TY - JOUR T1 - Assessing the benefits of hypothetical air pollution reduction interventions on stroke in Belgium JF - European Journal of Public Health Y1 - 2023 A1 - Ingrid Pelgrims A1 - Brecht Devleesschauwer A1 - Stefanie Vandevijvere A1 - Eva M De Clercq A1 - Vanessa Gorasso A1 - Johan Van der Heyden A1 - Stijn Vansteelandt KW - air pollution KW - g-computation KW - Stroke AB -
Abstract
Background
The adverse health impact of air pollution exposure on stroke is already well documented but there is a lack of methodological tools to provide actionable evidence on the potential health benefits of realistic interventions. This study demonstrates the use of a parametric g-computation approach to evaluate the impact of hypothetical interventions targeting long-term exposure to air pollution on reducing the stroke prevalence in Belgium using data from three national Health Interview surveys (BHIS 2008-2013-2018).
Methods
BHIS data (n = 27536) were linked to environmental data of the participant's residential address. A g-computation approach was used to calculate the potential impact fractions of five air pollution reduction interventions to decrease the prevalence of stroke. Regression models were adjusted for socio-economic, environmental and lifestyle factors. In the first and second scenario, the average annual exposure to PM2.5 was lowered to the WHO guideline (5 μg/m3) and reduced by 25%, respectively. In the third and fourth scenario, the average annual exposure to NO2 was lowered to the WHO guideline (10 μg/m3) and reduced by 25%, respectively. In the last scenario, the average annual exposure to BC was reduced by 25%.
Results
Stroke was significantly associated with all air pollutants. A reduction in the risk of stroke was observed under the five scenarios: -0.87% [SE:0.24], -0.47% [SE: 0.17], -0.32% [SE: 0.19], -0.16% [SE:0.10], -0.13 % [SE: 0.07]. The proportion of prevented stroke cases would be respectively of 65.5%, 35.4%, 23.9%, 12.3%, 10%.
Conclusions
This study highlights the importance of air pollution on the stroke burden and demonstrates that air pollution reduction interventions could decrease the prevalence of stroke in Belgium.
Key messages
• Air pollution reduction interventions could significantly decrease the prevalence of stroke in Belgium.
• Major benefits were observed for interventions targeting long-term exposure to PM2.5.
VL - 33 CP - Supplement_2 M3 - https://doi.org/10.1093/eurpub/ckad160.031 ER - TY - JOUR T1 - Potential impact fractions of body mass index reductions on the non-communicable disease burden in Belgium using G-computation JF - Population Medicine. 2023;5(Supplement):. doi:10.18332/popmed/165603. Y1 - 2023 A1 - Ingrid Pelgrims A1 - Eva M De Clercq A1 - Brecht Devleesschauwer A1 - Stefanie Vandevijvere A1 - Vanessa Gorasso A1 - Johan Van der Heyden A1 - Stijn Vansteelandt AB -Background: Overweight is the fourth most common risk factor for noncommunicable diseases (NCDs) in Europe, affecting almost 60% of all adults. In Belgium, as in many high-income countries, average body mass index (BMI) has significantly increased over the past decades. Tackling obesity is therefore vital to reduce premature mortality from NCDs. This study aims to assess the relative contribution of overweight as a risk factor for NCDs and the potential health impact of four BMI reduction scenarios in the Belgian adult population. Methods: Data from the Belgian health interview surveys 2013/2018 (n=18 212) were linked with objective environmental factors based on the residential address. Self-reported BMI and diabetes were corrected based on information from the 2018 Belgian health examination survey and a random-forest multiple imputation process. A G-computation approach was used to calculate the potential impact fractions of four BMI reduction scenarios on diabetes prevalence. The logistic regression model included several confounders related to socio-economic factors, lifestyle and environment. In the first scenario, the BMI distribution among people with overweight was shifted to the BMI distribution of people with “normal” BMI. In the second scenario, the BMI of people with overweight was reduced by one unit. In the third and fourth scenarios, the BMI of people with overweight was modified based on a weight loss of 5 and 10%, respectively. Results: Under the four scenarios, the proportion of diabetes cases prevented would be respectively 29.9% (SE 4.7), 4.2% (SE 0.77), 6.43% (SE 1.48), and 12.5% (SE 2.2). Conclusions: This study highlights the importance of overweight on the diabetes burden. Our results suggest that weight loss intervention programs among people with overweight could significantly reduce the prevalence of diabetes in the Belgian population. Further analyses will be performed for other NCDs and using a larger set of scenarios.
VL - 5 CP - Supplement M3 - https://doi.org/10.18332/popmed/165603 ER - TY - JOUR T1 - Association between urban environment and mental health in Brussels, Belgium JF - BMC Public Health Y1 - 2021 A1 - Ingrid Pelgrims A1 - Brecht Devleesschauwer A1 - Madeleine Guyot A1 - Keune, Hans A1 - Tim S. Nawrot A1 - Roy Remmen A1 - Nelly D. Saenen A1 - Sonia Trabelsi A1 - Isabelle Thomas A1 - Raf Aerts A1 - Eva M De Clercq KW - air pollution KW - Building morphology KW - Environmental epidemiology KW - Green space KW - Mental health KW - noise AB -Background: Mental health disorders appear as a growing problem in urban areas. While common mental health disorders are generally linked to demographic and socioeconomic factors, little is known about the interaction with the urban environment. With growing urbanization, more and more people are exposed to environmental stressors potentially contributing to increased stress and impairing mental health. It is therefore important to identify features of the urban environment that affect the mental health of city dwellers. The aim of this study was to define associations of combined long-term exposure to air pollution, noise, surrounding green at different scales, and building morphology with several dimensions of mental health in Brussels. Methods: Research focuses on the inhabitants of the Brussels Capital Region older than 15 years. The epidemiological study was carried out based on the linkage of data from the national health interview surveys (2008 and 2013) and specifically developed indicators describing each participant’s surroundings in terms of air quality, noise, surrounding green, and building morphology. These data are based on the geographical coordinates of the participant’s residence and processed using Geographical Information Systems (GIS). Mental health status was approached through several validated indicators: the Symptom Checklist-90-R subscales for depressive, anxiety and sleeping disorders and the 12-Item General Health Questionnaire for general well-being. For each mental health outcome, single and multi-exposure models were performed through multivariate logistic regressions. Results: Our results suggest that traffic-related air pollution (black carbon, NO2, PM10) exposure was positively associated with higher odds of depressive disorders. No association between green surrounding, noise, building morphology and mental health could be demonstrated. Conclusions: These findings have important implications because most of the Brussel’s population resides in areas where particulate matters concentrations are above the World Health Organization guidelines. This suggests that policies aiming to reduce traffic related-air pollution could also reduce the burden of depressive disorders in Brussels
VL - 21 CP - 1 M3 - 10.1186/s12889-021-10557-7 ER - TY - JOUR T1 - Exploring how the urban neighborhood environment influences mental well-being using walking interviews JF - Health & Place Y1 - 2021 A1 - Laura Lauwers A1 - Michael Leone A1 - Madeleine Guyot A1 - Ingrid Pelgrims A1 - Roy Remmen A1 - Kris Van den Broeck A1 - Keune, Hans A1 - Hilde Bastiaens AB -Mental well-being in cities is being challenged worldwide and a more detailed understanding of how urban environments influence mental well-being is needed. This qualitative study explores neighborhood factors and their interactions in relation to mental well-being. Individual semi-structured walking interviews were conducted with 28 adults living in the Brussels-Capital Region. This paper provides a detailed description of physical neighborhood factors (green-blue spaces, services, design and maintenance, traffic, cellphone towers) and social neighborhood factors (neighbor ties, neighbor diversity, social security) that link to mental well-being. A socioecological framework is presented to explain interactions among those neighborhood factors, and personal and institutional factors, in relation to mental well-being. The findings are linked to existing concepts and theories to better understand the mechanisms underlying the associations between the urban neighborhood environment and mental well-being. Finally, implications of the walking interview method are discussed.
VL - 67 M3 - 10.1016/j.healthplace.2020.102497 ER - TY - Generic T1 - Validity of self-reported data to assess the prevalence of overweight, hypertension and cholesterol Y1 - 2021 A1 - Ingrid Pelgrims A1 - Brecht Devleesschauwer A1 - Kris Doggen A1 - Stefanie Vandevijvere A1 - Eva M De Clercq A1 - S Vansteelandt A1 - Johan Van der Heyden AB -Background
Accurate data on the risk factors of non-communicable diseases is essential to build evidence-based prevention programs. In Belgium, this is assessed through self-reported (SR) data from the Belgian health interview surveys (BHIS) in a wide population sample or through objective measures from small-scale surveys (such as the Belgian health examination survey [BHES]). It has been shown, however, that relying on SR data leads to a prevalence underestimation. The objective of this study is to assess the agreement between SR and measured overweight, hypertension and high cholesterol and to provide information to do a valid correction for measurement error.
Methods
The BHIS/BHES 2018 database was used (n = 1184). Kappa coefficient was used to assess the agreement between SR and measured hypertension (systolic BP > 140 mmHg, diastolic BP > 90 mmHg, or reported use of medication for hypertension) and ICC was used to assess the agreement between SR and measured BMI. SR high cholesterol was compared to a measured total serum cholesterol >190 mg/dl.
Results
Risk factor prevalence based on SR data is severely underestimated. The agreement between SR and measured data is high for BMI (ICC: 0.92), moderate for hypertension (Kappa: 0.49) and poor for cholesterol (Kappa: 0.05). Using SR data, 45% of the people with a measured hypertension and 22% of the people with a measured high cholesterol are detected. With regressions based on the SR risk factor, age, sex and education, the measured BMI and hypertension can be predicted with a good accuracy (BMI: R2: 87%, HBP: AUC: 86%). A lower accuracy is observed for the cholesterol model (AUC: 65%). Using predicted values instead of SR data yields higher estimates of people suffering from overweight (+8% relative increase), obesity (+12%), hypertension (+24%) and cholesterol (+36%).
Conclusions
Using SR data yields to an underestimation of the prevalence of obesity, hypertension and high cholesterol in Belgium
Key messages
Relying on SR data to assess the prevalence of overweight, hypertension and high cholesterol requires a correction for measurement error.
Using the predicted values from regression models based on the SR risk factor, age, sex and education, yields higher estimates of people suffering from overweight, hypertension and cholesterol.
JF - European Journal of Public Health VL - 31 CP - Supplement_3 M3 - 10.1093/eurpub/ckab164.750 ER - TY - Generic T1 - Contribution relative de la surcharge pondérale comme facteur de risque des maladies non-transmissibles dans un contexte multi-expositionnel : le projet WaIST Y1 - 2020 A1 - Ingrid Pelgrims A1 - Vanessa Gorasso A1 - Delphine Desmedt A1 - Kris Doggen A1 - Johan Van der Heyden A1 - Stefanie Vandevijvere A1 - Stijn Vansteelandt A1 - Brecht Devleesschauwer A1 - Eva M De Clercq AB -Contexte
Les maladies non transmissibles (MNT) représentent une grande partie de la charge de morbidité dans le monde et en Belgique. La prévention des MNT représente donc un objectif politique majeur au niveau national et international. Les mécanismes qui contribuent au développement des MNT sont multiples et incluent des facteurs non modifiables, métaboliques, comportementaux et environnementaux. La surcharge pondérale représente un des principaux facteurs de risque métabolique des MNT. En Belgique, comme dans de nombreux pays industrialisés, la moyenne de l’indice de masse corporelle n’a cessé d’augmenter ces dernières décennies. Par ailleurs, la pollution environnementale et son impact sur la santé représente un enjeu de santé publique grandissant à l’échelle mondiale. L’objectif du projet WaIST est d’évaluer la contribution relative de la surcharge pondérale comme facteur de risque des MNT en Belgique dans un contexte multi-expositionnel.
Méthode
Les données des enquêtes nationales de santé seront couplées avec les données de cause de décès ainsi que des indicateurs décrivant l’environnement de chaque participant en terme de qualité de l’air, d’espace vert et de bruit (grâce aux coordonnées géographiques de l’adresse de résidence et via un Système d’Information Géographique). Les indicateurs de santé analysés seront la multimorbidité, le handicap et la mortalité pour cause spécifique.
Une méthode statistique, basée sur les modèles d’attribution, sera développée afin de pouvoir étudier la contribution relative de plusieurs facteurs de risque d’une maladie, en tenant compte des effets d’interaction et de médiation entre ces facteurs.
Résultats
Les résultats permettront d’évaluer la contribution relative de la surcharge pondérale comme facteur de risque des MNT en Belgique dans un contexte multi-expositionnel, ainsi que son évolution dans le temps.
Conclusion
En mesurant l’impact sociétal de la surcharge pondérale en Belgique, les conclusions de l’étude permettront de placer la surcharge pondérale au cœur de cible des futures politiques de santé.
JF - Multi-exposition conditions de vie et santé PB - Société Francophone Santé et Environnement CY - Lille, France ER - TY - JOUR T1 - Urban environment and mental health: the NAMED project, protocol for a mixed-method study. JF - BMJ Open Y1 - 2020 A1 - Laura Lauwers A1 - Sonia Trabelsi A1 - Ingrid Pelgrims A1 - Hilde Bastiaens A1 - Eva M De Clercq A1 - Ariane Guilbert A1 - Madeleine Guyot A1 - Michael Leone A1 - Nawrot, Tim A1 - An Van Nieuwenhuyse A1 - Roy Remmen A1 - Nelly Saenen A1 - Isabelle Thomas A1 - Keune, Hans KW - air pollution KW - Belgium KW - Cities KW - Environment Design KW - Humans KW - Mental health KW - noise KW - Research Design KW - Residence Characteristics KW - social class KW - Social Environment KW - Urban Health KW - Urban Population AB -INTRODUCTION: Mental health issues appear as a growing problem in modern societies and tend to be more frequent in big cities. Where increased evidence exists for positive links between nature and mental health, associations between urban environment characteristics and mental health are still not well understood. These associations are highly complex and require an interdisciplinary and integrated research approach to cover the broad range of mitigating factors. This article presents the study protocol of a project called Nature Impact on Mental Health Distribution that aims to generate a comprehensive understanding of associations between mental health and the urban residential environment.
METHODS AND ANALYSIS: Following a mixed-method approach, this project combines quantitative and qualitative research. In the quantitative part, we analyse among the Brussels urban population associations between the urban residential environment and mental health, taking respondents' socioeconomic status and physical health into account. Mental health is determined by the mental health indicators in the national Health Interview Survey (HIS). The urban residential environment is described by subjective indicators for the participant's dwelling and neighbourhood present in the HIS and objective indicators for buildings, network infrastructure and green environment developed for the purpose of this project. We assess the mediating role of physical activity, social life, noise and air pollution. In the qualitative part, we conduct walking interviews with Brussels residents to record their subjective well-being in association with their neighbourhood. In the validation part, results from these two approaches are triangulated and evaluated through interviews and focus groups with stakeholders of healthcare and urban planning sectors.
ETHICS AND DISSEMINATION: The Privacy Commission of Belgium and ethical committee from University Hospital of Antwerp respectively approved quantitative database merging and qualitative interviewing. We will share project results with a wide audience including the scientific community, policy authorities and civil society through scientific and non-expert communication.
VL - 10 CP - 2 M3 - 10.1136/bmjopen-2019-031963 ER - TY - Generic T1 - Validity of air pollution annoyance to assess long-term exposure to air pollution in Belgium Y1 - 2020 A1 - Ingrid Pelgrims A1 - Bastiaens, H A1 - Brecht Devleesschauwer A1 - Hans Keune A1 - T Nawrot A1 - R Remmen A1 - Nelly D Saenen A1 - M Guyot A1 - Eva M De Clercq AB -Background
In environmental epidemiology, air pollution exposure is often estimated at the population level. To avoid the risk of exposure misclassification, one possibility is to interpolate air pollution measures at the residence through a Geographical Information Systems. However, this might imply cumbersome administrative procedures. Data on air pollution annoyance from surveys can be an alternative to assess individual exposure to air pollution. This research investigates the association between air pollution annoyance and individual air pollution exposure.
Methods
Analyses were carried out based on a linkage of data from the Belgian Health Interview Survey (HIS 2009 and 2013; >15 years ; n = 9347) and annual means of air pollution concentration at the residence. Self-reported air pollution annoyance was assessed through a five-point Likert scale. Statistical analyses included Spearman correlation coefficient, analysis of variance and multivariable ordinal logistic regressions (OLR).
Results
A significant exposure-response relationship was observed between long term air pollution exposure and self-reported air pollution annoyance. However, Spearman coefficients were low (0.18-0.24), meaning a high heterogeneity of annoyance levels for a given exposure. In multivariable OLR, the odds of being annoyed by air pollution was 2.10 [CI 95% : 1.86-2.67] times higher for each Interquartile range (IQR) increase in NO2 concentration (PM2.5 ; 1.77 [CI 95% : 1.53-2.07], PM10 ; 1.61 (95% CI : 1.33-1.67), black carbon ; 1.45 [95% CI : 1.27-1.67]). Air pollution annoyance depended largely on individual factors especially health status.
Conclusions
Air pollution exposure has a significant influence on self-reported air pollution annoyance. However, many other factors were found to influence annoyance, independently of the exposure. We found a limited validity of self-reported air pollution annoyance to assess individual long term exposure to air pollution.
Main messages
Significant exposure-response relationship between individual long-term air pollution exposure and self-reported air pollution annoyance
Limited validity of self-reported air pollution annoyance for assessing individual long term exposure to air pollution
JF - European Journal of Public Health VL - 30 CP - Supplement_5 M3 - 10.1093/eurpub/ckaa166.088 ER - TY - Generic T1 - Disentangling the Link between Built/Non-Built Environment and Mental Health in Brussels Y1 - 2019 A1 - Ingrid Pelgrims A1 - Brecht Devleesschauwer A1 - Hans Keune A1 - Hilde Bastiaens A1 - Roy Remmen A1 - Tim Nawrot A1 - Sonia Trabelsi A1 - Madeleine Guyot A1 - Laura Lauwers A1 - Eva M De Clercq AB -Introduction
Mental illnesses are a growing problem in modern societies. While the impact of demographic or socioeconomic factors on these pathologies is acknowledged, the interaction with urbanized environment is little understood. This quantitative research is part of the interdisciplinary study “NAMED” which aim to investigate the impact of the (non-)built environment on mental health in Belgium, one of the most urbanized countries in Europe.
Methods
Research focuses on the inhabitants of Brussels and older than 15 years. The epidemiological study was carried out based on the coupling between data from the national health surveys (2009 and 2013) and specifically developed indicators describing each participant's surroundings in terms of (non-)built environment, air quality and noise. These data are based on the X,Y coordinates of the participant’s residence and processed using Geographical Information Systems (GIS).
Participant’s mental health was approached through different indicators from validated questionnaires (GHQ, SF36 vitality scale, etc.) and isolated variables (reported depression, suicidal ideation).
Multiple logistic regression models were run for each environmental indicator and mental health outcome, taking into account socio-economic factors.
Results
Adjusted measures of association between mental health and environmental indicators will be presented at three levels : the residential level (view of green, garden coverage, building characteristics), the street level (vegetation coverage, tree density, canyon/corridor effect) and the neighborhood level (green coverage with a buffer of 600 and 1km, typology of urban intensity). Same results will be provided for air quality/noise and subjective measures of the environment.
Discussion
The results permit to better understand the impact of urban environment on mental health and to formulate concrete, evidence-based policy regarding public health, urban planning and green space management.
JF - Cosmopolis: les Etats généraux de l'air ER -