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Risk of respiratory hospital admission associated with modelled concentrations of Aspergillus fumigatus from composting facilities in England.

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posted on 2020-05-04, 16:11 authored by Aina Roca-Barcelo, Philippa Douglas, Daniela Fecht, Anna Freni Sterrantino, Ben Williams, Marta Blangiardo, John Gulliver, Enda T Hayes, Anna L Hansell
Bioaerosols have been associated with adverse respiratory-related health effects and are emitted in elevated concentrations from composting facilities. We used modelled Aspergillus fumigatus concentrations, a good indicator for bioaerosol emissions, to assess associations with respiratory-related hospital admissions. Mean daily Aspergillus fumigatus concentrations were estimated for each composting site for first full year of permit issue from 2005 onwards to 2014 for Census Output Areas (COAs) within 4 km of 76 composting facilities in England, as previously described (Williams et al., 2019). We fitted a hierarchical generalized mixed model to examine the risk of hospital admission with a primary diagnosis of (i) any respiratory condition, (ii) respiratory infections, (iii) asthma, (iv) COPD, (v) diseases due to organic dust, and (vi) Cystic Fibrosis, in relation to quartiles of Aspergillus fumigatus concentrations. Models included a random intercept for each COA to account for over-dispersion, nested within composting facility, on which a random intercept was fitted to account for clustering of the data, with adjustments for age, sex, ethnicity, deprivation, tobacco sales (smoking proxy) and traffic load (as a proxy for traffic-related air pollution). We included 249,748 respiratory-related and 3163 Cystic Fibrosis hospital admissions in 9606 COAs with a population-weighted centroid within 4 km of the 76 included composting facilities. After adjustment for confounders, no statistically significant effect was observed for any respiratory-related (Relative Risk (RR) = 0.99; 95% Confidence Interval (CI) 0.96-1.01) or for Cystic Fibrosis (RR = 1.01; 95% CI 0.56-1.83) hospital admissions for COAs in the highest quartile of exposure. Similar results were observed across all respiratory disease sub-groups. This study does not provide evidence for increased risks of respiratory-related hospitalisations for those living near composting facilities. However, given the limitations in the dispersion modelling, risks cannot be completely ruled out. Hospital admissions represent severe respiratory episodes, so further study would be needed to investigate whether bioaerosols emitted from composting facilities have impacts on less severe episodes or respiratory symptoms.


This study was funded by the Natural Environment Research Council (NERC) (NE/P010806/1, grant title ‘‘BIOlogical air pollution Modelling and associations with Lung Disease (BIOMOLD))”. The study also received funding from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards at King’s College London in partnership with PHE and Imperial College London. Philippa Douglas was partially supported by a MRC-PHE Centre for Environment and Health research fellowship. The work of the UK Small Area Health Statistics Unit is funded by Public Health England (PHE) as part of the MRC-PHE Centre for Environment and Health, funded also by the UK Medical Research Council (MRC). The University of the West of England (UWE) would also like to acknowledge the provision of time given by colleagues of ‘Detection and characterisation of inflammatory agents associated with bioaerosol emitted from biowaste and intensive agriculture’ (EndotoxII), to complete this study (NE/M011631/1). The views expressed are of the authors and not necessarily those of NERC, PHE, MRC, the NHS, NIHR, or the Department of Health.



Environmental Research Volume 183, April 2020, 108949


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