1 2008 Vol: 7(1):8. DOI: 10.1186/1476-069X-7-8

Mortality and life expectancy of Yokkaichi Asthma patients, Japan: Late effects of air pollution in 1960–70s

The incidence of chronic obstructive pulmonary disease (COPD) and bronchial asthma began increasing in early 1960s in the population of Yokkaichi-city (Mie Prefecture, Japan). The cause of the disease was sulfur oxide air pollution, and it is known as Yokkaichi Asthma. The pollution markedly decreased by the end of 1970s; no new cases have been reported since 1988. This study aimed at examining the late effects of air pollution on the health of Yokkaichi Asthma patients. Mortality rate and life expectancy of patients, registered between 1965 and 1988, were investigated from 1975 through 2000. Mortality rates for COPD and asthma in patients from Yokkaichi-city were significantly higher than in the whole population of Mie Prefecture. For all ages (except for males between 80 and 84 years in 1985), the life expectancy of both males and females were significantly reduced in patients from Yokkaichi-city as compared with the whole population of Mie Prefecture. The potential gains in life expectancy excluding the mortality for respiratory diseases including COPD and asthma were larger for all ages in patients from Yokkaichi-city. Mortality and life expectancy were adversely affected in patients from Yokkaichi-city, despite the fact that the air pollution problem has been already solved.

Mentions
Figures
Figure 1: Age-adjusted mortality rates in Yokkaichi Asthma patients and in the whole population of Mie Prefecture. Per 100,000 population. Closed = patients, open = Mie Prefecture. COPD = chronic bronchitis and pulmonary emphysema. *p < 0.05. Figure 2: Life expectancy for Yokkaichi Asthma patients and whole population of Mie Prefecture. Average with standard error of mean (SEM). SEM was less than 0.04–0.19 years for Mie Prefecture. Closed = patients, open = Mie Prefecture. Significantly different (p < 0.05) between Yokkaichi patients and Mie population for all age subgroups except for males aged 80–84 years in 1985 (t-test). Figure 3: Differences in life expectancy (years) between Yokkaichi patients and Mie Prefecture. Blanks = unable to calculate because of no deaths.
Altmetric
References
  1. Yokkaichi Environment Division Link Accessed May 29, 2007 , .
    • . . . Sulfur oxide air pollution in this region has been markedly reduced and the pollution reached the same level as that in un-polluted areas by the end of 1970s; atmospheric sulfur oxide level is now below 0.01 ppm in the Yokkaichi area 1 . . .
  2. K Yoshida; K Morio; K Yokoyama Epidemiology and environmental pollution: a lesson from Yokkaichi Asthma, Japan Progress in Environmental Research , 263-278 (2007) .
    • . . . Recently, a historical review of Yokkaichi pollution problem has been published 2. . . .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  3. M Imai; H Oshima; Y Takatsuka; K Yoshida On the Yokkaichi-asthma Nippon Eiseigaku Zasshi 22, 323-335 (1967) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . However, monthly prevalence of respiratory disease during the period from 1962–65 was significantly correlated with the corresponding values of SO2as well as with the amount of dust fall in the Yokkaichi area, although the level of total SP and dust fall in this area were reported to be low 38 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  4. M Imai; H Oshima; T Kawagishi; K Yoshida; M Kitabatake Epidemiological studies on patients in relation to air pollution in Yokkaichi Nippon Eiseigaku Zasshi 26, 386-393 (1971) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
    • . . . Increase in cardiovascular mortality has not been demonstrated in the registered patients of Yokkaichi Asthma 4910 . . .
  5. M Imai; H Oshima; T Kawagishi; K Yoshida; K Kitabatake Air pollution and respiratory diseases in Yokkaichi City Nippon Eiseigaku Zasshi 28, 347-357 (1973) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  6. M Imai; K Yoshida; Y Tomita; K Kasama; M Kitabatake Air pollution levels and death from chronic obstructive lung diseases in Yokkaichi Nippon Eiseigaku Zasshi 36, 671-677 (1981) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  7. M Imai; K Yoshida; Y Tomita; K Kasama; M Kitabatake A clinico-epidemiological investigations of bronchial asthma in Yokkaichi Nippon Eiseigaku Zasshi 37, 722-728 (1982) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  8. M Imai; K Yoshida; M Kitabatake Mortality from asthma and chronic bronchitis associated with changes in sulfur oxides air pollution Archives of Environmental Health 41, 29-35 (1986) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . Also, Imai et al 8 observed that, during the period of 1963–82, the mortality due to chronic bronchitis was 0.82, 4.60, and 57.72 per 100,000 population between ages of 40–49, 50–59, and 60-years, respectively, in polluted areas of Yokkaichi-city, whereas it was 2.22, 1.51, and 33.82, respectively, in un-polluted areas. . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
    • . . . However, monthly prevalence of respiratory disease during the period from 1962–65 was significantly correlated with the corresponding values of SO2as well as with the amount of dust fall in the Yokkaichi area, although the level of total SP and dust fall in this area were reported to be low 38 . . .
    • . . . It had been suspected that low pH value of dust contributed to Yokkaichi Asthma problems 838. . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  9. M Kitabatake; H Manjurul; FY Piao; S Murase; T Yamauchi Trends of air pollution versus those of consultation rate and mortality rate for bronchial asthma in individuals aged 40 years and above in the Yokkaichi region Nippon Eiseigaku Zasshi 50, 737-747 (1995) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
    • . . . Increase in cardiovascular mortality has not been demonstrated in the registered patients of Yokkaichi Asthma 4910 . . .
  10. M Kitabatake; FY Piao; S Murase; T Yamauchi Remission and recurrence of chronic obstructive lung disease in air pollution caused lung disease patients in the Yokkaichi area [in Japanese] Japanese Journal of Public Health 42, 171-186 (1995) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
    • . . . Increase in cardiovascular mortality has not been demonstrated in the registered patients of Yokkaichi Asthma 4910 . . .
  11. H Oshima; M Imai; T Kawagishi Air pollution and mortality in Yokkaichi Area Nippon Eiseigaku Zasshi 26, 371-376 (1971) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  12. K Yoshida; H Oshima; M Imai Air pollution and asthma in Yokkaichi Archives of Environmental Health 13, 763-768 (1966) .
    • . . . Many investigators of Mie University 23456789101112 published a bulk of reports regarding health problems among residents of Yokkaichi-city up to 1990 . . .
    • . . . For example, using British Medical Research Council questionnaires, Yoshida et al 12 examined inhabitants over 40 years of age in six districts of Yokkaichi-city and reported that 5–10% of the population living in the polluted areas suffered from chronic bronchitis and obstructive diseases whereas less than 3% suffered from the same diseases in un-polluted areas . . .
    • . . . By contrast, no increased cardiovascular mortality has been observed in residents of Yokkaichi11 where elevated mortality for COPD and asthma has been reported 23456789101112 . . .
  13. LJ Folinsbee Human health effects of air pollution Environmental Health Perspectives 100, 45-56 (1993) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
  14. HE Wichmann; J Heinrich Health effects of high level exposure to traditional pollutants in East Germany-Review and ongoing research Environmental Health Perspectives 103, 29-35 (1995) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
  15. B Brunekreef; DW Dockery; M Krzyzanowski Epidemiologic studies on short-term effects of low levels of major ambient air pollution components Environmental Health Perspectives 103, 3-13 (1995) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
  16. B Brunekreef; ST Holgate Air pollution and health Lancet 360, 1233-1242 (2002) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . Evidence has also shown that SP may exert adverse effects on health without high level of SO2 161820 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
  17. K Katsouyanni Ambient air pollution and health British Medical Bulletin 68, 143-156 (2003) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
    • . . . It has been demonstrated that SO2 causes increased cardiovascular mortality 171939 and hospital admission rate 194041 . . .
  18. S Vedal; M Brauer; R White; J Petkau Air pollution and daily mortality in a city with low levels of pollution Environmental Health Perspectives 111, 45-51 (2003) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . Evidence has also shown that SP may exert adverse effects on health without high level of SO2 161820 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
  19. SA Venners; BY Wang; ZG Peng; Y Xu; LH Wang; XP Xu Particulate matter, sulfur dioxide, and daily mortality in Chongqing, China Environmental Health Perspectives 111, 562-567 (2003) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
    • . . . It has been demonstrated that SO2 causes increased cardiovascular mortality 171939 and hospital admission rate 194041 . . .
  20. D Schwela Air pollution and health in urban areas Reviews on Environmental Health 15, 13-42 (2000) .
    • . . . It has been frequently documented that, as a traditional pollutants, both SO2 and suspended particulate (SP) usually occur together, representing a complex mixture produced by fossil fuel (especially coal) consumption 1314151617181920 . . .
    • . . . Evidence has also shown that SP may exert adverse effects on health without high level of SO2 161820 . . .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
  21. B Brunekreef Air pollution and life expectancy: is there a relation? Occup Environ Med 54, 781-784 (1997) .
    • . . . Also, life expectancy of the patients was assessed, because this is one approach to assess health effects of air pollution 212223. . . .
    • . . . Decrease of 1.51 year was reported in Dutch men 21, 1.34–1.69 years in Shanghai 22, and 2.5–3.1 years in US population 36 . . .
  22. HD Kan; BH Chen Impact of long-term exposure to air particulate matter on life expectancy and survival rate of Shanghai residents Biomed Environ Sci 15, 209-214 (2002) .
    • . . . Also, life expectancy of the patients was assessed, because this is one approach to assess health effects of air pollution 212223. . . .
    • . . . Decrease of 1.51 year was reported in Dutch men 21, 1.34–1.69 years in Shanghai 22, and 2.5–3.1 years in US population 36 . . .
  23. Group Mizushina-Kyodo General Hospital Research on the deceased victims of air pollution , (2005) .
    • . . . Also, life expectancy of the patients was assessed, because this is one approach to assess health effects of air pollution 212223. . . .
    • . . . Patients from Kurashiki-city, Japan, that suffered from respiratory diseases due to air pollution, have reported life expectancy of 5.1 and 7.3 years (males and females) shorter than the general Japanese population 23 . . .
  24. Department of Health and Welfare, Mie Prefecture Annual Report on Health Statistics 1973–2002 [in Japanese] Department of Health and Welfare, Mie Prefecture 1975 Annual Report on Health Statistics 1973&#x2013;2002 [in Japanese] , (1975) .
    • . . . Records of 1,232 patients [survival 518 (243 males and 275 females), death 714 (410 males and 304 females, on December 30, 2002)] registered after 1973 were used for the analysis and to compare with the whole population of Mie Prefecture, where the mortality data are available since 1973 2425. . . .
  25. Statistics of Mie Prefecture: Link Accessed May 29, 2007 , .
    • . . . Records of 1,232 patients [survival 518 (243 males and 275 females), death 714 (410 males and 304 females, on December 30, 2002)] registered after 1973 were used for the analysis and to compare with the whole population of Mie Prefecture, where the mortality data are available since 1973 2425. . . .
    • . . . The population of Mie Prefecture was 1,514,467 (male 727,802; female 786,665), 1,626,002 (male 787,280; female 838,722), 1,747,311 (male 847,420; female 899,891) and 179,2514 (male 869,515; female 922,999), in 1965, 1975, 1985 and 1990, respectively 25. . . .
    • . . . By the same method, the life expectancy of the whole population of Mie prefecture was calculated based on data of Mie Prefecture 25 registered in the same period. . . .
  26. T Colton Statistics in Medicine , (1974) .
    • . . . Age-adjusted mortality rates of patients for all and specific causes were calculated by the indirect method 26 using age-specific mortality rates of the whole population of Mie prefecture (standard population) in the census years of 1975–2000 (every 5th year) . . .
  27. Statistics and Information Department, Minister's Secretariat, Ministry of Health and Welfare, Japan (ed) International Statistical Classification of Diseases and Related Health Problems, 10th Revision [in Japanese] Health and Welfare Statistics Association, Tokyo 2006 International Statistical Classification of Diseases and Related Health Problems, 10th Revision [in Japanese] , (2006) .
    • . . . Chronic bronchitis and pulmonary emphysema were included in the group with chronic obstructive pulmonary disease (COPD) by ICD10 27, and the comparison between patients from Yokkaichi and the whole Mie Prefecture was performed in groups with COPD and asthma, respectively. . . .
  28. CL Chiang The Life Table and Its Applications , (1984) .
    • . . . The abridged life table method 28293031 was used to calculate the life expectancy of patients with ages of 0–84 years (5-year intervals) . . .
    • . . . The fraction of the last age interval of life 28 was used to construct an abridged life table . . .
    • . . . Standard error (SE) for life expectancy was estimated by Chiang method 282930313334 . . .
  29. K Yamaguchi; Z Nanjyou; T Shigematsu; K Kobayashi Seimei-hyo Kenkyu (Life Table Analysis) [in Japanese] , pp54-107 (1995) .
    • . . . The abridged life table method 28293031 was used to calculate the life expectancy of patients with ages of 0–84 years (5-year intervals) . . .
    • . . . Standard error (SE) for life expectancy was estimated by Chiang method 282930313334 . . .
    • . . . Techniques for partial multiple decremental life tables 2935 were used to calculate the corresponding life expectancies of patients from Yokkaichi and from the whole population of Mie Prefecture by excluding the death due to respiratory diseases such as chronic bronchitis, pulmonary emphysema, asthma, pneumonia and acute bronchitis . . .
  30. M Suenaga; S Yoshida; Y Takesaki; M Ikeuchi; N Hayakawa Life expectancy of the Hiroshima a-bomb survivors [in Japanese] Nagasaki Medical Journal 79, 215-218 (2004) .
    • . . . The abridged life table method 28293031 was used to calculate the life expectancy of patients with ages of 0–84 years (5-year intervals) . . .
    • . . . Standard error (SE) for life expectancy was estimated by Chiang method 282930313334 . . .
  31. M Suenaga Study on life expectancy of the Hiroshima atomic bomb survivors [in Japanese] Medical Journal of Hiroshima University 53, 1-13 (2005) .
    • . . . The abridged life table method 28293031 was used to calculate the life expectancy of patients with ages of 0–84 years (5-year intervals) . . .
    • . . . Standard error (SE) for life expectancy was estimated by Chiang method 282930313334 . . .
  32. Statistics and Information Department, Minister's Secretariat, Ministry of Health and Welfare Japan: Complete Life Tables for 1975, 1980, 1985, 1990, 1995, 2000 [in Japanese] Health and Welfare Statistics Association, Tokyo 1977 Japan: Complete Life Tables for 1975, 1980, 1985, 1990, 1995, 2000 [in Japanese] , (1977) .
    • . . . Those fractions were calculated from a complete life table in the Japan census years of 1975–2000 (every 5th year) 32 . . .
  33. Health and Welfare Statistics Association (ed) A Text Book of Health and Welfare Statistics [in Japanese] Health and Welfare Statistics Association. Tokyo 4 2003 pp191 211 A Text Book of Health and Welfare Statistics [in Japanese] , pp191-211 (2003) .
    • . . . Standard error (SE) for life expectancy was estimated by Chiang method 282930313334 . . .
  34. Y Murakami; H Ueshima; T Okamura; T Kadowaki; A Hozawa; Y Kita; T Hayakawa; A Okayama Life expectancy among Japanese of different smoking status in Japan: NIPPON DATA80 J Epidemiol 17, 31-37 (2007) .
    • . . . Standard error (SE) for life expectancy was estimated by Chiang method 282930313334 . . .
    • . . . Loss of life expectancy has been also reported in smokers. i.e. 3.5 and 2.2 years in 40 years old men and women in the Japanese 34 and 8.6 years in the US population 36 . . .
  35. DJ Lai; PM Tarwater; RJ Hardy Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000 Public Health 120, 486-492 (2006) .
    • . . . Techniques for partial multiple decremental life tables 2935 were used to calculate the corresponding life expectancies of patients from Yokkaichi and from the whole population of Mie Prefecture by excluding the death due to respiratory diseases such as chronic bronchitis, pulmonary emphysema, asthma, pneumonia and acute bronchitis . . .
  36. CA Pope Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk? Environ Health Perspect 108, 713-723 (2000) .
    • . . . Decrease of 1.51 year was reported in Dutch men 21, 1.34–1.69 years in Shanghai 22, and 2.5–3.1 years in US population 36 . . .
  37. MR Mölken; TA Lee Economic modeling in chronic obstructive pulmonary disease Proceedings of the American Thoracic Society 3, 630-634 (2006) .
    • . . . Although it has been argued that COPD models lack good data on life expectancy 37, estimation of life expectancy and its potential gains after excluding specific causes appear to be useful for assessing the effects of air pollution on health. . . .
  38. T Kitagawa Cause analysis of the Yokkaichi Asthma episode in Japan Journal of the Air Pollution Control Association 34, 743-746 (1984) .
    • . . . The studies on Yokkaichi Asthma had focused mainly on the effects of SO2and/or sulfuric acid mists 2838 whereas those in other countries have shown that SO2 + SP or SP alone lead to adverse health effects 1314151617181920 . . .
    • . . . It had been suspected that low pH value of dust contributed to Yokkaichi Asthma problems 838. . . .
  39. A Analitis; K Katsouyanni; K Dimakopoulou; E Samoli; AK Nikoloulopoulos; Y Petasakis; G Touloumi; J Schwartz; HR Anderson; K Cambra; F Forastiere; D Zmirou; JM Vonk; L Clancy; B Kriz; J Bobvos; J Pekkanen Short-term effects of ambient particles on cardiovascular and respiratory mortality Epidemiology 17, 230-233 (2006) .
    • . . . It has been demonstrated that SO2 causes increased cardiovascular mortality 171939 and hospital admission rate 194041 . . .
  40. J Schwartz; R Moms Air pollution and hospital admissions for cardio-vascular disease in Detroit, Michigan American Journal of Epidemiology 142, 23-35 (1995) .
    • . . . It has been demonstrated that SO2 causes increased cardiovascular mortality 171939 and hospital admission rate 194041 . . .
  41. A Le Tertre; S Medina; E Samoli; B Forsberg; P Michelozzi; A Boumghar; JM Vonk; A Bellini; R Atkinson; JG Ayres; J Sunyer; J Schwartz; K Katsouyanni Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities J Epidemiol Community Health 56, 773-779 (2002) .
    • . . . It has been demonstrated that SO2 causes increased cardiovascular mortality 171939 and hospital admission rate 194041 . . .
  42. K Okuma; Y Matsumura; M Fukuta; O Nakayama Estimates of active life expectancy based on the data of the public nursing-care insurance in Mie prefecture [in Japanese] Japanese Journal of Public Health 53, 437-447 (2006) .
    • . . . In the present study, there could have had an error in the estimates of life expectancies by the Chiang method when the population size is smaller than 1000 42 . . .
  43. R Doll; R Peto; J Boreham; I Sutherland Mortality in relation to smoking: 50 years' observations on male British doctors British medical journal 328, 1519 (2004) .
    • . . . The most important risk factor of COPD in the developed world is cigarette smoking 4344 . . .
  44. RA Wise; DP Tashkin Preventing chronic obstructive pilmomary disease: what is known and wath needs to be done to make a difference to the patient? The American Journal of Medicine 120, S14-22 (2007) .
    • . . . The most important risk factor of COPD in the developed world is cigarette smoking 4344 . . .
  45. L Trupin; G Earnest; M San Pedro; JR Balmes; MD Eisner; E Yelin; PP Katz; PD Blanc The occupational burden of chronic obstructive pulmonary disease European Respiratory Journal 22, 462-469 (2003) .
    • . . . Other risk factors are occupational or environmental exposure to dust, gas, vapor or fumes 45, malnutrition 46 and increased airway responsiveness 47 . . .
  46. I Romieu; C Trenga Diet and obstructive lung diseases Epidemiologic Reviews 23, 268-287 (2001) .
    • . . . Other risk factors are occupational or environmental exposure to dust, gas, vapor or fumes 45, malnutrition 46 and increased airway responsiveness 47 . . .
  47. D Sparrow; G O'Connor; ST Weiss The relation of airways responsiveness and atopy to the development of chronic obstructive lung disease Epidemiologic Reviews 10, 29-47 (1988) .
    • . . . Other risk factors are occupational or environmental exposure to dust, gas, vapor or fumes 45, malnutrition 46 and increased airway responsiveness 47 . . .
  48. DV Bates Observations on asthma Environmental Health Perspectives 103, 243-247 (1995) .
    • . . . Further, asthmatics are sensitive to air pollutants such as SO2, SP, ozone and nitrogen dioxide 48 . . .
  49. NR Anthonisen; EC Wright; JE Hodgkin Prognosis in chronic obstructive pulmonary disease The American Review of Respiratory Disease 133, 14-20 (1986) .
    • . . . Since prognosis of COPD can be predicted by lung function such as FEV1 4950, analysis using lung function should be carried out in Yokkaichi Asthma patients . . .
  50. RE Kanner; AD Renzetti; WM Stanish; HW Barkman; MR Klauber Predictors of survival in subjects with chronic airflow limitation The American Journal of Medicine 74, 249-255 (1983) .
    • . . . Since prognosis of COPD can be predicted by lung function such as FEV1 4950, analysis using lung function should be carried out in Yokkaichi Asthma patients . . .
Expand