Abstract
PurposeAdverse health impact of air pollution on health may not only be associated with the level of exposure, but rather mediated by perception of the pollution and by top-down processing (e.g. beliefs of the exposure being hazardous), especially in areas with relatively low levels of pollutants. The aim of this study was to test a model that describes interrelations between air pollution (particles < 10 {upmu }m, PM10), perceived pollution, health risk perception, health symptoms and diseases.MethodsA population-based questionnaire study was conducted among 1000 Estonian residents (sample was stratified by age, sex, and geographical location) about health risk perception and coping. The PM10 levels were modelled in 1 × 1 km grids using a Eulerian air quality dispersion model. Respondents were ascribed their annual mean PM10 exposure according to their home address. Path analysis was performed to test the validity of the model.ResultsThe data refute the model proposing that exposure level significantly influences symptoms and disease. Instead, the perceived exposure influences symptoms and the effect of perceived exposure on disease is mediated by health risk perception. This relationship is more pronounced in large cities compared to smaller towns or rural areas.ConclusionsPerceived pollution and health risk perception, in particular in large cities, play important roles in understanding and predicting environmentally induced symptoms and diseases at relatively low levels of air pollution.
Highlights
There is strong epidemiological evidence for relationships between short- and long-term exposure to particulates and cardiopulmonary mortality, hospitalization and respiratory disease (WHO 2013)
The objective of the present study was to test a model of interrelations between physical air pollution, perceived air pollution, health risk perception, symptoms and disease among Estonian inhabitants
Results from the path analysis showed that level of air pollution exposure did not significantly influence perceived pollution and health risk perception, symptoms or diseases
Summary
There is strong epidemiological evidence for relationships between short- and long-term exposure to particulates and cardiopulmonary mortality, hospitalization and respiratory disease (e.g. asthma, chronic bronchitis, rhinitis) (WHO 2013). Recent evidence relates air pollution to diabetes (Thiering and Heinrich 2015), rheumatic diseases (Sun et al 2016), cognitive functioning (Clifford et al 2016) and University, Tartu, Estonia 5 Department of Public Health and Clinical Medicine, Umeå. The main mechanism behind the development of diabetes and rheumatoid arthritis is oxidative stress and initial inflammation. Experimental evidence suggests air pollution increasing systemic insulin resistance (Brook et al 2013) and oxidative stress in the lungs may be an intermediate step between exposure and health effects (Haberzettl et al 2016). Persistent amplified chronic inflammation together with production of cytokines (e.g. IL-1, IL-6) may lead to rheumatoid arthritis (Ruiz-Esquide and Sanmartí 2012; Ying et al 2015). Air pollution may induce oxidative stress in the brain, similar to that seen in cells elsewhere in the body (Clifford et al 2016), appeal and accumulate larger deposits of beta-amyloid, as a pathological driver of neurodegeneration
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