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

Aina Roca-Barcelo; Philippa Douglas; Daniela Fecht; Anna Freni Sterrantino; Ben Williams; Marta Blangiardo; John Gulliver; Enda T Hayes; Anna L Hansell

doi:10.1016/j.envres.2019.108949

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

Environ Res. 2020 Apr:183:108949. doi: 10.1016/j.envres.2019.108949. Epub 2020 Jan 3.

Authors

Aina Roca-Barcelo¹, Philippa Douglas², Daniela Fecht¹, Anna Freni Sterrantino¹, Ben Williams³, Marta Blangiardo⁴, John Gulliver⁵, Enda T Hayes³, Anna L Hansell⁶

Affiliations

¹ UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, W2 1PG, UK.
² UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, W2 1PG, UK; Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK; Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, OX11 0RQ, UK. Electronic address: Philippa.douglas@phe.gov.uk.
³ Air Quality Management Resource Centre, University of the West of England, Faculty of Environment and Technology, Coldharbour Lane, Bristol, BS16 1QY, UK.
⁴ MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK.
⁵ MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK; Centre for Environmental Health and Sustainability, University of Leicester, Leicester, LE1 7RH, UK.
⁶ UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, W2 1PG, UK; Centre for Environmental Health and Sustainability, University of Leicester, Leicester, LE1 7RH, UK; Directorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, W2 1NY, UK. Electronic address: ah618@le.ac.uk.

PMID: 31902481
DOI: 10.1016/j.envres.2019.108949

Abstract

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.

Keywords: Aspergillus fumigatus; Asthma; Bioaerosol; Composting facility; Respiratory health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aerosols
Aspergillus fumigatus* / pathogenicity
Composting*
England
Environmental Exposure
Hospitalization* / statistics & numerical data
Humans

Substances

Aerosols