,

Palomares-Sancho²,

Díaz³

et al. 2015

Journal of the International AIDS Society

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IntroductionSpecific environmental factors may play a role in the development of Pneumocystis pneumonia (PCP) in HIV-positive patients. The aim of this study was to estimate the PCP incidence and mortality in hospitalized HIV-positive patients in Spain during the combination antiretroviral therapy (cART) era (1997 to 2011), as well as to analyze the climatological factors and air pollution levels in relation to hospital admissions and deaths.MethodsWe carried out a retrospective study. Data were collected from the National Hospital Discharge Database and the State Meteorological Agency of Spain. A case-crossover analysis was applied to identify environmental risk factors related to hospitalizations and deaths. For each patient, climatic factors and pollution levels were assigned based on readings from the nearest meteorological station to his or her postal code.ResultsThere were 13,139 new PCP diagnoses and 1754 deaths in hospitalized HIV-positive patients from 1997 to 2011. The PCP incidence (events per 1000 person-years) dropped from 11.6 in 1997 to 2000, to 5.4 in 2004 to 2011 (p<0.001). The mortality (events per 10,000 person-years) also decreased from 14.3 in 1997 to 2000, to 7.5 in 2004 to 2011 (p<0.001). Most hospital admissions and deaths occurred in the winter season and the fewest occurred in the summer, overlapping respectively with the lowest and highest temperatures of the year in Spain. Moreover, lower temperatures prior to PCP admission, as well as higher concentrations of NO2 and particulate matter up to 10 m in size (PM10) at the time of admission were associated with higher likelihoods of hospital admission due to PCP when two weeks, one month, 1.5 months or two months were used as controls (p<0.01). Furthermore, higher concentrations of ozone at one month (p=0.007), 1.5 months (p<0.001) and two months (p=0.006) prior to admission were associated with higher likelihoods of hospital admission with PCP. For PCP-related deaths, lower temperatures prior to admission and higher concentrations of atmospheric PM10 at the time of admission were related to higher likelihood of death when two weeks, one month and 1.5 months were used as controls (p<0.05).ConclusionsPCP was a significant health problem in the cART era (1997 to 2011), and PCP epidemiology was adversely influenced by colder climatological factors and higher ambient air pollution levels.

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Environmental Risk Factors for Pneumocystis Pneumonia Hospitalizations in HIV Patients

Cited by 32 publications

References 42 publications

Environmental injustice and sexual minority health disparities: A national study of inequitable health risks from air pollution among same-sex partners

Environmental injustice and sexual minority health disparities: A national study of inequitable health risks from air pollution among same-sex partners

Respiratory risks from household air pollution in low and middle income countries

Pneumocystis pneumonia in HIV‐positive patients in Spain: epidemiology and environmental risk factors

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