Abstract
BackgroundMost of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive.MethodsFrom September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus.ResultsTwo hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7–27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1–10.0) but not men (AOR 1.3, 95%CI 0.4–4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01–6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1–14.4) participants.ConclusionsIn a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.
Highlights
Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where Human immunodeficiency virus (HIV) serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity
In a mixed cohort of people with and without HIV in rural southwestern Uganda, we found that personal carbon monoxide (CO) exposure exceeded World Health Organization (WHO) air quality thresholds for one in five participants, that the odds of CO exposure exceeding air quality thresholds were over 10 times higher among those living in homes where charcoal was used for cooking, and that CO exposure was associated with respiratory symptoms among vulnerable populations such as women and those living with HIV
The results of our work suggest that the convergence of the HIV and air pollution epidemics on the African continent may underlie the disproportionate regional burden of respiratory diseases
Summary
Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. Most of the global burden of pollution-related morbidity and mortality is believed to occur in resourcelimited settings (RLS) [3], where ground-level air quality estimates are sparse due to limitations in the human capital and infrastructure necessary to establish and maintain air monitoring networks. Recent data suggest that the higher burden of air pollution-related respiratory symptoms among women in RLS – often attributed to higher exposure among women due to cooking-related biomass burning – may at least partially result from sex hormone-based differences in the pulmonary effects of inhaled pollutants [9, 10] Despite these plausible relationships, little is known about whether these potentially vulnerable populations are at heightened risk for pollution-associated respiratory morbidity
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