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Industry, air quality, cigarette smoke and rates of respiratory illness in Port Adelaide

Industry, air quality, cigarette smoke and rates of respiratory illness in Port Adelaide Clinical Epidemiology and Health Outcomes Unit, The Queen Elizabeth Hospital, South Australia Abstract Objectives:To examine the prevalence of self-reported asthma, bronchitis/ emphysema, wheezing, night cough and smoking in Port Adelaide;to explore the relationship of the disorders to the presence of industry, tobacco smoke, indoor appliances and air quality. Methods: Prevalence data from a 1995 survey of Port Adelaide residents were compared with data from the 1995 National Health Survey and the 1995 South Australian Health Omnibus Survey. These data were then compared across three geographic areas in Port Adelaide, one being highly industrialised.Their relation to tobacco smoke and the presence of unflued gas appliances were examined. Finally, outdoor gaseous air pollutants were examined across the three areas. Results: Males in P o r t Adelaide had higher rates of asthma and bronchitis/ emphysema than nationally. Asthma was significantly higher for children aged 5-14 years and for adults aged 25-44 years. Bronchitis/emphysema was significantly higher for males aged 25-64. The highly industrial area had a higher rate of asthma (OR 1.85, 95% CI 1.07-3.22) in males that appeared unrelated to smoking or ambient gaseous pollutants. Smoking in Port Adelaide was significantly higher than in the general population, and was significantly associated with wheeze, night cough and bronchitis/emphysema. The presence of unflued gas heaters at home was significantly associated with asthma prevalence in males (OR 3.27, 95% CI 1.40-7.64). Conclusions: Respiratory disease appeared to be independently related to an area o high industry, smoking and f 3resence of unflued gas appliances in Port 4delaide. (Aust N Z J Public Healfh 1999; 23:657-60) Brian J. Smith, Monika Nitschke, Richard E. Ruffin Department of Medicine, The Queen Elizabeth Hospital Campus, The University of Adeleide, South Australia Robert Mitchell Environment Protection Authority of South Australia ort Adelaide is a statistical local area (SLA) o f approximately 40,000 people in the north-west ofAdelaide that has large pockets ofhigh unemployment, public housing and low income. A survey has shown that morbidity and mortality from respiratory diseases in the area significantly exceeded state-wide figures between 1989 and 1993.’ There is concern that these figures may be related to poor outdoor air quality and that this, in turn, may be related to the high concentration of heavy local industry.2 Also, regional smoking prevalence has not been directly compared to national data previously and the contribution of smoking to regional respiratory disease is unclear. We conducted a health survey in Port Adelaide to estimate the prevalence of asthma, bronchitislemphysema, wheezing, night cough, smoking and household gas appliances; monitored gaseous outdoor pollutants in three areas within Port Adelaide; and evaluated respiratory disease across the three areas, one area linked to a high level of heavy industry. Methods Health surveys A cross-sectional survey was conducted in the Port Adelaide SLA to derive self- reported prevalence data for asthma, bronchitidemphysema, wheezing, night cough, smoking, and household appliances. The Australian Bureau of Statistics (ABS) random sampling method was used in 44 of the 75 data collection districts. The aim was to achieve a sample size of 2,000 participants, with 80% power and 95% confidence, to demonstrate a 4% difference in the prevalence of asthma between Port Adelaide and National Health Survey (NHS) controls, who provided national benchmark data.3 Personal interviews were conducted with all members of the selected households to record a history of asthma, bronchitis, emphysema, wheeze and night cough. Questions were identical to those used in the 1995 NHS, which was conducted at the same time and was used to provide control data. For children below the age of 15, information was obtained from their parents or responsible guardian. Smoking information was elicited only on participants aged 18 or more years in keeping with the NHS. Questions about household appliances were also included in the participant questionnaire. Interviewers, who were trained according to ABS guidelines, conducted the personal interviews. An independent state-wide South Australian health survey (SA Health Omnibus Survey) was conducted at the same time as the Correspondence to: Dr Louis S. Pilotto, Clinical Epidemiology and Health Outcomes Unit, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville. S A 5001. Fax: (08) 8222 6121; e-mail: lpilotto@tqeh.nwahs.sa.gov.au 1999 VOL. 23 NO. 6 Submitted: ADril 1999 Revision requested: June 1999 Accepted: August 1999 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Pilotto et al. Table 1 : Adjusted’ comparison of asthma and bronchitidemphysema prevalence (“A)between Port Adelaide participants and National Health Survey (NHS) by age group and sex. Category ~~~~ ~~ Port Adelaide 6.9 24.6b 16.2 11.7b 9.1 9.0 6.5 13.4b 11.6 12.5 Asthma NHS 95%C1 for the difference 10.4 18.9 14.9 8.9 8.1 8.5 7.2 10.7 11.4 11.1 -7.8-1.1 0.3-11.0 -4.1-6.6 0.1-5.4 -1.8-3.7 -3.4-4.5 -5.0-3.6 0.4-4.9 -1.8-2.2 -0.1-2.9 Bronchitidemphysema Port NHS 95%CI for Adelaide the difference 6.2 2.8 3.3 6.6b 8.76 10.5 6.6 7.76 5.2 6.5b 2.5 2.6 3.3 3.1 4.7 8.6 10.1 4.0 4.1 4.1 -0.5-7.8 ____~_._ . . 128 Aged ___-___.<5 years 260 5-14 years ______ 15-24 years 186 ____ 25-44 years 577 45-64 years 441 65-74 years 222 Over 75 132 __._ Males 922 Females 1,024 Total 1,946 Notes: (a) Weighf adjusted b age andsex. r (b) pc0.05. . _ _ _ _ _ ~ -1.9-2.3 __ -2.6-2.6 . . 1.5-5.6 1.4-6.8 -2.3-6.0 -7.8-1.O 2.0-5.4 -0.3-2.5 1.3-3.5 ____ -. ~~~ - -_ . ___~ __ ~- _________ the difference in prevalence were used for this Logistic regression analysis was used to test the association between area and respiratory conditions, adjusted for age and sex. This was repeated for participants aged 18 years and over (on whom smoking information was known) and adjusted for smoking as well. For this group, logistic regression was used to test the association between the health outcomes and tobacco smoke (adjusted for age, sex and area) and indoor gas appliances (adjusted for age, sex, area and smoking). Gender differences for these associations were also explored. All analyses allowed for clustering within households. Statistical significance was accepted atp<0.05. Hourly mean measurements of gaseous pollutants were compared between the three areas, and compared to the National Health and Medical Research Council (NHMRC) one-hour guideline.’ personal interviews to provide control information about household appliances. The questions were the same as those used in the participant questionnaire and the same sampling techniques were used as for the NHS. Ambient exposure measurements Monitoring of daily ambient nitrogen dioxide (NO,), sulphur dioxide (SO,) and ozone (0,)levels in three geographically distinct areas in Port Adelaide was performed using standardised equipment by the Environmental Protection Authority during winter 1995. These areas were suburban and contiguous, with Area 1 having little industry, Area 2 having a cement works and Area 3 being the most industrialised, including a soda plant and the State’s principal power generation facility. Monitoring rotated weekly between the three areas over a period of 18 weeks, which included winter, giving each area six weeks of measurements. Total suspended particulates were not monitored for this project. Statistical methods Data were managed and analysed with Epi-Info 6.04 and Stata The prevalences of respiratory conditions and smoking in Port Adelaide were compared with those of the NHS survey, allowing for the weighting used in the calculation of these estimates to adjust for age and sex. The t-test and 95% confidence intervals for Results The response rates for households in the Port Adelaide survey (n=884), the National Health Survey (n=21,418) and the SA Health Omnibus Survey (n=3,001) were 70%, 92% and 74% respectively. The participation rates within these households were 88%, 97% and 1OO%, providing 1,946,53,751 and 3,001 participants respectively. Of the Port Adelaide participants, 488 lived in Area 1,678 in Area 2 and 780 in Area 3. 5!b5 Table 2: Adjusted’ odds ratio and 95% confidence interval for the occurrence of asthma, bronchitis, wheeze or night cough in people aged 18 years and above associated with a) current smokers, b) exposure to any tobacco smoke and c) exposure only to another household member smoking (ETS only). Asthma OR 95YocI 0.50-1.10 0.56-1.13 0.65-1.82 Bronchitid emphysema OR 95%CI 1.92 1.78 1.22 1.27-2.91 1.18-2.67 0.63-2.36 Wheeze OR Night cough OR 95%CI 1.47-2.49 1.31-2.20 0.72-1.64 95%CI 1.34-2.47 1.21 -2.25 ~- Current smoking (n = 1,502) Any tobacco smoke exposure (n = 1,510) ETS only (n = 1,123) 0.77-2.14 Note: (a) Adjusfed for age, sex and area, and allowing for clustering within households. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999 VOL. 23 NO. 6 Industry, air quality, cigarette smoke and rates of respiratory illness Prevalence comparisons The prevalence of asthma in Port Adelaide was not significantly different to that in the national controls (Table 1). However, stratification by age showed a significantly higher prevalence in children aged 5-14 years and in adults aged 25-44 years, and in males when stratified by gender (Table I ) . Overall, a significantly higher proportion of bronchitis/emphysema occurred in Port Adelaide than nationally, which was also true in the 25-64 age group (Table 1). It was also significantly higher in Port Adelaide males. The prevalence of wheeze in the past 12 months was significantly higher in Port Adelaide males than nationally (25% vs. 21%; 95% CI of % difference: 0.99-6.65),but not significantly higher in females (20% vs. 18% respectively). Night cough was also significantly higher in the past year for males in Port Adelaide ( 1 6% vs. 1 1%; 95% CI of % difference: 3.05-7.87) but not for females ( 13% vs. 1 1 % respectively). Overall, smoking prevalence was significantly higher in Port Adelaide than the NHS (27% vs. 24%; 95% CI of % difference: 0.6-5.2),with the greatest difference present in the 35-44 year age group (37% vs. 26%;95% CI of % difference: 4.6-18.9).The prevalence of smoking in males in the two surveys was similar (28% vs. 27%), but was significantly higher in women in Port Adelaide (25% vs. 20%; 95% CI of % difference: 1.4-7.5).The prevalence of male ex-smokers was similar between Port Adelaide (34%)and the N H S survey (32%), but there were significantly fewer female ex-smokers in Port Adelaide (19%vs. 23%;95%CI of % difference: -6.0 - -0.4). Asthma was significantly higher in males (OR 1.85; 95% CI 1.07-3.22) Area 3, in which wheeze in males was of borderline in significance (OR 1.46; 95% CI 0.98-2.16). No area differences in illness were found for females. When analysis was restricted to those aged 18 years and over, and adjusted for smoking, there was still a tendency to higher asthma in males @=0.09) in Area 3. There was a significantly higher proportion of current smokers and people exposed to any tobacco smoke among participants with bronchitis/emphysema, wheeze and night cough after adjusting for age, gender and area (Table 2). However, current smoking was only associated with night cough in females (OR 2.33; 95% CI I .48-3.66) but not males (OR 1.43; 95% CI 0.92-2.24). Exposure to another household member smoking, but not being a current smoker, was not associated with respiratory symptoms (Table 2). There were no significant differences in the proportion of smokers in Areas 1,2 and 3, being 28%, 30% and 26% respectively. females. Bronchitis/emphysema, wheeze and night cough were not associated with the presence of unflued gas heaters. Ambient pollutants The mean of the one-hour average daily levels of ambient NO,, SO, and 0, recorded over the 18 weeks of monitoring did not vary substantially between Areas 1 , 2 and 3 (NO,: 9.9, 1 1.7 and 6.7 ppm; SO,: 2.7,2.8 and 2.7 ppm; 0,: 18.6, 15.7 and 18.3 ppm respectively). These levels were well within NHMRC guidelines. Discussion Our results provide evidence that the Port Adelaide SLA has high rates of self-reported asthma and bronchitis/emphysema among certain subgroups. A high level of validity and reliability for self-reported asthma questionnaires has been previously reported in Australia.' We have demonstrated evidence of increased smoking prevalence in the region. Females in particular are more likeIy to smoke than their national counterparts, and are also less likely to report having given up smoking. We have not found evidence of unacceptable regional ambient gaseous air quality, but asthma in males appears to be linked to the area with highest industry independently of smoking. The significant increase in wheeze, night cough and bronchitis/emphysema in. relation to current smoking and tobacco smoke exposure is of concern but not unexpected. The finding of an association between the use of unflued gas heaters and asthma is consistent with other studies involving gas appliances, including two Australian report^.^-'^ We also demonstrated a higher prevalence of gas stoves in Port Adelaide but did not find an association between the presence of gas stoves and respiratory illness. The significantly higher asthma prevalence in males in the highly industrial Area 3 does not appear to be explained by smoking or gaseous air pollution, although gaseous pollutant monitoring was limited to only three sampling points in the region. Also, our measurements do not necessarily reflect past, seasonal or occupational exposures. Nevertheless, the findings raise the question as to the role of other industrial chemicals and particulate air pollution in relation to this disorder. Study limitations included the lack of objective lung function measurement. However, we utilised identical sampling strategies and questionnaire administration techniques in the Port Adelaide region as for the State and national surveys. Our response rate at household level was not as high as for NHS, but participation in the NHS Survey can be enforced by legal obligation. Response bias and self-reporting bias cannot be fully excluded given regional air quality concerns, however our self-reported data are consistent with other objective sources of respiratory disease data, including death registry figures and hospital separations. Also, it is unlikely that smokers were more likely to participate in the health survey than non-smokers. A higher response among male asthmatic households in Area 3 is a possible explanation for the link with industry. However, such a response bias might also be expected to link Area 3 with bronchitis/emphysema, but this did Household appliances The prevalence of gas stoves was significantly higher in Port Adelaide (64%vs. 54%;p<O.Ol),but similar for gas heaters (40% vs. 42%), when compared to Omnibus data. After adjustment for age, area and smoking, asthma in males was significantly associated with the presence of unflued gas heating appliances when compared to flued gas heating (OR 4.93; 95% C1 1.96-12.45)or to a combination of flued gas and non-gas heating appliances (OR 3.27; 95% CI 1.40-7.64). N o association was shown in 1999 VOL. 23 NO. 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Pilotto et al. not occur. This cross-sectional study did not take into account length of residence and occupation, and locations of workplaces and schools, which would need to be considered in further analytic studies. In relation to household appliances, their presence acted as a surrogate NO, exposure and some misclassification of exposure may have resulted from this approach. The available evidence of disease prevalence and risk factors for regional respiratory disease in Port Adelaide remains incomplete. However, there is sufficient evidence that further regional research resources should now be directed to particulate and other industry-linked exposure in Area 3. Measures to improve the ventilation of household gas appliances should also be considered. Although the strength of evidence for the latter intervention is not as strong, it is relatively simple and inexpensive. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Industry, air quality, cigarette smoke and rates of respiratory illness in Port Adelaide

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Publisher
Wiley
Copyright
Copyright © 1999 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.1999.tb01556.x
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Abstract

Clinical Epidemiology and Health Outcomes Unit, The Queen Elizabeth Hospital, South Australia Abstract Objectives:To examine the prevalence of self-reported asthma, bronchitis/ emphysema, wheezing, night cough and smoking in Port Adelaide;to explore the relationship of the disorders to the presence of industry, tobacco smoke, indoor appliances and air quality. Methods: Prevalence data from a 1995 survey of Port Adelaide residents were compared with data from the 1995 National Health Survey and the 1995 South Australian Health Omnibus Survey. These data were then compared across three geographic areas in Port Adelaide, one being highly industrialised.Their relation to tobacco smoke and the presence of unflued gas appliances were examined. Finally, outdoor gaseous air pollutants were examined across the three areas. Results: Males in P o r t Adelaide had higher rates of asthma and bronchitis/ emphysema than nationally. Asthma was significantly higher for children aged 5-14 years and for adults aged 25-44 years. Bronchitis/emphysema was significantly higher for males aged 25-64. The highly industrial area had a higher rate of asthma (OR 1.85, 95% CI 1.07-3.22) in males that appeared unrelated to smoking or ambient gaseous pollutants. Smoking in Port Adelaide was significantly higher than in the general population, and was significantly associated with wheeze, night cough and bronchitis/emphysema. The presence of unflued gas heaters at home was significantly associated with asthma prevalence in males (OR 3.27, 95% CI 1.40-7.64). Conclusions: Respiratory disease appeared to be independently related to an area o high industry, smoking and f 3resence of unflued gas appliances in Port 4delaide. (Aust N Z J Public Healfh 1999; 23:657-60) Brian J. Smith, Monika Nitschke, Richard E. Ruffin Department of Medicine, The Queen Elizabeth Hospital Campus, The University of Adeleide, South Australia Robert Mitchell Environment Protection Authority of South Australia ort Adelaide is a statistical local area (SLA) o f approximately 40,000 people in the north-west ofAdelaide that has large pockets ofhigh unemployment, public housing and low income. A survey has shown that morbidity and mortality from respiratory diseases in the area significantly exceeded state-wide figures between 1989 and 1993.’ There is concern that these figures may be related to poor outdoor air quality and that this, in turn, may be related to the high concentration of heavy local industry.2 Also, regional smoking prevalence has not been directly compared to national data previously and the contribution of smoking to regional respiratory disease is unclear. We conducted a health survey in Port Adelaide to estimate the prevalence of asthma, bronchitislemphysema, wheezing, night cough, smoking and household gas appliances; monitored gaseous outdoor pollutants in three areas within Port Adelaide; and evaluated respiratory disease across the three areas, one area linked to a high level of heavy industry. Methods Health surveys A cross-sectional survey was conducted in the Port Adelaide SLA to derive self- reported prevalence data for asthma, bronchitidemphysema, wheezing, night cough, smoking, and household appliances. The Australian Bureau of Statistics (ABS) random sampling method was used in 44 of the 75 data collection districts. The aim was to achieve a sample size of 2,000 participants, with 80% power and 95% confidence, to demonstrate a 4% difference in the prevalence of asthma between Port Adelaide and National Health Survey (NHS) controls, who provided national benchmark data.3 Personal interviews were conducted with all members of the selected households to record a history of asthma, bronchitis, emphysema, wheeze and night cough. Questions were identical to those used in the 1995 NHS, which was conducted at the same time and was used to provide control data. For children below the age of 15, information was obtained from their parents or responsible guardian. Smoking information was elicited only on participants aged 18 or more years in keeping with the NHS. Questions about household appliances were also included in the participant questionnaire. Interviewers, who were trained according to ABS guidelines, conducted the personal interviews. An independent state-wide South Australian health survey (SA Health Omnibus Survey) was conducted at the same time as the Correspondence to: Dr Louis S. Pilotto, Clinical Epidemiology and Health Outcomes Unit, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville. S A 5001. Fax: (08) 8222 6121; e-mail: lpilotto@tqeh.nwahs.sa.gov.au 1999 VOL. 23 NO. 6 Submitted: ADril 1999 Revision requested: June 1999 Accepted: August 1999 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Pilotto et al. Table 1 : Adjusted’ comparison of asthma and bronchitidemphysema prevalence (“A)between Port Adelaide participants and National Health Survey (NHS) by age group and sex. Category ~~~~ ~~ Port Adelaide 6.9 24.6b 16.2 11.7b 9.1 9.0 6.5 13.4b 11.6 12.5 Asthma NHS 95%C1 for the difference 10.4 18.9 14.9 8.9 8.1 8.5 7.2 10.7 11.4 11.1 -7.8-1.1 0.3-11.0 -4.1-6.6 0.1-5.4 -1.8-3.7 -3.4-4.5 -5.0-3.6 0.4-4.9 -1.8-2.2 -0.1-2.9 Bronchitidemphysema Port NHS 95%CI for Adelaide the difference 6.2 2.8 3.3 6.6b 8.76 10.5 6.6 7.76 5.2 6.5b 2.5 2.6 3.3 3.1 4.7 8.6 10.1 4.0 4.1 4.1 -0.5-7.8 ____~_._ . . 128 Aged ___-___.<5 years 260 5-14 years ______ 15-24 years 186 ____ 25-44 years 577 45-64 years 441 65-74 years 222 Over 75 132 __._ Males 922 Females 1,024 Total 1,946 Notes: (a) Weighf adjusted b age andsex. r (b) pc0.05. . _ _ _ _ _ ~ -1.9-2.3 __ -2.6-2.6 . . 1.5-5.6 1.4-6.8 -2.3-6.0 -7.8-1.O 2.0-5.4 -0.3-2.5 1.3-3.5 ____ -. ~~~ - -_ . ___~ __ ~- _________ the difference in prevalence were used for this Logistic regression analysis was used to test the association between area and respiratory conditions, adjusted for age and sex. This was repeated for participants aged 18 years and over (on whom smoking information was known) and adjusted for smoking as well. For this group, logistic regression was used to test the association between the health outcomes and tobacco smoke (adjusted for age, sex and area) and indoor gas appliances (adjusted for age, sex, area and smoking). Gender differences for these associations were also explored. All analyses allowed for clustering within households. Statistical significance was accepted atp<0.05. Hourly mean measurements of gaseous pollutants were compared between the three areas, and compared to the National Health and Medical Research Council (NHMRC) one-hour guideline.’ personal interviews to provide control information about household appliances. The questions were the same as those used in the participant questionnaire and the same sampling techniques were used as for the NHS. Ambient exposure measurements Monitoring of daily ambient nitrogen dioxide (NO,), sulphur dioxide (SO,) and ozone (0,)levels in three geographically distinct areas in Port Adelaide was performed using standardised equipment by the Environmental Protection Authority during winter 1995. These areas were suburban and contiguous, with Area 1 having little industry, Area 2 having a cement works and Area 3 being the most industrialised, including a soda plant and the State’s principal power generation facility. Monitoring rotated weekly between the three areas over a period of 18 weeks, which included winter, giving each area six weeks of measurements. Total suspended particulates were not monitored for this project. Statistical methods Data were managed and analysed with Epi-Info 6.04 and Stata The prevalences of respiratory conditions and smoking in Port Adelaide were compared with those of the NHS survey, allowing for the weighting used in the calculation of these estimates to adjust for age and sex. The t-test and 95% confidence intervals for Results The response rates for households in the Port Adelaide survey (n=884), the National Health Survey (n=21,418) and the SA Health Omnibus Survey (n=3,001) were 70%, 92% and 74% respectively. The participation rates within these households were 88%, 97% and 1OO%, providing 1,946,53,751 and 3,001 participants respectively. Of the Port Adelaide participants, 488 lived in Area 1,678 in Area 2 and 780 in Area 3. 5!b5 Table 2: Adjusted’ odds ratio and 95% confidence interval for the occurrence of asthma, bronchitis, wheeze or night cough in people aged 18 years and above associated with a) current smokers, b) exposure to any tobacco smoke and c) exposure only to another household member smoking (ETS only). Asthma OR 95YocI 0.50-1.10 0.56-1.13 0.65-1.82 Bronchitid emphysema OR 95%CI 1.92 1.78 1.22 1.27-2.91 1.18-2.67 0.63-2.36 Wheeze OR Night cough OR 95%CI 1.47-2.49 1.31-2.20 0.72-1.64 95%CI 1.34-2.47 1.21 -2.25 ~- Current smoking (n = 1,502) Any tobacco smoke exposure (n = 1,510) ETS only (n = 1,123) 0.77-2.14 Note: (a) Adjusfed for age, sex and area, and allowing for clustering within households. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999 VOL. 23 NO. 6 Industry, air quality, cigarette smoke and rates of respiratory illness Prevalence comparisons The prevalence of asthma in Port Adelaide was not significantly different to that in the national controls (Table 1). However, stratification by age showed a significantly higher prevalence in children aged 5-14 years and in adults aged 25-44 years, and in males when stratified by gender (Table I ) . Overall, a significantly higher proportion of bronchitis/emphysema occurred in Port Adelaide than nationally, which was also true in the 25-64 age group (Table 1). It was also significantly higher in Port Adelaide males. The prevalence of wheeze in the past 12 months was significantly higher in Port Adelaide males than nationally (25% vs. 21%; 95% CI of % difference: 0.99-6.65),but not significantly higher in females (20% vs. 18% respectively). Night cough was also significantly higher in the past year for males in Port Adelaide ( 1 6% vs. 1 1%; 95% CI of % difference: 3.05-7.87) but not for females ( 13% vs. 1 1 % respectively). Overall, smoking prevalence was significantly higher in Port Adelaide than the NHS (27% vs. 24%; 95% CI of % difference: 0.6-5.2),with the greatest difference present in the 35-44 year age group (37% vs. 26%;95% CI of % difference: 4.6-18.9).The prevalence of smoking in males in the two surveys was similar (28% vs. 27%), but was significantly higher in women in Port Adelaide (25% vs. 20%; 95% CI of % difference: 1.4-7.5).The prevalence of male ex-smokers was similar between Port Adelaide (34%)and the N H S survey (32%), but there were significantly fewer female ex-smokers in Port Adelaide (19%vs. 23%;95%CI of % difference: -6.0 - -0.4). Asthma was significantly higher in males (OR 1.85; 95% CI 1.07-3.22) Area 3, in which wheeze in males was of borderline in significance (OR 1.46; 95% CI 0.98-2.16). No area differences in illness were found for females. When analysis was restricted to those aged 18 years and over, and adjusted for smoking, there was still a tendency to higher asthma in males @=0.09) in Area 3. There was a significantly higher proportion of current smokers and people exposed to any tobacco smoke among participants with bronchitis/emphysema, wheeze and night cough after adjusting for age, gender and area (Table 2). However, current smoking was only associated with night cough in females (OR 2.33; 95% CI I .48-3.66) but not males (OR 1.43; 95% CI 0.92-2.24). Exposure to another household member smoking, but not being a current smoker, was not associated with respiratory symptoms (Table 2). There were no significant differences in the proportion of smokers in Areas 1,2 and 3, being 28%, 30% and 26% respectively. females. Bronchitis/emphysema, wheeze and night cough were not associated with the presence of unflued gas heaters. Ambient pollutants The mean of the one-hour average daily levels of ambient NO,, SO, and 0, recorded over the 18 weeks of monitoring did not vary substantially between Areas 1 , 2 and 3 (NO,: 9.9, 1 1.7 and 6.7 ppm; SO,: 2.7,2.8 and 2.7 ppm; 0,: 18.6, 15.7 and 18.3 ppm respectively). These levels were well within NHMRC guidelines. Discussion Our results provide evidence that the Port Adelaide SLA has high rates of self-reported asthma and bronchitis/emphysema among certain subgroups. A high level of validity and reliability for self-reported asthma questionnaires has been previously reported in Australia.' We have demonstrated evidence of increased smoking prevalence in the region. Females in particular are more likeIy to smoke than their national counterparts, and are also less likely to report having given up smoking. We have not found evidence of unacceptable regional ambient gaseous air quality, but asthma in males appears to be linked to the area with highest industry independently of smoking. The significant increase in wheeze, night cough and bronchitis/emphysema in. relation to current smoking and tobacco smoke exposure is of concern but not unexpected. The finding of an association between the use of unflued gas heaters and asthma is consistent with other studies involving gas appliances, including two Australian report^.^-'^ We also demonstrated a higher prevalence of gas stoves in Port Adelaide but did not find an association between the presence of gas stoves and respiratory illness. The significantly higher asthma prevalence in males in the highly industrial Area 3 does not appear to be explained by smoking or gaseous air pollution, although gaseous pollutant monitoring was limited to only three sampling points in the region. Also, our measurements do not necessarily reflect past, seasonal or occupational exposures. Nevertheless, the findings raise the question as to the role of other industrial chemicals and particulate air pollution in relation to this disorder. Study limitations included the lack of objective lung function measurement. However, we utilised identical sampling strategies and questionnaire administration techniques in the Port Adelaide region as for the State and national surveys. Our response rate at household level was not as high as for NHS, but participation in the NHS Survey can be enforced by legal obligation. Response bias and self-reporting bias cannot be fully excluded given regional air quality concerns, however our self-reported data are consistent with other objective sources of respiratory disease data, including death registry figures and hospital separations. Also, it is unlikely that smokers were more likely to participate in the health survey than non-smokers. A higher response among male asthmatic households in Area 3 is a possible explanation for the link with industry. However, such a response bias might also be expected to link Area 3 with bronchitis/emphysema, but this did Household appliances The prevalence of gas stoves was significantly higher in Port Adelaide (64%vs. 54%;p<O.Ol),but similar for gas heaters (40% vs. 42%), when compared to Omnibus data. After adjustment for age, area and smoking, asthma in males was significantly associated with the presence of unflued gas heating appliances when compared to flued gas heating (OR 4.93; 95% C1 1.96-12.45)or to a combination of flued gas and non-gas heating appliances (OR 3.27; 95% CI 1.40-7.64). N o association was shown in 1999 VOL. 23 NO. 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Pilotto et al. not occur. This cross-sectional study did not take into account length of residence and occupation, and locations of workplaces and schools, which would need to be considered in further analytic studies. In relation to household appliances, their presence acted as a surrogate NO, exposure and some misclassification of exposure may have resulted from this approach. The available evidence of disease prevalence and risk factors for regional respiratory disease in Port Adelaide remains incomplete. However, there is sufficient evidence that further regional research resources should now be directed to particulate and other industry-linked exposure in Area 3. Measures to improve the ventilation of household gas appliances should also be considered. Although the strength of evidence for the latter intervention is not as strong, it is relatively simple and inexpensive.

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Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 1999

There are no references for this article.