Research Projects
Through previous activities conducted under the GeoHealth Hub planning grant we have identified key areas for environmental health research and training in Peru, which comprise the four areas of focus of the linked U01 research grant proposal: indoor air pollution, outdoor air pollution, climate change, and arsenic contamination.
Phase 2: Research Projects
Air pollution is the most important environmental risk factor worldwide, as per the latest Global Burden of Disease Study. During our previous GEOHealth Hub centered in Peru, we published 21 articles on air pollution research and identified important gaps in air pollution data nationwide, to be addressed in this proposal. Ambient air pollution (AAP) is a priority in Peru, especially in big cities like Lima (2016 mean PM2.5 of 25 μg/m3), and Arequipa (2019 mean PM2.5 of 72 μg/m3), far above the WHO recommended annual level of 10 μg/m3. The overall objective of this renewal application is to build capacity in AAP research in Peru and study the association between AAP and cardiovascular and respiratory conditions, including COVID-19, and Alzheimer’s disease (AD) where the association with AAP is not well established. Specific Aims are as follows:
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Estimate the short and long-term effects of AAP on cardiorespiratory disease and Alzheimer’s disease in Peru.
Mitigation strategies to reduce greenhouse gas emissions under the 2015 Paris accord will lead to reductions in AAP and improvements in health. We will update current 2010-2016 PM2.5 estimates (1-km2 resolution) through December 2025, build a new model for NO2 in Lima, and develop an atmospheric model of PM2.5 concentrations (5-km2 resolution) across Peru combining remote sensing with on-ground air pollution monitoring data. We will develop a database of emergency room visits and hospital outcomes in major hospitals in Peru. We will construct exposure-response curves of PM2.5 with cardiorespiratory hospitalizations in adults and calculate the decrease in mortality attributed to PM2.5 under different greenhouse gas mitigation scenarios as proposed in the Peruvian Nationally Determined Contributions under the 2015 Paris accord. Hypothesis 1c: Higher AAP is associated with Alzheimer’s disease and fronto-temporal dementia. We will collaborate with a leading neurology clinic in Lima on an ongoing study of Alzheimer’s and fronto-temporal dementia to analyze the association between historical NO2 and PM2.5 estimates and incident cases between 2020 and 2024. We anticipate over 500 cases and 500 controls. We will also assess a history of COVID-19 among cases/controls. |
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Evaluate the effectiveness of different traffic mitigation strategies on traffic count, AAP concentrations and hospital outcomes for COPD and asthma in Lima, Peru.Alternative mitigation strategies including incremental replacement of the existing car fleet with electric vehicles and mass-transit solutions provide cost- effective strategies to reduce AAP concentrations and improve health. We seek to model the relation between traffic count, AAP, and hospital outcomes, and to identify policy interventions that best mitigate traffic-related air pollution (TRAP). We will evaluate the effectiveness of Pico y Placa introduced in 2019 vs. alternative strategies (e.g., bans on older vehicles, better regulation on emission inspections, replacement of existing fleet with electric vehicles, congestion charges, or new mass-transit) on traffic count, AAP and hospital outcomes using data between 1/2016 and 12/2025. We will a) use an interrupted time series to model the effect of Pico y Placa on traffic count, PM2.5 and NO2, the number of ER visits, and hospitalizations for COPD and asthma, b) develop exposure-response curves for traffic count and AAP with ER visits, and hospital outcomes; and, c) conduct a life cycle assessment of Pico y Placa vs. alternative strategies to reduce AAP and improve health.
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Study AAP and COVID-19 and non-COVID-19 pneumonia in Lima and Arequipa, and assess whether severe COVID is associated with long-term cognitive deficits.
1) Higher AAP is associated with higher risk of COVID and non-COVID pneumonia. Peru has been hit hard with COVID-19, with the highest death rate in the world. We will evaluate the relationship between short and long-term AAP and incident COVID-19 cases and deaths, and case fatality rate, in the general population of Lima and Arequipa during the pre-vaccination period (March 2020 to March 2021). Exposures will be assigned to cases using the models in Aim 1, based on residence. We will extend these models to non-COVID-19 pneumonia between 2010 and 2025. 2) Severe COVID affects cognitive function. We will leverage our access to a prior trial population to compare cognitive function in 100 severe COVID-19 cases (who were hospitalized and required >6 L/min of supplemental oxygen) at 2-4 years after their hospitalization, with 100 age-, sex- and neighborhood-matched controls, using the Telephone Interview for Cognitive Status (TICs) questionnaire. We also have access to a Lima data base of 531 hospitalized COVID cases and over 10,000 non-severe cases; we will explore the possibility of assessing cognition in severe vs non-severe cases (via TICs), and possible interactions with AAP. Impact: Peru lacks high quality air pollution data. We have assembled a multidisciplinary research team to develop novel atmospheric models that combine remote-sensing and ground monitor data to estimate AAP and study its relationship with health outcomes.
1) Higher AAP is associated with higher risk of COVID and non-COVID pneumonia. Peru has been hit hard with COVID-19, with the highest death rate in the world. We will evaluate the relationship between short and long-term AAP and incident COVID-19 cases and deaths, and case fatality rate, in the general population of Lima and Arequipa during the pre-vaccination period (March 2020 to March 2021). Exposures will be assigned to cases using the models in Aim 1, based on residence. We will extend these models to non-COVID-19 pneumonia between 2010 and 2025. 2) Severe COVID affects cognitive function. We will leverage our access to a prior trial population to compare cognitive function in 100 severe COVID-19 cases (who were hospitalized and required >6 L/min of supplemental oxygen) at 2-4 years after their hospitalization, with 100 age-, sex- and neighborhood-matched controls, using the Telephone Interview for Cognitive Status (TICs) questionnaire. We also have access to a Lima data base of 531 hospitalized COVID cases and over 10,000 non-severe cases; we will explore the possibility of assessing cognition in severe vs non-severe cases (via TICs), and possible interactions with AAP. Impact: Peru lacks high quality air pollution data. We have assembled a multidisciplinary research team to develop novel atmospheric models that combine remote-sensing and ground monitor data to estimate AAP and study its relationship with health outcomes.
Phase 1: Research Projects
Effects of a Liquefied Petroleum Gas Stove Intervention on Pollutant Exposure and Adult Cardiopulmonary Outcomes: the Cardiopulmonary and Household Air Pollution (CHAP) Trial
Household air pollution (HAP) from combustion of biomass fuels is a leading risk factor for disease burden worldwide. Globally, approximately 50% of all households and 90% of rural households use biomass fuels as the main domestic source of energy.
The burning of biomass fuels (typically comprised of wood, dung, and agricultural crop waste) is most pervasive in low and middle-income countries (LMIC), and is recognized as a leading risk factor for COPD, childhood pneumonia, low birthweight, and all-cause mortality.
Our primary objective is to conduct a field intervention trial of liquefied-petroleum gas (LPG) stove use and fuel distribution in the southern Peruvian region of Puno, compared to standard cooking practices with open-fire biomass burning stoves, and determine if provision of cleaner fuels will result in important reductions of household air pollution and consequently an improvement in cardiopulmonary outcomes over a one-year period. Publications resulted from this work:
Household air pollution (HAP) from combustion of biomass fuels is a leading risk factor for disease burden worldwide. Globally, approximately 50% of all households and 90% of rural households use biomass fuels as the main domestic source of energy.
The burning of biomass fuels (typically comprised of wood, dung, and agricultural crop waste) is most pervasive in low and middle-income countries (LMIC), and is recognized as a leading risk factor for COPD, childhood pneumonia, low birthweight, and all-cause mortality.
Our primary objective is to conduct a field intervention trial of liquefied-petroleum gas (LPG) stove use and fuel distribution in the southern Peruvian region of Puno, compared to standard cooking practices with open-fire biomass burning stoves, and determine if provision of cleaner fuels will result in important reductions of household air pollution and consequently an improvement in cardiopulmonary outcomes over a one-year period. Publications resulted from this work:
- Effects of a liquefied petroleum gas stove intervention on pollutant exposure and adult cardiopulmonary outcomes (CHAP): study protocol for a randomized controlled trial. Trials, 2017
- An evaluation of the Fondo de Inclusión Social Energético program to promote access to liquefied petroleum gas in Peru. Energy for Sustainable Development, 2018
- Perceptions of Improved Biomass and Liquefied Petroleum Gas Stoves in Puno, Peru: Implications for Promoting Sustained and Exclusive Adoption of Clean Cooking Technologies. Int. J. Environ. Res. Public Health, 2017
- Effects of a Cleaner Energy Intervention on Cardiopulmonary Outcomes in Peru: A Randomized Controlled Trial. American Journal of Respiratory and Critical Care Medicine, 2020
Air Pollution and Cardio-Respiratory Diseases in Lima, Peru
Lima is one of the most polluted cities in Latin America, according to a recent WHO report. Air pollution by particulate matter less than 2.5 microns (PM 2.5) is known as a cause of premature death from cardio-respiratory diseases.
Several studies associate exposure to environmental contaminants with the increase to emergency room visits for acute respiratory and cardiovascular diseases in children and adults. We are performing an ecological study of time series to determine the relationship between outdoor air pollution in metropolitan Lima (daily measurements) and its effect on daily admissions to emergency rooms in large hospital (level II and III) due to respiratory and cardiovascular diseases. Likewise, a sub-study will determine if proximity to points of greatest concentration of pollutants increase the risk of cardiovascular or respiratory diseases.
No such time series study has been conducted in Perú and we believe such a study has potential public health policy implications.
Publications resulted from this work:
Lima is one of the most polluted cities in Latin America, according to a recent WHO report. Air pollution by particulate matter less than 2.5 microns (PM 2.5) is known as a cause of premature death from cardio-respiratory diseases.
Several studies associate exposure to environmental contaminants with the increase to emergency room visits for acute respiratory and cardiovascular diseases in children and adults. We are performing an ecological study of time series to determine the relationship between outdoor air pollution in metropolitan Lima (daily measurements) and its effect on daily admissions to emergency rooms in large hospital (level II and III) due to respiratory and cardiovascular diseases. Likewise, a sub-study will determine if proximity to points of greatest concentration of pollutants increase the risk of cardiovascular or respiratory diseases.
No such time series study has been conducted in Perú and we believe such a study has potential public health policy implications.
Publications resulted from this work:
- Developing an Advanced PM2.5 Exposure Model in Lima, Peru. Remote Sensing, 2018
- Reordenamiento vehicular y contaminación de material particulado (PM10, PM2.5). Rev. Peru. Med. Exp. Salud Publica, 2018
- Increased Outdoor PM2.5 Concentration Is Associated with Moderate/Severe Anemia in Children Aged 6–59 Months in Lima, Peru. Journal of Environmental and Public Health, 2019
- Modeling Study of the Particulate Matter in Lima with the WRF-Chem Model: Case Study of April 2016. International Journal of Applied Engineering Research , 2018
Impact of Rotavirus Vaccination and Piped Water Access on Childhood Diarrhea Rates in Peru, 2005-2015
In the past two decades Perú has made significant progress toward increasing access to improved water and sanitation facilities and has seen large declines in the burden of morbidity from diarrheal disease. While improved water and sanitation coverage have increased at the national level, large disparities still persist between urban and rural areas. Regions that have made substantial gains toward lowering diarrheal disease rates may have these trends slowed or reversed as climate change brings additional challenges. Temperature increases associated with climate change are expected to greatly increase the global risk of diarrhea by the end of the century. In addition to having disparities in improved water and sanitation coverage and underlying rates of diarrheal illnesses, Perú has several diverse climatic zones, thus challenges in reducing diarrheal disease in light of climate change may vary widely throughout the country. Better understanding of health risks related to climate change can draw attention to the consequences changing climatic conditions and may inform methods of adaptation to such changes.
Given presentations:
In the past two decades Perú has made significant progress toward increasing access to improved water and sanitation facilities and has seen large declines in the burden of morbidity from diarrheal disease. While improved water and sanitation coverage have increased at the national level, large disparities still persist between urban and rural areas. Regions that have made substantial gains toward lowering diarrheal disease rates may have these trends slowed or reversed as climate change brings additional challenges. Temperature increases associated with climate change are expected to greatly increase the global risk of diarrhea by the end of the century. In addition to having disparities in improved water and sanitation coverage and underlying rates of diarrheal illnesses, Perú has several diverse climatic zones, thus challenges in reducing diarrheal disease in light of climate change may vary widely throughout the country. Better understanding of health risks related to climate change can draw attention to the consequences changing climatic conditions and may inform methods of adaptation to such changes.
Given presentations:
- Delahoy MJ, Carcamo C, Ordoñez L, Vasquez V, Lopman B, Clasen T, Gonzales GF, Steenland K, Levy K. Impact of rotavirus vaccination and piped water access on childhood diarrhea rates in Peru, 2005-2015. International Society for Environmental Epidemiology annual conference; 2019 Aug 25-28; Utrecht, the Netherlands. Oral presentation.
- Delahoy MJ, Carcamo C, Ordoñez L, Vasquez V, Lopman B, Clasen T, Gonzales GF, Steenland K, Levy K. Impact of rotavirus vaccination at differing levels of piped water and sewerage access: an analysis of childhood clinic visits for diarrhea in Peru, 2005-2015. 20th International Symposium on Health Related Water Microbiology. 2019 Sep 15-20; Vienna, Austria. Poster.
- Delahoy MJ, Carcamo C, Ordoñez L, Huerta A, Lavado W, Escajadillo Y, Vasquez V, Lopman B, Clasen T, Gonzales GF, Steenland K, Levy K. Association between ambient temperature and childhood diarrhea in Peru 2005-2015: pre- and post-rotavirus vaccine introduction. UNC Water & Health Conference; 2019 Oct 7-11; Chapel Hill, North Carolina. Oral presentation.
Impact of Inorganic Arsenic in Drinking Water on Adverse Birth Outcomes in Tacna, Peru
Arsenic is a semi-metallic element widely distributed in the geosphere. As other inorganic compounds, it can suffer biomodifications, especially methylations, which make it easier to be excreted from the body but still may be toxic. Arsenic-related health problems are associated with inorganic arsenic (iAs), which is known to increase the risk of different kinds of cancer, and cardio-respiratory diseases. It can to pass through the hemato-placenta barrier, potentially increasing the risk of abortions, preterm births, low birth weight, etc. Although arsenic is mainly geogenic, its levels tend to rise due to human activities like fossil fuels combustion, pesticides use, mining, etc. The city of Tacna, located in the South of Peru, is primarily a mining city, being the fourth copper producer in Peru. A previous study found levels in Tacna drinking water 5 times the recommended WHO levels. We are conducting a pilot study in Tacna to determine birth outcomes in relation to urinary arsenic. This project is made with a collaboration with our partners from the GEOHealth Hub in Suriname.
Publications:
Arsenic is a semi-metallic element widely distributed in the geosphere. As other inorganic compounds, it can suffer biomodifications, especially methylations, which make it easier to be excreted from the body but still may be toxic. Arsenic-related health problems are associated with inorganic arsenic (iAs), which is known to increase the risk of different kinds of cancer, and cardio-respiratory diseases. It can to pass through the hemato-placenta barrier, potentially increasing the risk of abortions, preterm births, low birth weight, etc. Although arsenic is mainly geogenic, its levels tend to rise due to human activities like fossil fuels combustion, pesticides use, mining, etc. The city of Tacna, located in the South of Peru, is primarily a mining city, being the fourth copper producer in Peru. A previous study found levels in Tacna drinking water 5 times the recommended WHO levels. We are conducting a pilot study in Tacna to determine birth outcomes in relation to urinary arsenic. This project is made with a collaboration with our partners from the GEOHealth Hub in Suriname.
Publications:
- Arsenic Concentrations in Household Drinking Water: A Cross-Sectional Survey of Pregnant Women in Tacna, Peru, 2019. Expo Health, 2019.
- Reproductive outcomes in pregnant women and its association with arsenic contamination in drinking water, in a region characterized by high birth weight rates in Peru [published online ahead of print, 2019 Dec 16]. J Matern Fetal Neonatal Med. 2019
