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We found some evidence that long-term exposure to NO2 is negatively associated with cardiac autonomic dysfunction in middle-age to elderly women and in subjects with cardiovascular disease. The different associations in men and women might be at least in part due to confounding by behavioral differences between the sexes.
Stratification by cardiovascular disease showed that subjects who had a medical examination or treatment because of cardiovascular problems in the previous 12 months had a 4% (95% CI, −8 to −1) lower SDNN per 10-μg/m3 increase in NO2. Subjects with-out self-reported cardiovascular problems in the previous 12 months did not show a significant negative association between HRV and long-term exposure to NO2. When further stratifying by sex, this association was stronger in women than in men, but this difference was not statistically significant, with only 115 women and 121 men in this category ().
Appleton JD, Williams TM, Orbea H., Carrasco M. 2001. Fluvial contamination associated with artisanal gold mining in the Ponce Enriquez, Portovelo-Zruma and Mabija areas, Ecuador. Water Air Soil Pollut 131(1):19–39.
Limitations. Villages of interest were identified through a chain-referral sampling process that might not have captured all villages involved with gold ore processing in Zamfara State, and hard-to-reach or inaccessible villages of interest were not investigated. Therefore, we did not fully determine the geographic extent of childhood lead poisoning in Zamfara State. Second, we could only sample approximately five children in each village. Although we oversampled children from homes with gold ore processing and sick children to increase the likelihood of detecting elevated BLLs, the number of villages with childhood lead poisoning might have been underestimated. Third, we used convulsions and deaths as clinical indicators for lead poisoning because symptoms of lead poisoning are generally nonspecific, and blood lead testing was unavailable at the beginning of the outbreak when the majority of affected children died. However, convulsions and deaths are not sensitive as markers of lead poisoning because they typically occur at BLLs that are higher than the levels detected in most blood samples collected from these villages, and convulsions and death are not specific for lead poisoning because they can result from other locally endemic diseases, including malaria and bacterial meningitis. Finally, we did not assess lead poisoning among children ≥ 5 years of age, adults, or livestock. Older children and adults are also at risk for harmful lead exposure and its adverse health effects, and children may be exposed in utero or through breast-feeding if their mothers have elevated BLLs. In addition, villagers may be exposed through consumption of lead-contaminated food or dairy products. Therefore, characterizing the depth and extent of lead poisoning in older children, adults, and livestock is an important topic for further investigation.
This investigation was conducted in accordance with the Declaration of Helsinki, developed by the World Medical Association (). The Human Subjects Review Board at the CDC determined that this investigation was a public health response that was exempt from full institutional review board review.
There is some evidence that long-term exposure to NO2 is associated with cardiac autonomic dysfunction in elderly women and in subjects with cardiovascular disease.
Associations between nitrogen dioxide and HRV have been reported but, to our knowledge, only in short-term studies (; ; ). Long-term exposure to NO2 might lead to altered HRV through structural changes of the heart. The aim of this study was to test the hypothesis that long-term exposure to traffic-related air pollution, as measure by NO2 concentrations, is negatively associated with HRV in the population-based Swiss cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA).
During May–June 2010, the team surveyed the two most-affected villages and confirmed lead poisoning as the cause of the outbreak (; ). Among these two villages, 25% of children ). Factors associated with child mortality in the two surveyed villages were the child’s age, maternal participation in ore processing, and environmental factors such as primary water source type and soil-lead level of the family compound (). The investigation concluded that 118 child fatalities were strongly associated with gold ore processing.
Gold mining and lead exposure. Gold production has increased worldwide concomitant with global demand. The price of gold has increased approximately 360% from 2001 to 2010 (). Among developing countries, small-scale gold ore processing and production have increasingly been adopted by rural communities. The environmental and health impacts of small-scale gold production are often overlooked. Gold mining and processing are known to cause air and water pollution from arsenic, mercury, and cyanide. Gold processing can also cause mercury poisoning in workers because of direct exposure to liquid or vaporized mercury during ore processing (). Although lead pollution is not commonly associated with gold mining, studies of small-scale gold mining sites in the Migori gold belt (Kenya) have demonstrated lead, mercury, and arsenic pollution of multiple gold processing sites; recorded soil lead levels ranged from 16 to 14,999 ppm (; ). A study in Ecuador demonstrated lead, manganese, and mercury pollution of river water near the surveyed small-scale gold-mining sites; approximately 40% of adults from the affected communities had BLLs > 20 µg/dL (). The widespread childhood lead poisoning and lead contamination identified during our investigation illustrates the urgent need to monitor and prevent lead pollution from gold ore–processing activities, particularly among small-scale gold mining communities globally.
Among developing countries, major sources of childhood lead poisoning include lead mining and smelting, paint, leaded gasoline, battery recycling, and traditional medicines (; ). Exposure to lead ore dust through ingestion or inhalation can result in high BLLs in children. A limited number of studies have documented environmental lead contamination or adults with elevated BLLs in small-scale gold ore–processing communities (; ; ; ). However, childhood lead poisoning was not reported to be associated with gold ore processing in these studies.
This is the first study to describe effects of long-term exposure to NO2 on HRV in a general population sample of middle-age to elderly persons. Our results suggest that exposure to ambient air concentrations of NO2 averaged over 1 year is negatively associated with autonomic cardiac dysfunction in women and subjects with cardiovascular disease. Higher exposure to NO2 was associated with a reduction in 24-hr overall HRV and in nighttime LF power, which is influenced by both the sympathetic and parasympathetic nervous system. Because we saw no effect of NO2 on HF power, which is influenced by the parasympathetic nervous system (; ), the adverse effects of ambient NO2 on cardiovascular health might primarily involve pathways over the sympathetic nervous system.