Regionalization of the Mortality Risk from Cardiomyopathy and Respiratory Diseases Based on the Maximum Entropy Model

Our plain-English summary of Regionalization of the Mortality Risk from Cardiomyopathy and Respiratory Diseases Based on the Maximum Entropy Model, by R. Ordoñez-Sierra, G. Domínguez-Cortinas, I.Y. Hernández-Paniagua, et al (Global Health, Epidemiology and Genomics, 2024).

The study

• Authors: R. Ordoñez-Sierra, G. Domínguez-Cortinas, I.Y. Hernández-Paniagua, J.L. Expósito-Castillo, M.A. Gómez-Albores, M.G. Rodríguez-Reyes, B.V. Carrasco-Gallegos, L.R. Manzano-Solís
• Journal: Global Health, Epidemiology and Genomics
• Published: 2024;2024:6103589
• Read it: PubMed · Publisher · Free full text

Abstract

This research presents a time-series study in one of the most polluted regions in Mexico, the southern part of the Mezquital Valley. Three mortality causes related to areas highly contaminated by industrial activities were considered to carry out this model, namely, ischemic cardiomyopathy, mesothelioma, and pneumoconiosis. The pollutant exposure factors used in the maximum entropy modeling were distance to rivers, distance to industries, particulate matter less than 2.5 microns (PM < 2.5 µm), and the digital elevation model (DEM). A model that expresses the presence of the disease by areas of exposure to pollutants was also obtained. In addition, the odds ratio was calculated to evaluate the level of association of ischemic cardiomyopathy (OR = 3.37 and 95% CI: 3.05-3.6) and mesothelioma (OR = 4.79 and 95% CI: 3.5-6.08) by areas of exposure. In the case of pneumoconiosis, only cases in the very high exposure category were recorded, so it was not comparable with the remaining areas. It is important to mention that particulate matter in the municipalities of the Mezquital Valley presented values above 20 μg/m3 and that in accordance with the provisions of the Norma Oficial Mexicana de Salud Ambiental or NOM (translated as Mexican Official Standard for Environmental Health) and the Agency for Toxic Substances and the Disease Registry (ATSDR), high concentrations of particulate matter can have a severe impact on the development of some diseases. In the studied area, ischemic cardiomyopathy and mesothelioma were attributed to pollution in 70.3% and 79.1%, respectively; therefore, pollution mitigation could prevent the occurrence of these two diseases.

Copyright © 2024 Raymundo Ordoñez-Sierra et al.

In plain English

This study mapped deaths in four municipalities of the southern Mezquital Valley, Mexico, using Ministry of Health death records. The authors compared local with national death rates. They then applied a mapping method called maximum entropy modeling to deaths from 2013 to 2020, using distance to rivers, distance to industries, fine particulate matter (PM2.5) and elevation as pollution factors. Asbestos itself was not measured. There were 13 mesothelioma deaths (2.5 per 100,000), 201 ischemic cardiomyopathy deaths and 5 pneumoconiosis deaths. The mesothelioma death rate was 4.72 per 100,000 in the highest exposure zone, against 1.04 in the medium zone and 0.88 in the low zone. The odds ratio for the highest zone versus the other two zones was 4.79 (95% CI 3.50 to 6.08). All pneumoconiosis deaths fell in the highest zone, so no comparison was possible. The authors suggested that asbestos linked to industrial activity might explain the mesothelioma pattern. They concluded that mesothelioma and ischemic cardiomyopathy were distributed in association with polluted rivers and industries. They noted that the death records lacked clinical details, which made confounding factors hard to rule out.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Ecological spatial study of death records. It compared local and national mortality rates, modeled exposure zones with the MaxEnt maximum entropy algorithm, and compared death rates between zones using odds ratios and attributable risk.
• Who was studied: Deaths recorded by the Ministry of Health in four municipalities of the RESA region of the southern Mezquital Valley, Mexico: Atitalaquia, Atotonilco de Tula, Tula de Allende and Apaxco. Municipal-level rates covered 2000 to 2020; locality-level analysis covered 2013 to 2020.
• Exposure: Environmental pollution factors used in the model: distance to rivers, distance to industries (refineries, thermoelectric and cement plants, textile-related microindustries), PM2.5 and elevation. No asbestos exposure was measured; asbestos appears only in the authors' interpretation.
• Main results:
  • Compared with national rates, the mortality rate ratio for the study area was 3.1 for ischemic cardiomyopathy, 2.3 for mesothelioma and 3.7 for pneumoconiosis.
  • For 2013 to 2020, the death rate per 100,000 was 38.9 for ischemic cardiomyopathy (201 deaths), 2.5 for mesothelioma (13 deaths) and 0.96 for pneumoconiosis (5 deaths).
  • The models had AUC values of 0.82 for ischemic cardiomyopathy and 0.85 for mesothelioma.
  • In the mesothelioma model, distance to rivers contributed 63.5% and distance to industries 30.1%. The authors suggested the industry link may be due to asbestos exposure associated with industrial activity.
  • Mesothelioma death rates per 100,000 were 4.72 in the very high exposure zone, 1.04 in the medium exposure zone and 0.88 in the low exposure zone.
  • For mesothelioma, the odds ratio for the very high exposure zone versus the medium and low exposure zones was 4.79 (95% CI 3.50 to 6.08).
  • For mesothelioma, the odds ratio for the high exposure zone versus the low exposure zone was 5.35 (95% CI 3.29 to 7.40).
  • Versus the medium exposure zone, the high exposure zone had an odds ratio of 2.49 (95% CI 2.16 to 2.83) for ischemic cardiomyopathy and 4.52 (95% CI 3.0 to 6.04) for mesothelioma.
  • For ischemic cardiomyopathy, the odds ratio for the high exposure zone versus the medium and low zones was 4.03 (95% CI 3.72 to 4.33).
  • Attributable risk for the very high exposure zone was 89% (ischemic cardiomyopathy) and 81% (mesothelioma) versus the low zone, and 75% and 79% versus the medium and low zones.
  • All pneumoconiosis deaths occurred in the zone of greatest exposure, so zones could not be compared for this disease.
• The authors' conclusion: The authors concluded that ischemic cardiomyopathy and mesothelioma showed a distribution associated with the main pollution sources, such as polluted rivers and bodies of water and industries, and that reducing pollution could prevent these two diseases.
• Limitations the authors state:
  • The official health records do not specify the clinical characteristics by which the diseases were acquired, so confounding factors are hard to distinguish and more detailed studies are needed.
  • The satellite-based PM2.5 estimates could not be checked against local measurements, because the two monitoring stations in the area had limited data.
  • The locality-level analysis was limited to 2013 to 2020 because of data availability.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pneumoconiosis, Odds Ratio, ATSDR.

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