There is increasing evidence of an inverse relationship between air pollution and cognitive functioning. Yet, the biological mechanisms underlying this relationship remain underexplored in healthy and vulnerable populations. This study examined cross-sectional and longitudinal associations between air pollution and global cognitive functioning in individuals without or with heart failure, carotid occlusive disease, or vascular cognitive impairment. We also assessed whether the cross-sectional associations were mediated by white matter hyperintensities (WMH), total brain volume (TBV), and cerebral blood flow (CBF). The cross-sectional and longitudinal analyses included data from 341 and 180 Heart-Brain Study participants, respectively. Cognitive functioning was measured using neuropsychological tests at baseline and two-year follow-up. Brain Magnetic Resonance Imaging provided WMH and TBV in mL, and CBF in mL/100g/min. WMH and TBV were divided by total intracranial volume. Annual average outdoor concentrations of particulate matter with diameters <2.5 µm and <10.0 µm, and nitrogen dioxide in µg/m3 in residential six-digit postal code areas were linked to participants at baseline. Adjusted multi-level regression analyses showed no significant cross-sectional or longitudinal associations between air pollution and global cognitive functioning. The associations between air pollutants and global cognitive functioning were not significantly mediated by WMH, TBV, and CBF. In this study, air pollution was not associated with global cognitive functioning or brain health indicators in healthy individuals and those with cardiovascular disorders along the heart-brain axis. Larger studies with longer follow-up periods are warranted to extend the present findings and to further elucidate potential associations between air pollution, cognition, and the underlying biological mechanisms.

Abstract Background Ethnic disparities in ischemic stroke are substantial and differences in exposure to air pollution have been demonstrated as well. However, the role of air pollution in mediating ethnic disparities in risk of ischemic stroke remains unclear. Understanding this relationship is crucial, as air pollution is a major modifiable risk factor for ischemic stroke. This study aims to determine whether air pollution exposure mediates ischemic stroke risk differences between Indonesian, Surinamese, Dutch Caribbean, and ethnic Dutch populations. Methods We carried out a nationwide cohort study in the Netherlands (2014–2019), including 9,248,484 residents aged 30 or older, free of ischemic stroke at baseline, of Dutch, Surinamese, Indonesian, or Dutch Caribbean ethnicity. Ethnicity was defined based on the country of birth of the individual and their parents. Air pollution exposure was measured via annual residential estimates of particulate matter < 2.5 micrometers (PM2.5) and nitrogen dioxide (NO2) for 2014. The study outcome was time to ischemic stroke occurrence or mortality, identified from nationwide hospital discharge and death registries using ICD-9/ICD-10 codes. Results The cohort included 314,082 (3.4%) Indonesian, 204,158 (2.2%) Surinamese, 69,580 (0.8%) Dutch Caribbean and 8,660,664 (93.7%) ethnic Dutch individuals. Air pollution levels were highest among Surinamese and lowest among Dutch. For Surinamese, NO2 mediated 13.8% (11.0-17.5%) and PM2.5 mediated 7.9% (6.3–9.9%) of the ischemic stroke difference compared to ethnic Dutch. For Dutch Caribbeans, NO2 mediated 14.7% (9.8–26.7%) and PM2.5 mediated 8.0% (8.1–23.3%). Percentages could not be calculated for Indonesians. Conclusion Air pollution substantially mediates the increased ischemic stroke risk in Surinamese and Dutch Caribbean populations. These findings emphasize the urgent need for air pollution reduction strategies to mitigate the disproportionate ischemic stroke burden in these populations.

BACKGROUND:Individuals with lower socioeconomic status (SES) are at a higher risk of being exposed to adverse environmental factors. Children are more vulnerable to the harmful effects of air pollutants. Therefore, this study examined socioeconomic inequalities in air pollution exposure among children in Flanders, Belgium. METHODS:Data were used from 298 children (age range: 9-12 years), and from their parents who participated in the COGNition and Air pollution in Children study. Socioeconomic status was measured using highest parental education at the individual level and median income at the neighborhood (aggregated) level. Annual average outdoor concentrations of particulate matter with diameters <2.5 μm (PM2.5) and <10.0 μm (PM10), nitrogen dioxide (NO2), and black carbon (BC) in μg/m3 were estimated at the residential address. Mixed regression models were applied to examine the associations. RESULTS:Children from parents with a low education level were exposed to significantly higher levels of PM2.5, PM10, and BC compared to children from parents with a high education level. However, the associations were not significant when tested using regression models. Children who lived in areas with a lower median neighborhood income were exposed to significantly higher levels of air pollution; an interquartile range (IQR; €4505.00) decrease in income was associated with an increase in exposure to PM2.5 of 0.198 μg/m3, PM10 of 0.406 μg/m3, NO2 of 0.740 μg/m3, and BC of 0.063 μg/m3. Children of parents with a low/high education level had a higher exposure to PM2.5, PM10, NO2, and BC when living in a low income neighborhood. Exposure to all air pollutants was the highest for low parental education level and low neighborhood income. CONCLUSIONS:Low neighborhood income was significantly associated with higher levels of air pollution, while parental education level was not significantly associated. Children from parents with a low education and low income were exposed to the highest levels of air pollution.

We aimed to map the spatial distribution of green space in the Netherlands, and to first comprehensively assess socio-demographic and socio-economic differences in the availability of green space in the Netherlands. Data was analyzed from all registered residents of the Netherlands aged one and above on January 1, 2017 (16,440,620 individuals). Socio-demographic and socio-economic information was derived from Statistics Netherlands. Data on green space density (percent of the area) around home were assembled by the Institute for Public Health and the Environment at the address level. The distribution of exposure to green space was described by age groups, sex, ethnicity, household socioeconomic status (SES), and urbanicity degree, and stratified by green space type. The distribution of green space by all vegetation, trees, shrubs, low vegetation, grass field, and agriculture was mapped for the Netherlands in 2017. Small differences in green space density were found across age and sex groups. Ethnic Dutch (58.1%) and Indonesian (54.5%) had more green space coverage around residence than Turkish (50.0%) and Moroccan (50.0%). People with higher household SES generally had greater green space coverage, although it slightly decreased at the highest SES level. Higher urbanicity levels were monotonously associated with lower green space exposure. These differences particularly originated from differences in low vegetation. Observed differences between ethnic and SES groups originated mostly from differences in rural to moderately urbanized areas. Environmental injustice was found among ethnic, SES, and urbanicity groups. The differences were mostly present in low vegetation and in rural to moderately urbanized areas.

The impacts of sex and gender on the health effects of environmental change are unclear and understudied. We describe the sex and gender dimensions of the health impacts of environmental change and provide a critical reflection on improving the quality of sex- and gender-disaggregated data and research, ultimately paving the way for evidence-based policies and interventions that account for the diverse experiences of individuals across the sex and gender spectrum.

BACKGROUND:The adverse health effects of air pollution are well-established. Previous reviews have highlighted disparities in air pollution exposure between minoritized ethnic groups and majoritized ethnic groups. However, these reviews primarily focused on proximity to pollution sources rather than objectively measured concentrations. This scoping review aims to provide an overview of the extent of inequalities in objectively measured air pollution exposure among ethnic groups in high-income countries. METHODS:We systematically searched PubMed, Scopus, Web of Science, and Google Scholar for studies published in English, that reported on objectively measured air pollution exposure stratified by ethnic groups in high-income countries. Data on study characteristics and air pollution exposure were extracted. RESULTS:The majority of all 55 included studies were conducted in North America (n = 46), followed by Europe (n = 8), and Oceania (n = 1). Across studies, 25 ethnic groups were identified, with African American, Hispanic, Latino, and Asian populations being the most studied minoritized ethnic groups. PM2.5 was the most studied (n = 38) air pollutant. Eighteen studies statistically tested differences in exposure across ethnic groups. Thirteen studies reported significantly higher air pollution exposure among minoritized ethnic populations compared to the majoritized ethnic population, and five studies showed mixed evidence. CONCLUSIONS:This review highlights the extent of disparities in air pollution exposure among ethnic groups in high-income countries. It underscores the need for further research to understand the contributing factors and potential interventions to address these disparities.

Background To simplify the assessment of the recording and control of coronary heart disease risk factors in different countries and regions. Design The SUrvey of Risk Factors (SURF) is an international clinical audit. Methods Data on consecutive patients with established coronary heart disease from countries in Europe, Asia and the Middle East were collected on a one-page collection sheet or electronically during routine clinic visits. Information on demographics, diagnostic category, risk factors, physical and laboratory measurements, and medications were included and key variables summarized in a Cardiovascular Health Index Score. Results Coronary heart disease patients (N = 10,186; 29% women) were enrolled from 79 centres in 11 countries. Recording of risk factors varied considerably: smoking was recorded in over 98% of subjects, while about 20% lacked data on laboratory measurements relevant to cardiovascular disease risk. Sixteen per cent of participants reported smoking, 29% were obese, and 46% had abdominal obesity. Sixty per cent of participants had blood pressure <140/90 mmHg (140/80 mmHg for diabetics), 48% had HbA1c<7%, 30% had low-density lipoprotein <1.8 mmol/l and 17% had a good cardiovascular health index score. There were substantial regional variations. Less than 3% of patients attended cardiac rehabilitation in Asia or the Middle East, compared with 45% in Europe. In Asia, 15% of patients had low-density lipoprotein cholesterol <1.8 mmol/l compared with 33% in Europe and 36% in the Middle East. Variations in medications were noted, with lower use of statins in Asia. Conclusions SURF proved to be practical in daily practice. Results indicated poor control of risk factors with substantial variation between countries, calling for development and implementation of clinical standards of secondary prevention of coronary heart disease.

Background Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness have important public health consequences. Objective To assess age-sex-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands. Methods Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalization rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 205,649 chronic forms of CHD (ICD-9 412, 414) admissions. Results Between 1998 and 2007, the age-standardized CHD hospitalization rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall, hospitalization rates decreased at younger age (<75 years) but increased in very old age (≥85 years). The annual percentage change in hospitalization rates was larger for AMI (men:-5.1%, women:-4.4%) than for unstable angina patients (men:-2.0%, women:-2.0%). For chronic CHD, the average annual percentage change was +0.7% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women. Conclusions An increasing proportion of Dutch CHD hospital admissions was for chronic forms of CHD. The age at hospitalization was pushed towards older age: premature CHD admission declined over time and admission rates at very old age increased.

Objective: The potential burden of a congenital heart defect on adult life is scarcely investigated. Our aim was to evaluate whether the presence and severity of congenital heart disease (CHD) influences socioeconomic status, household situation and life style in the adult population. Methods: Patients were randomly selected from CONCOR (n=11,047), the national registry of adult patients with CHD in the Netherlands, to complete a questionnaire addressing employment status, educational attainment, marital status & offspring, and life style. The reference group was derived from the Utrecht Health Project (n=6,810). Logistic regression models were used to adjust for age, gender and socio-economic status. Results: A total of 1571 adult patients (51% male; median age 39 years (range 18-94)) with mild (45%), moderate (45%), and severe (10%) CHD completed the questionnaire (response rate of 87%). Employment rates were significantly lower among patients with mild, moderate, and severe CHD (61% vs. 70% vs. 65% res...