TY - RPRT T1 - EBoD-FL. Guidelines for mapping the environmental burden of disease in Flanders, 2023 Y1 - 2024 A1 - Arno Pauwels A1 - Claire Demoury A1 - Eva M De Clercq A1 - Brecht Devleesschauwer KW - air pollution KW - burden of disease KW - environment KW - extreme temperatures KW - noise KW - Risk Factors AB -

The environment poses a diverse range of health risks. Environmental burden of disease (EBD) studies try to estimate the impact of environmental stressors in terms mortality or morbidity on a population level. Although environmental risks have been studied in Flanders, an effort to routinely quantify the environmental disease burden completely and coherently has thus far not been established. For this reason, Sciensano and Departement Zorg are partnering up in a project to map the Environmental Burden of Disease in Flanders (EBoD-FL).

The aim of the research is to inventory the burden of disease attributable to all relevant environmental stressors according to a coherent framework. To tackle this objective, the disease burden attributable to environmental stressors is estimated using comparative risk assessment (CRA). As this method determines the attributable burden proportionally, figures for the total disease burden are required as a baseline to obtain absolute estimates. In EBoD-FL, the EBD is quantified as disability-adjusted life years (DALYs), a summary measure that combines both mortality and morbidity.

Given the extensive list of potential risk factor-health outcome pairs, a set of priorities was defined in terms of environmental stressors and health outcomes. The risk factors that were prioritised are those related to air quality, environmental noise and extreme temperature. In terms of outcomes, priority was given to all-cause mortality, respiratory diseases and cardiovascular diseases. This report outlines the CRA methodology in general, and the application on the risk-outcome pairs that have been given priority. The basic steps of CRA are:

  1. Selection of risk factors: Which risk factors are included in the study and how is exposure quantified as a metric?
  2. Exposure assessment: how to measure or model exposure to the risk factors in the population?
  3. Identification of risk-outcome pairs: which health outcomes are caused by the risk factors?
  4. Quantification of the risk-outcome relation: what is the risk of developing the outcome in function of exposure?
  5. Calculation of the population attributable fraction: what is the proportion of the disease burden attributed to one or multiple risk factors?

The purpose of this report is to outline the general methodology used to tackle the objective of EBoD-FL and to apply the CRA methodology to the stressors that are prioritized. Additionally, possibilities for the application of the results for evidence-based policy are explored, as well as some challenges and limitations.

PB - Sciensano CY - Brussels, Belgium ER - TY - JOUR T1 - Impact of short-term exposure to air pollution on natural mortality and vulnerable populations: a multi-city case-crossover analysis in Belgium JF - Environmental Health Y1 - 2024 A1 - Claire Demoury A1 - Raf Aerts A1 - Finaba Berete A1 - Wouter Lefebvre A1 - Arno Pauwels A1 - Charlotte Vanpoucke A1 - Johan Van der Heyden A1 - Eva M De Clercq VL - 23 CP - 1 M3 - 10.1186/s12940-024-01050-w ER - TY - RPRT T1 - EBoD-FL. Guidelines for mapping the environmental burden of disease in Flanders Y1 - 2023 A1 - Arno Pauwels A1 - Claire Demoury A1 - Eva M De Clercq A1 - Brecht Devleesschauwer KW - air pollution KW - burden of disease KW - environmental risks KW - extreme temperatures KW - noise AB -

The environment poses a diverse range of health risks. Environmental burden of disease (EBD) studies try to estimate the impact of environmental stressors in terms of mortality or morbidity on a population level. Although environmental risks have been studied in Flanders, an effort to routinely quantify the environmental disease burden completely and coherently has thus far not been established. For this reason, Sciensano and Agentschap Zorg & Gezondheid are partnering up in a project to map the Environmental Burden of Disease in Flanders (EBoD-FL).

The aim of the research is to inventory the burden of disease attributable to all relevant environmental stressors according to a coherent framework. To tackle this objective, the disease burden attributable to environmental stressors is estimated using comparative risk assessment (CRA). As this method determines the attributable burden as a proportion of the total, figures for the recorded disease burden are required to obtain absolute numbers. In EBoD-FL, the EBD is quantified as disability-adjusted life years (DALYs), a summary measure that combines both mortality and morbidity.

Given the extensive list of potential stressor-health outcome pairs, a set of priorities was defined in terms of environmental stressors and health outcomes. The risk factors that will be studied first are those related to air quality, environmental noise and extreme temperature. In terms of outcomes, priority was given to all-cause mortality, respiratory diseases and cardiovascular diseases. This report outlines the CRA methodology in general, and applied to the risk factor-outcome pairs that have been given priority. The basic steps of CRA are:

  1. Selection of risk factors: Which risk factors are included in the study and how is exposure quantified as a metric?
  2. Exposure assessment: how to measure or model exposure to the risk factors in the population?
  3. Identification of stressor-outcome pairs: which health outcomes are caused by the risk factors?
  4. Quantification of the stressor-outcome relation: what is the risk of developing the outcome in function of exposure?
  5. Calculation of the population attributable fraction: what is the proportion of a disease burden attributed to one or multiple risk factors?

The purpose of this report is to outline the general methodology used to tackle the objective of EBoD-FL and to apply the CRA methodology to the stressors that are prioritized. Additionally, possibilities for the application of the results for evidence-based policy are explored, as well as some challenges and limitations.

PB - Sciensano CY - Brussels, Belgium ER - TY - BOOK T1 - Environnement et santé publique Chapitre 31. Rayonnements ionisants Y1 - 2023 A1 - Dominique Laurier A1 - Enora Cléro A1 - Claire Demoury A1 - Aimée Lauzon A1 - Jean-François Lecomte PB - Presses de l’EHESP M3 - 10.3917/ehesp.goupi.2023.01.0829 ER - TY - JOUR T1 - The impact of ambient temperature and air pollution on SARS-CoV2 infection and post COVID-19 condition in Belgium (2021–2022) JF - Environmental Research Y1 - 2023 A1 - Thi Khanh, Huyen Nguyen A1 - Katrien De Troeyer A1 - Pierre Smith A1 - Claire Demoury A1 - Casas, Lidia KW - air pollution KW - Ambient temperature(s) KW - Climate change KW - Post COVID-19 conditions KW - SARS-CoV2 infection AB -

Introduction

The associations between non-optimal ambient temperature, air pollution and SARS-CoV-2 infection and post COVID-19 condition (PCC) remain constrained in current understanding. We conducted a retrospective analysis to explore how ambient temperature affected SARS-CoV-2 infection in individuals who later developed PCC compared to those who did not. We investigated if these associations were modified by air pollution.

Methods

We conducted a bidirectional time-stratified case-crossover study among individuals who tested positive for SARS-CoV-2 between May 2021 and June 2022. We included 6302 infections, with 2850 PCC cases. We used conditional logistic regression and distributed lag non-linear models to obtain odds ratios (OR) and 95% confidence intervals (CI) for non-optimal temperatures relative to the period median temperature (10.6 °C) on lags 0 to 5. For effect modification, daily average PM2.5 concentrations were categorized using the period median concentration (8.8 μg/m3). Z-tests were used to compare the results by PCC status and PM2.5.

Results

Non-optimal cold temperatures increased the cumulative odds of infection (OR = 1.93; 95%CI:1.67–2.23, OR = 3.53; 95%CI:2.72–4.58, for moderate and extreme cold, respectively), with the strongest associations observed for non-PCC cases. Non-optimal heat temperatures decreased the odds of infection except for moderate heat among PCC cases (OR = 1.32; 95%CI:0.89–1.96). When PM2.5 was >8.8 μg/m3, the associations with cold were stronger, and moderate heat doubled the odds of infection with later development of PCC (OR = 2.18; 95%CI:1.01–4.69). When PM2.5 was ≤8.8 μg/m3, exposure to non-optimal temperatures reduced the odds of infection.

Conclusion

Exposure to cold increases SARS-CoV2 risk, especially on days with moderate to high air pollution. Heated temperatures and moderate to high air pollution during infection may cause PCC. These findings stress the need for mitigation and adaptation strategies for climate change to reduce increasing trends in the frequency of weather extremes that have consequences on air pollution concentrations.

M3 - 10.1016/j.envres.2023.118066 ER - TY - JOUR T1 - Modelling the pesticide transfer during tea and herbal tea infusions by the identification of critical infusion parameters. JF - Food Chem Y1 - 2023 A1 - Philippe Szternfeld A1 - Claire Demoury A1 - Wendy Brian A1 - Jean-Yves Michelet A1 - Virginie Van Leeuw A1 - Els Van Hoeck A1 - Laure Joly KW - Databases, Factual KW - Flavoring Agents KW - Pesticide residues KW - Pesticides KW - Tea KW - Teas, Herbal AB -

Pesticide residues in tea and herbal tea often exceed EU maximum residue limits. Consideration of the transfer of pesticides from the leaves (called transfer factors) to the brew is essential to assess the associated risk. This study identified infusion parameters influencing the transfer behaviour of 61 pesticides and elaborated a predictive model for pesticides with unknown transfer factors in black, green, herbal and flavoured teas. Tea type and the presence of flavours were the criteria that most influenced the pesticide transfer. Interestingly, infusion parameters that are individual and area dependent such as infusion time, temperature and water hardness, did not play a significant role. Beta regression models developed to characterise pesticide behaviour during infusion showed good predictions for most pesticides and revealed that log (P) was the main physico-chemical parameter to estimate the pesticide transfer. The transfer factors database and validated models are valuable tools for improving risk assessment.

VL - 429 M3 - 10.1016/j.foodchem.2023.136893 ER - TY - JOUR T1 - Response to Tsuda et al. “demonstrating the undermining of science and health policy after the Fukushima nuclear accident by applying the toolkit for detecting misused epidemiological methods”AbstractBackgroundMain bodyConclusion JF - Environmental Health Y1 - 2023 A1 - Enora Cléro A1 - Claire Demoury A1 - Bernd Grosche A1 - Liudmila Liutsko A1 - Yvon Motreff A1 - Takashi Ohba A1 - Deborah Oughton A1 - Philippe Pirard A1 - Agnès Rogel A1 - Thierry Schneider A1 - An Van Nieuwenhuyse A1 - Dominique Laurier A1 - Elisabeth Cardis KW - nuclear accidents ; recommendations VL - 22 CP - 1 M3 - 10.1186/s12940-023-00966-z ER - TY - JOUR T1 - Association between temperature and natural mortality in Belgium: Effect modification by individual characteristics and residential environment JF - Science of The Total Environment Y1 - 2022 A1 - Claire Demoury A1 - Katrien, De Troeyer A1 - Finaba Berete A1 - Raf Aerts A1 - Bert, Van Schaeybroeck A1 - Johan Van der Heyden A1 - Eva M De Clercq KW - air pollution KW - Effect modification KW - Preexisting conditions KW - TemperatureMortality KW - Vulnerability AB -

Background

There is strong evidence of mortality being associated to extreme temperatures but the extent to which individual or residential factors modulate this temperature vulnerability is less clear.

Methods

We conducted a multi-city study with a time-stratified case-crossover design and used conditional logistic regression to examine the association between extreme temperatures and overall natural and cause-specific mortality. City-specific estimates were pooled using a random-effect meta-analysis to describe the global association. Cold and heat effects were assessed by comparing the mortality risks corresponding to the 2.5th and 97.5th percentiles of the daily temperature, respectively, with the minimum mortality temperature. For cold, we cumulated the risk over lags of 0 to 28 days before death and 0 to 7 days for heat. We carried out stratified analyses and assessed effect modification by individual characteristics, preexisting chronic health conditions and residential environment (population density, built-up area and air pollutants: PM2.5, NO2, O3 and black carbon) to identify more vulnerable population subgroups.

Results

Based on 307,859 deaths from natural causes, we found significant cold effect (OR = 1.42, 95%CI: 1.30–1.57) and heat effect (OR = 1.17, 95%CI: 1.12–1.21) for overall natural mortality and for respiratory causes in particular. There were significant effects modifications for some health conditions: people with asthma were at higher risk for cold, and people with psychoses for heat. In addition, people with long or frequent hospital admissions in the year preceding death were at lower risk. Despite large uncertainties, there was suggestion of effect modification by air pollutants: the effect of heat was higher on more polluted days of O3 and black carbon, and a higher cold effect was observed on more polluted days of PM2.5 and NO2 while for O3, the effect was lower.

Conclusions

These findings allow for targeted planning of public-health measures aiming to prevent the effects of extreme temperatures.

VL - 851 M3 - 10.1016/j.scitotenv.2022.158336 ER - TY - JOUR T1 - Impact of Short-Term Exposure to Extreme Temperatures on Mortality: A Multi-City Study in Belgium JF - International Journal of Environmental Research and Public Health Y1 - 2022 A1 - Claire Demoury A1 - Raf Aerts A1 - Bram Vandeninden A1 - Bert Van Schaeybroeck A1 - Eva M De Clercq VL - 19 CP - 7 M3 - 10.3390/ijerph19073763 ER - TY - JOUR T1 - Residential Exposure to Urban Trees and Medication Sales for Mood Disorders and Cardiovascular Disease in Brussels, Belgium: An Ecological Study JF - Environmental Health Perspectives Y1 - 2022 A1 - Dengkai, Chi A1 - Raf Aerts A1 - An Van Nieuwenhuyse A1 - Mariska, Bauwelinck A1 - Claire Demoury A1 - Michelle, Plusquin A1 - Tim S., Nawrot A1 - Lidia, Casas A1 - Ben, Somers AB -

Background:

The available evidence for positive associations between urban trees and human health is mixed, partly because the assessment of exposure to trees is often imprecise because of, for instance, exclusion of trees in private areas and the lack of three-dimensional (3D) exposure indicators (e.g., crown volume).

Objectives:

We aimed to quantify all trees and relevant 3D structural traits in Brussels (Belgium) and to investigate associations between the number of trees, tree traits, and sales of medication commonly prescribed for mood disorders and cardiovascular disease.

Methods:

We developed a workflow to automatically isolate all individual trees from airborne light detection and ranging (LiDAR) data collected in 2012. Trait data were subsequently extracted for 309,757 trees in 604 census tracts. We used the average annual age-standardized rate of medication sales in Brussels for the period 2006 to 2014, calculated from reimbursement information on medication prescribed to adults (19–64 years of age). The medication sales data were provided by sex at the census tract level. Generalized log-linear models were used to investigate associations between the number of trees, the crown volume, tree structural variation, and medication sales. Models were run separately for mood disorder and cardiovascular medication and for men and women. All models were adjusted for indicators of area-level socioeconomic status.

Results:

Single-factor models showed that higher stem densities and higher crown volumes are both associated with lower medication sales, but opposing associations emerged in multifactor models. Higher crown volume [an increase by one interquartile range (IQR) of 1.4×104 m³/hainterquartile range (IQR) of 1.4×104 m³/ha] was associated with 34% lower mood disorder medication sales [women, β=−0.341β=−0.341 (95% CI: −0.379−0.379, −0.303−0.303); men, β=−0.340β=−0.340 (95% CI: −0.378−0.378, −0.303−0.303)] and with 21–25% lower cardiovascular medication sales [women, β=−0.214β=−0.214 (95% CI: −0.246−0.246, −0.182−0.182); men, β=−0.252β=−0.252 (95% CI: −0.285−0.285, −0.219−0.219)]. Conversely, a higher stem density (an increase by one IQR of 21.8 trees/haIQR of 21.8 trees/ha) was associated with 28–32% higher mood disorder medication sales [women, β=0.322β=0.322 (95% CI: 0.284, 0.361); men, β=0.281β=0.281 (95% CI: 0.243, 0.319)] and with 20–24% higher cardiovascular medication sales [women, β=0.202β=0.202 (95% CI: 0.169, 0.236); men, β=0.240β=0.240 (95% CI: 0.206, 0.273)].

Discussion:

We found a trade-off between the number of trees and the crown volumes of those trees for human health benefits in an urban environment. Our results demonstrate that conserving large trees in urban environments may not only support conservation of biodiversity but also human health. https://doi.org/10.1289/EHP9924

VL - 130 CP - 5 M3 - 10.1289/EHP9924 ER - TY - JOUR T1 - Residential green space and mental health-related prescription medication sales: An ecological study in Belgium. JF - Environmental Research Y1 - 2022 A1 - Raf Aerts A1 - Naomi Vanlessen A1 - Sébastien Dujardin A1 - Nemery, Benoit A1 - An Van Nieuwenhuyse A1 - Mariska Bauwelinck A1 - Casas, Lidia A1 - Claire Demoury A1 - Michelle Plusquin A1 - Nawrot, Tim S KW - Environmental epidemiology KW - medication sales KW - Mental health KW - mood disorders KW - Residential green space AB -

BACKGROUND: Residential green space has been associated with mental health benefits, but how such associations vary with green space types is insufficiently known.

OBJECTIVE: We aimed to investigate associations between types and quantities of green space and sales of mood disorder medication in Belgium.

METHODS: We used aggregated sales data of psycholeptics and psychoanaleptics prescribed to adults from 2006 to 2014. Generalized mixed effects models were used to investigate associations between relative covers of woodland, low-green, grassland, and garden, and average annual medication sales. Models were adjusted for socio-economic background variables, urban-rural differences, and administrative region, and included random effects of latitude and longitude.

RESULTS: Urban census tracts were associated with 9-10% higher medication sales. In nationwide models, a 10% increase in relative cover of woodland, garden, and grass was associated with a 1-2% decrease in medication sales. The same association was found for low green but only for men. In stratified models, a 10% increase in relative cover of any green space type in urban census tracts was associated with a decrease of medication sales by 1-3%. In rural census tracts, no protective associations between green space and mood disorder medication sales were observed, with the exception of relative woodland cover for women (-1%), and low green was associated with higher medication sales (+6-7%).

CONCLUSIONS: Taken together, these results suggest that living in green environments may be beneficial for adult mental health. Woodland exposure seemed the most beneficial, but the amount of green space was more important than the type. Results underline the importance of conserving green space in our living environment, for the conservation of biodiversity and for human health.

VL - 211 M3 - 10.1016/j.envres.2022.113056 ER - TY - JOUR T1 - Variability in the association between long-term exposure to ambient air pollution and mortality by exposure assessment method and covariate adjustment: A census-based country-wide cohort study JF - Science of The Total Environment Y1 - 2022 A1 - Mariska Bauwelinck A1 - Chen, Jie A1 - Kees de Hoogh A1 - Klea Katsouyanni A1 - Sophia Rodopoulou A1 - Evangelia Samoli A1 - Zorana J. Andersen A1 - Richard Atkinson A1 - Casas, Lidia A1 - Deboosere, Patrick A1 - Claire Demoury A1 - Nicole Janssen A1 - Jochem O. Klompmaker A1 - Wouter Lefebvre A1 - Amar Jayant Mehta A1 - Tim S. Nawrot A1 - Bente Oftedal A1 - Matteo Renzi A1 - Massimo Stafoggia A1 - Maciek Strak A1 - Vandenheede, Hadewijch A1 - Charlotte Vanpoucke A1 - An Van Nieuwenhuyse A1 - Danielle Vienneau A1 - Bert Brunekreef A1 - Gerard Hoek KW - cause-specific mortality KW - Environmental hazard KW - exposure assessment KW - health effects KW - population-based KW - Survival Analysis AB -

Background

Ambient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions.

Methods

We used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43).

Results

We found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 μg/m3 increase for NO2 were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 μg/m3 increase for PM2.5 for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3].

Conclusion

Long-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.

VL - 804 M3 - 10.1016/j.scitotenv.2021.150091 ER - TY - Generic T1 - Childhood leukemia around the Belgian nuclear sites, 2006-2016: an ecological study at small geographical level Y1 - 2021 A1 - Claire Demoury A1 - C Faes A1 - J Francart A1 - Sylviane Carbonnelle A1 - N Van Damme A1 - L Van Bladel A1 - Eva M De Clercq JF - IRPA15, 15th International Congress of the International Radiation Protection Association ER - TY - JOUR T1 - Childhood leukemia near nuclear sites in Belgium: An ecological study at small geographical level JF - Cancer Epidemiology Y1 - 2021 A1 - Claire Demoury A1 - Faes, Christel A1 - De Schutter, Harlinde A1 - Sylviane Carbonnelle A1 - Michael Rosskamp A1 - Francart, Julie A1 - Van Damme, Nancy A1 - Van Bladel, Lodewijk A1 - An Van Nieuwenhuyse A1 - Eva M De Clercq VL - 72 M3 - 10.1016/j.canep.2021.101910 ER - TY - JOUR T1 - Childhood leukemia near nuclear sites in Belgium: An ecological study at small geographical level. JF - Cancer Epidemiol Y1 - 2021 A1 - Claire Demoury A1 - Faes, Christel A1 - De Schutter, Harlinde A1 - Sylviane Carbonnelle A1 - Michael Rosskamp A1 - Francart, Julie A1 - Van Damme, Nancy A1 - Van Bladel, Lodewijk A1 - An Van Nieuwenhuyse A1 - Eva M De Clercq KW - ADOLESCENT KW - Belgium KW - Child KW - Child, Preschool KW - Female KW - Humans KW - incidence KW - Leukemia KW - Male KW - Nuclear Power Plants KW - REGISTRIES KW - Small-Area Analysis AB -

BACKGROUND: A previous investigation of the occurrence of childhood acute leukemia around the Belgian nuclear sites has shown positive associations around one nuclear site (Mol-Dessel). In the following years, the Belgian Cancer Registry has made data available at the smallest administrative unit for which demographic information exists in Belgium, i.e. the statistical sector. This offers the advantage to reduce the potential misclassification due to large geographical scales.

METHODS: The current study performed for the period 2006-2016 uses Poisson models to investigate (i) the incidence of childhood acute leukemia within 20 km around the four Belgian nuclear sites, (ii) exposure-response relationships between cancer incidence and surrogate exposures from the nuclear sites (distance, wind direction frequency and exposure by hypothetical radioactive discharges taking into account historical meteorological conditions). All analyses are carried out at statistical sector level.

RESULTS: Higher incidence rate ratios were found for children <15 years (7 cases, RR = 3.01, 95% CI: 1.43;6.35) and children <5 years (< 5 cases, RR = 3.62, 95% CI: 1.35;9.74) living less than 5 km from the site of Mol-Dessel. In addition, there was an indication for positive exposure-response relationships with the different types of surrogate exposures.

CONCLUSION: Results confirm an increased incidence of acute childhood leukemia around Mol-Dessel, but the number of cases remains very small. Random variation cannot be excluded and the ecological design does not allow concluding on causality. These findings emphasize the need for more in-depth research into the risk factors of childhood leukemia, for a better understanding of the etiology of this disease.

VL - 72 M3 - 10.1016/j.canep.2021.101910 ER - TY - Generic T1 - Etude des facteurs d’infusion pour les résidus de pesticides présents dans le thé et les infusions Y1 - 2021 A1 - Philippe Szternfeld A1 - Claire Demoury A1 - Virginie Van Leeuw A1 - Jean-Yves Michelet A1 - F. Scholz A1 - Els Van Hoeck A1 - Laure Joly JF - Comité Scientifique de l'AFSCA - juin 2021 PB - Comité Scientifique de l'AFSCA ER - TY - Generic T1 - Incidence des leucémies de l’enfant à proximité des sites nucléaires belges, 2006-2016 Y1 - 2021 A1 - Claire Demoury A1 - C Faes A1 - J Francart A1 - Sylviane Carbonnelle A1 - N Van Damm A1 - H De Schutter A1 - L Van Bladel A1 - Eva M De Clercq JF - 13ème Congrès national de radioprotection, Société Française de Radioprotection ER - TY - JOUR T1 - Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident. JF - Environ Int Y1 - 2021 A1 - Enora Cléro A1 - Evgenia Ostroumova A1 - Claire Demoury A1 - Bernd Grosche A1 - Ausrele Kesminiene A1 - Liudmila Liutsko A1 - Yvon Motreff A1 - Deborah Oughton A1 - Philippe Pirard A1 - Agnès Rogel A1 - An Van Nieuwenhuyse A1 - Dominique Laurier A1 - Elisabeth Cardis KW - Chernobyl Nuclear Accident KW - Child KW - Early Detection of Cancer KW - Fukushima Nuclear Accident KW - Humans KW - Japan KW - Quality of Life KW - Republic of Korea KW - Thyroid Neoplasms AB -

Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.

VL - 146 M3 - 10.1016/j.envint.2020.106230 ER - TY - Generic T1 - Modélisation du transfert des pesticides des feuilles de thés vers les eaux d’infusion Y1 - 2021 A1 - Philippe Szternfeld A1 - Claire Demoury A1 - Virginie Van Leeuw A1 - J-Y. Michelet A1 - F. Scholz A1 - Els Van Hoeck A1 - Laure Joly KW - Pesticides KW - thé JF - Groupes français de recherches sur les pesticides ER - TY - Generic T1 - Pesticides transfer from tea leaves to tea brew: identification of critical infusion parameters and database creation  Y1 - 2021 A1 - Philippe Szternfeld A1 - Claire Demoury A1 - Virginie Van Leeuw A1 - J-Y. Michelet A1 - F. Scholz A1 - Els Van Hoeck A1 - Laure Joly JF - EURLs pesticides - joint workshop 2021 PB - EURLs pesticides - joint workshop 2021 CY - Videoconference - Almeria ER - TY - Generic T1 - Short-term exposure to temperature and all-cause and cause-specific mortality: a study in nine Belgian cities, 2010-2015 Y1 - 2021 A1 - Claire Demoury A1 - Eva M De Clercq JF - Conference of the International Society for Environmental Epidemiology ER - TY - JOUR T1 - Tree pollen allergy risks and changes across scenarios in urban green spaces in Brussels, Belgium JF - Landscape and Urban Planning Y1 - 2021 A1 - Raf Aerts A1 - Nicolas Bruffaerts A1 - Ben Somers A1 - Claire Demoury A1 - Michelle Plusquin A1 - Tim S. Nawrot A1 - Marijke Hendrickx KW - Allergenic trees KW - Allergy risk scenarios KW - Climate change KW - Index of allergenicity KW - pollen allergy risk KW - Urban green areas KW - Urban parks AB -

Urban green spaces may improve human health and well-being. However, green spaces may also emit allergenic pollen and these may trigger asthma, allergic disease, and respiratory infections.  How allergy risks in green spaces may be modified by environmental change is still not widely understood.

This study analyzed tree inventory data of 18 urban green spaces (5940 trees; 278 taxa; 93 ha) in the Brussels Capital Region, Belgium. We investigated present tree pollen allergy risk (AR) and changes in AR driven by changes in tree species composition, allergenic potential and pollen season duration.  AR was estimated by calculating the allergenicity index IUGZA (range 0–1, 1 worst) for the present situation and 13 scenarios.

The average AR was 0.08 (SD 0.05; range 0.002–0.17). The AR increased by 11–27% in increased allergenic potential scenarios, and by 44% in the increased pollen season duration scenario. Preventive removal of birch, hazel and alder reduced the AR by 13%. The AR increased by 99–111% in combined scenarios with and without preventive removal of the main allergenic taxa.

These findings indicate that tree pollen allergy risks could considerably rise when ongoing environmental changes lead to a combination of longer pollen seasons, increased pollen allergen potency, and increased sensitization for one or more species.  The preventive removal of the main allergenic tree species cannot sufficiently counter allergy risks caused by other species and that are amplified by environmental change, highlighting the importance of careful tree species selection in urban green space policy and planning.

VL - 207 M3 - 10.1016/j.landurbplan.2020.104001 ER - TY - JOUR T1 - Heat related mortality in the two largest Belgian urban areas: A time series analysis JF - Environmental Research Y1 - 2020 A1 - Katrien De Troeyer A1 - Mariska Bauwelinck A1 - Raf Aerts A1 - Dimitrios Profer A1 - Julie Berckmans A1 - Delcloo, Andy A1 - Rafiq Hamdi A1 - Bert Van Schaeybroeck A1 - Hans Hooyberghs A1 - Dirk Lauwaet A1 - Claire Demoury A1 - An Van Nieuwenhuyse KW - Ambient temperature KW - Belgium KW - mortality KW - Short-term effect KW - Urban heat island AB -

Background

Summer temperatures are expected to increase and heat waves will occur more frequently, be longer, and be more intense as a result of global warming. A growing body of evidence indicates that increasing temperature and heatwaves are associated with excess mortality and therefore global heating may become a major public health threat. However, the heat-mortality relationship has been shown to be location-specific and differences could largely be explained by the most frequent temperature. So far, in Belgium there is little known regarding the heat-mortality relationship in the different urban areas.

Objectives

The objective of this study is to assess the heat-mortality relationship in the two largest urban areas in Belgium, i.e. Antwerp and Brussels for the warm seasons from 2002 until 2011 taking into account the effect of air pollution.

Methods

The threshold in temperature above which mortality increases was determined using segmented regressions for both urban areas. The relationship between daily temperature and mortality above the threshold was investigated using a generalized estimated equation with Poisson distribution to finally determine the percentage of deaths attributable to the effect of heat.

Results

Although only 50 km apart, the heat-mortality curves for the two urban areas are different. More specifically, an increase in mortality occurs above a maximum temperature of 25.2 °C in Antwerp and 22.8 °C in Brussels. We estimated that above these thresholds, there is an increase in mortality of 4.9% per 1 °C in Antwerp and of 3.1% in Brussels. During the study period, 1.5% of the deaths in Antwerp and 3.5% of the deaths in Brussels can be attributed to the effect of heat. The thresholds differed considerably from the most frequent temperature, particularly in Antwerp. Adjustment for air pollution attenuated the effect of temperature on mortality and this attenuation was more pronounced when adjusting for ambient ozone.

Conclusion

Our results show a significant effect of temperature on mortality above a city-specific threshold, both in Antwerp and in Brussels. These findings are important given the ongoing global warming. Recurrent, intense and longer episodes of high temperature and expected changes in air pollutant levels will have an important impact on health in urban areas.

VL - 188 M3 - 10.1016/j.envres.2020.109848 ER - TY - JOUR T1 - Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium JF - Environmental Research Y1 - 2020 A1 - Raf Aerts A1 - Sébastien Dujardin A1 - Nemery, Benoit A1 - An Van Nieuwenhuyse A1 - Jos Van Orshoven A1 - Jean-Marie Aerts A1 - Ben Somers A1 - Marijke Hendrickx A1 - Nicolas Bruffaerts A1 - Mariska Bauwelinck A1 - Casas, Lidia A1 - Claire Demoury A1 - Michelle Plusquin A1 - Tim S. Nawrot KW - Environmental epidemiology KW - medication sales KW - Pediatric asthma KW - Residential green space KW - respiratory health AB -

Background: Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous.

Objective: To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium.

Methods: Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6–12 and 13–18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region.

Results: Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15–0.17; garden, β = 0.13–0.17).  The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10–0.14; garden, β = 0.07–0.09). There was no association between OAD medication sales and forest cover.

Conclusions: Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.

VL - 189 M3 - https://doi.org/10.1016/j.envres.2020.109914 ER - TY - Generic T1 - Santé, environnement et populations susceptibles, le projet HEASP Y1 - 2020 A1 - Claire Demoury A1 - Eva M De Clercq JF - Société française de santé environnement. 17.11.2020 ER - TY - JOUR T1 - Thyroid cancer incidence near nuclear sites in Belgium: An ecological study at small geographical level. JF - Int J Cancer Y1 - 2020 A1 - Claire Demoury A1 - De Schutter, Harlinde A1 - Faes, Christel A1 - Sylviane Carbonnelle A1 - Sébastien Fierens A1 - Molenberghs, Geert A1 - Van Damme, Nancy A1 - Van Bladel, Lodewijk A1 - An Van Nieuwenhuyse A1 - Christiane Vleminckx KW - ADOLESCENT KW - Adult KW - Aged KW - Aged, 80 and over KW - Belgium KW - Child KW - Child, Preschool KW - environmental exposure KW - Female KW - Geography KW - Humans KW - incidence KW - Infant KW - Infant, Newborn KW - Iodine Radioisotopes KW - Male KW - middle aged KW - Neoplasms, Radiation-Induced KW - Nuclear Power Plants KW - Radiation, Ionizing KW - Radioactive Hazard Release KW - Thyroid Neoplasms KW - Weather KW - Young adult AB -

In Belgium, variations in thyroid cancer incidence were observed around the major nuclear sites. The present ecological study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the four nuclear sites at the smallest Belgian geographical level. Rate ratios were obtained from a Bayesian hierarchical model for areas of varying sizes around the nuclear sites. Focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. No evidence was found for more incident cases of thyroid cancer near the two nuclear power plants. Regarding the two industrial and research nuclear sites, no evidence for a higher incidence in the vicinity of Mol-Dessel was observed, whereas a slightly nonsignificant higher incidence was found in the close vicinity of Fleurus. In addition, significant gradients for thyroid cancer incidence were observed with the different types of surrogate exposure considered in the 20 km area around the site of Fleurus (decreasing distance, increasing wind direction frequency and increasing exposure to estimated hypothetical radioactive discharges of iodine-131). In the investigation at the smallest Belgian geographical level, variations in thyroid cancer incidence were found around the Belgian nuclear sites. Significant exposure-response relationships were also observed for the site of Fleurus. Further investigations into these findings could be useful to allow inferring causal relationships on the origin of variations in incidence and to provide information at the individual level.

VL - 146 CP - 11 M3 - 10.1002/ijc.32796 ER - TY - Generic T1 - The HEASP Project: Health, Environment and Susceptible Populations Y1 - 2019 A1 - Claire Demoury A1 - Raf Aerts A1 - Eva M De Clercq JF - Etats généraux de l’air de Bruxelles, Brussels, Belgium ER - TY - RPRT T1 - Monitoring Of Possible Health Effects Of Living In The Vicinity Of Nuclear Sites In Belgium II Part A Thyroid Cancer Incidence : Summary Y1 - 2019 A1 - Claire Demoury A1 - Harlinde De Schutter A1 - Christel Faes A1 - Sylviane Carbonnelle A1 - Nancy Van Damme A1 - Lodewijk Van Bladel A1 - Christiane Vleminckx KW - ecological study KW - incidence KW - Nuclear sites KW - statistical sector KW - thyroid cancer PB - Sciensano CY - Brussels, Belgium M3 - 10.25608/5853-1p91 ER - TY - RPRT T1 - Monitoring of possible health effects of living in the vicinity of nuclear sites in Belgium II Part B: childhood leukemia incidence Y1 - 2019 A1 - Claire Demoury A1 - Christel Faes A1 - Sylviane Carbonnelle A1 - Harlinde De Schutter A1 - Francart,J. A1 - Nancy Van Damme A1 - Lodewijk Van Bladel A1 - Christiane Vleminckx A1 - Eva M De Clercq ER - TY - JOUR T1 - Personal exposure to traffic-related air pollutants and relationships with respiratory symptoms and oxidative stress: A pilot cross-sectional study among urban green space workers JF - Science of The Total Environment Y1 - 2019 A1 - Ariane Guilbert A1 - Koen De Cremer A1 - Billie Heene A1 - Claire Demoury A1 - Raf Aerts A1 - Declerck, Priscilla A1 - Brasseur, Olivier A1 - An Van Nieuwenhuyse KW - Belgium KW - Black carbon KW - Health outcomes KW - Human biomonitoring KW - Polycyclic Aromatic Hydrocarbons AB -

Exposure to ambient air pollution has been associated with various adverse health effects including respiratory, cardiovascular and neurological diseases. Exposure data for some specific pollutants and settings are however still insufficient and mechanisms underlying negative health outcomes are not fully elucidated. This pilot study aimed to assess individual exposure to three traffic-related air pollutants, black carbon (BC), polycyclic aromatic hydrocarbons (PAHs) and benzene, and the relationship with respiratory and oxidative stress outcomes in a cross-sectional sample of 48 green space workers in Brussels, Belgium. Participants were followed during four consecutive working days in 2016–2017 during which their individual exposure to BC, PAHs, benzene and more generally air pollution was measured using aethalometers, urinary biomarkers (1-hydroxypyrene, 1-naphthol, 2-naphthol, S-phenylmercapturic acid) and questionnaires. Data on respiratory health and oxidative stress were collected using questionnaires and respiratory/urinary biomarkers (exhaled nitric oxide [NO], 8-hydroxydeoxyguanosine [8-OHdG]). Associations between exposure and health outcomes were investigated using comparison tests and linear regression models, after stratification by present-day smoking status. Spatial variation in BC exposure was high, with concentrations varying between 0.26 and 5.69 μg/m3. The highest levels were recorded during transport and, to a lesser extent, in green spaces located in the vicinity of roads with high traffic intensity. Concentrations of PAHs and benzene biomarkers did not systematically exceed the limits of detection. Among smokers, respiratory inflammation increased linearly with exposure to BC measured over the four days of follow-up (β = 8.73, 95% CI: 4.04, 13.41). Among non-smokers, oxidative stress increased linearly with BC measured on the fourth day (β = 2.88, 95% CI: 1.52, 4.24). Despite some limitations, this work supports the hypothesis that BC induces respiratory inflammation and oxidative stress. It also highlights the value of this compound as well as exhaled NO and urinary 8-OHdG biomarkers to detect early/mild effects of air pollution.

VL - 649 M3 - 10.1016/j.scitotenv.2018.08.338 ER - TY - JOUR T1 - Personal exposure to traffic-related air pollutants and relationships with respiratory symptoms and oxidative stress: A pilot cross-sectional study among urban green space workers. JF - Sci Total Environ Y1 - 2019 A1 - Ariane Guilbert A1 - Koen De Cremer A1 - Billie Heene A1 - Claire Demoury A1 - Raf Aerts A1 - Declerck, Priscilla A1 - Brasseur, Olivier A1 - An Van Nieuwenhuyse KW - Air Pollutants KW - Belgium KW - benzene KW - Cities KW - cross-sectional studies KW - environmental exposure KW - Environmental Monitoring KW - Humans KW - Inflammation KW - Oxidative Stress KW - Pilot Projects KW - Polycyclic Aromatic Hydrocarbons KW - Respiratory System KW - Soot KW - Urban Population KW - Vehicle Emissions AB -

Exposure to ambient air pollution has been associated with various adverse health effects including respiratory, cardiovascular and neurological diseases. Exposure data for some specific pollutants and settings are however still insufficient and mechanisms underlying negative health outcomes are not fully elucidated. This pilot study aimed to assess individual exposure to three traffic-related air pollutants, black carbon (BC), polycyclic aromatic hydrocarbons (PAHs) and benzene, and the relationship with respiratory and oxidative stress outcomes in a cross-sectional sample of 48 green space workers in Brussels, Belgium. Participants were followed during four consecutive working days in 2016-2017 during which their individual exposure to BC, PAHs, benzene and more generally air pollution was measured using aethalometers, urinary biomarkers (1-hydroxypyrene, 1-naphthol, 2-naphthol, S-phenylmercapturic acid) and questionnaires. Data on respiratory health and oxidative stress were collected using questionnaires and respiratory/urinary biomarkers (exhaled nitric oxide [NO], 8-hydroxydeoxyguanosine [8-OHdG]). Associations between exposure and health outcomes were investigated using comparison tests and linear regression models, after stratification by present-day smoking status. Spatial variation in BC exposure was high, with concentrations varying between 0.26 and 5.69 μg/m. The highest levels were recorded during transport and, to a lesser extent, in green spaces located in the vicinity of roads with high traffic intensity. Concentrations of PAHs and benzene biomarkers did not systematically exceed the limits of detection. Among smokers, respiratory inflammation increased linearly with exposure to BC measured over the four days of follow-up (β = 8.73, 95% CI: 4.04, 13.41). Among non-smokers, oxidative stress increased linearly with BC measured on the fourth day (β = 2.88, 95% CI: 1.52, 4.24). Despite some limitations, this work supports the hypothesis that BC induces respiratory inflammation and oxidative stress. It also highlights the value of this compound as well as exhaled NO and urinary 8-OHdG biomarkers to detect early/mild effects of air pollution.

VL - 649 M3 - 10.1016/j.scitotenv.2018.08.338 ER - TY - JOUR T1 - Thyroid cancer incidence near nuclear sites in Belgium: An ecological study at small geographical level JF - International Journal of Cancer Y1 - 2019 A1 - Claire Demoury A1 - De Schutter, Harlinde A1 - Faes, Christel A1 - Sylviane Carbonnelle A1 - Sébastien Fierens A1 - Molenberghs, Geert A1 - Van Damme, Nancy A1 - Van Bladel, Lodewijk A1 - An Van Nieuwenhuyse A1 - Christiane Vleminckx KW - ecological study KW - incidence KW - Nuclear sites KW - statistical sector KW - thyroid cancer AB -

In Belgium, variations in thyroid cancer incidence were observed around the major nuclear sites. The present ecological study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the four nuclear sites at the smallest Belgian geographical level. Rate ratios were obtained from a Bayesian hierarchical model for areas of varying sizes around the nuclear sites. Focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. No evidence was found for more incident cases of thyroid cancer near the two nuclear power plants. Regarding the two industrial and research nuclear sites, no evidence for a higher incidence in the vicinity of Mol‐Dessel was observed, whereas a slightly nonsignificant higher incidence was found in the close vicinity of Fleurus. In addition, significant gradients for thyroid cancer incidence were observed with the different types of surrogate exposure considered in the 20 km area around the site of Fleurus (decreasing distance, increasing wind direction frequency and increasing exposure to estimated hypothetical radioactive discharges of iodine‐131). In the investigation at the smallest Belgian geographical level, variations in thyroid cancer incidence were found around the Belgian nuclear sites. Significant exposure–response relationships were also observed for the site of Fleurus. Further investigations into these findings could be useful to allow inferring causal relationships on the origin of variations in incidence and to provide information at the individual level.

M3 - 10.1002/ijc.32796 ER - TY - RPRT T1 - Analyse des données sur l’allergie en Région de Bruxelles-Capitale - Exploitation de quatre bases de données relatives à la morbidité et la mortalité associées à l’asthme et la rhinite allergique. Y1 - 2017 A1 - Ariane Guilbert A1 - Koen Simons A1 - Raf Aerts A1 - Claire Demoury A1 - Michele Rasoloharimahefa A1 - Koen De Cremer A1 - Nicolas Bruffaerts A1 - Lucie Hoebeke A1 - Ann Packeu A1 - Marijke Hendrickx A1 - Bianca Cox A1 - Sophie Viart A1 - Charles Pilette A1 - An Van Nieuwenhuyse KW - asthme KW - bases de données KW - Bruxelles KW - épidémiologie KW - hospitalisations KW - médicaments KW - mortalité KW - rhinite allergique PB - WIV-ISP CY - Bruxelles, Belgique ER - TY - RPRT T1 - Evaluation d’impact de l’exposition à la pollution émise par le trafic routier sur la santé de la population bruxelloise : projet pilote pour les personnes à faible et haut niveau d’exposition. Y1 - 2017 A1 - Ariane Guilbert A1 - Koen De Cremer A1 - Raf Aerts A1 - Claire Demoury A1 - An Van Nieuwenhuyse KW - biomonitoring KW - Bruxelles KW - épidémiologie KW - pollution de l’air KW - santé PB - WIV-ISP CY - Bruxelles, Belgique ER - TY - JOUR T1 - Thyroid Cancer Incidence around the Belgian Nuclear Sites, 2000-2014. JF - Int J Environ Res Public Health Y1 - 2017 A1 - Claire Demoury A1 - De Smedt, Tom A1 - De Schutter, Harlinde A1 - Sonck, Michel A1 - Van Damme, Nancy A1 - Bollaerts, Kaatje A1 - Molenberghs, Geert A1 - Van Bladel, Lodewijk A1 - Van Nieuwenhuyse, An KW - ADOLESCENT KW - Adult KW - Age factors KW - Aged KW - Aged, 80 and over KW - Belgium KW - Child KW - Child, Preschool KW - Female KW - Geography KW - Humans KW - incidence KW - Infant KW - Infant, Newborn KW - Male KW - middle aged KW - Nuclear Power Plants KW - sex factors KW - Thyroid Neoplasms KW - Young adult AB -

The present study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the nuclear sites in Belgium. Adjusted Rate Ratios were obtained from Poisson regressions for proximity areas of varying sizes. In addition, focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. Residential proximity to the nuclear site, prevailing dominant winds frequency from the site, and simulated radioactive discharges were used as surrogate exposures. No excess incidence of thyroid cancer was observed around the nuclear power plants of Doel or Tihange. In contrast, increases in thyroid cancer incidence were found around the nuclear sites of Mol-Dessel and Fleurus; risk ratios were borderline not significant. For Mol-Dessel, there was evidence for a gradient in thyroid cancer incidence with increased proximity, prevailing winds, and simulated radioactive discharges. For Fleurus, a gradient was observed with increasing prevailing winds and, to a lesser extent, with increasing simulated radioactive discharges. This study strengthens earlier findings and suggests increased incidences in thyroid cancer around two of the four Belgian nuclear sites. Further analyses will be performed at a more detailed geographical level.

VL - 14 CP - 9 U1 - https://www.ncbi.nlm.nih.gov/pubmed/28858225?dopt=Abstract M3 - 10.3390/ijerph14090988 ER -