Leveraging Existing Cohorts to Study Health Effects of Air Pollution on Cardiometabolic Disorders: India Global Environmental and Occupational Health Hub.

Gagandeep K Walia,Suganthi Jaganathan,D Prabhakaran,K Srinath Reddy,Lindsay M Jaacks,Kishore K Madhipatla,Siddhartha Mandal,Melina S Magsumbol,Dimple Kondal,Joel Schwartz,Richard A Cash,Preet K Dhillon,Nancy L Sieber,Bhargav Krishna

doi:10.1177/1178630220915688

Abstract

Air pollution is a growing public health concern in developing countries and poses a huge epidemiological burden. Despite the growing awareness of ill effects of air pollution, the evidence linking air pollution and health effects is sparse. This requires environmental exposure scientist and public health researchers to work more cohesively to generate evidence on health impacts of air pollution in developing countries for policy advocacy. In the Global Environmental and Occupational Health (GEOHealth) Program, we aim to build exposure assessment model to estimate ambient air pollution exposure at a very fine resolution which can be linked with health outcomes leveraging well-phenotyped cohorts which have information on geolocation of households of study participants. We aim to address how air pollution interacts with meteorological and weather parameters and other aspects of the urban environment, occupational classification, and socioeconomic status, to affect cardiometabolic risk factors and disease outcomes. This will help us generate evidence for cardiovascular health impacts of ambient air pollution in India needed for necessary policy advocacy. The other exploratory aims are to explore mediatory role of the epigenetic mechanisms (DNA methylation) and vitamin D exposure in determining the association between air pollution exposure and cardiovascular health outcomes. Other components of the GEOHealth program include building capacity and strengthening the skills of public health researchers in India through variety of training programs and international collaborations. This will help generate research capacity to address environmental and occupational health research questions in India. The expertise that we bring together in GEOHealth hub are public health, clinical epidemiology, environmental exposure science, statistical modeling, and policy advocacy.

Highlights

Air pollution is a growing concern in developing countries contributing to >620 000 deaths among Indians annually.[1]
The majority of evidence of health effects of air pollution has come from developed countries which does not account for the complex rapid urbanization happening in developing countries
The composition of air pollution is very different in low- and middle-income countries (LMICs), and the health impact is influenced by several other meteorological, demographic, and built environment factors

Summary

Background

Air pollution is a growing concern in developing countries contributing to >620 000 deaths among Indians annually.[1]. Methylomics provides a unique opportunity to reconstruct past exposures, those such as air pollution and other exposures that augment oxidative stress, to which the methylome is exquisitely sensitive.[12] Air pollution in particular is known to alter DNA methylation that in turn is known to be associated with cardiometabolic health outcomes.[13,14,15] there is strong evidence on effect of Vitamin D levels and deficiency with various cardiometabolic outcomes.[16,17,18,19,20,21] Particulate air pollution reduces effective UV-B exposure, which is critical for producing the biologically active form of vitamin D, and contributes to variation in the UV index, along with other factors such as latitude, season, skin pigmentation, and the use of sun-protective wear.[22,23] Similar to this context, the GBD estimates emerge from a low-resolution chemical transport model that estimates particulate matter levels with considerable error and exposureresponse functions based largely on research from low- and mid-level exposure settings.[24] Most of the air pollution studies in LMICs (largely represented by China) are time-series/ecological study design with a short observation period which often has no spatiotemporal resolution of pollution parameters and focuses only on short-term health outcomes.[25] this research will provide crucial, country-specific evidence of the health effects of air pollution to provide evidence for appropriate policy reforms.

Available dataa

Research aims

Findings

Analysis approach