by tyler | Mar 24, 2023 | CNN, health
Everyone benefits when there is less air pollution, but it pays off more for older communities with high poverty rates and those where larger populations of Black people live, regardless of income, a new study finds.
The study, published Friday in the New England Journal of Medicine, looked at the connection between deaths and a type of air pollution called PM2.5.
The US Environmental Protection Agency said in January that it is trying to determine how it can best create regulations to strengthen the standards for PM2.5 pollution.
The researchers on the new study said that with that in mind, they wanted to provide policy-makers with additional evidence on how marginalized communities, which already tend to have poorer health outcomes, are disproportionately affected by air pollution.
Other studies have shown this connection for individual groups such as people of color or those with low income, but these researchers wanted to look at the effects on communities based simultaneously on socioeconomic status and race.
Fine particulate matter, or particle pollution, is the mix of solid and liquid droplets floating in the air. It can come in the form of dirt, dust, soot or smoke. Coal- and natural gas-fired power plants create it, as do cars, agriculture, unpaved roads, construction sites and wildfires.
PM2.5 has particles that are 2.5 microns or less in diameter. It’s so tiny – 1/20th the width of a human hair – that it can travel past your body’s usual defenses when you breathe it in.
Instead of being carried out of your body when you exhale, it can get stuck in your lungs or go into your bloodstream. In the short term, the pollution can irritate the eyes, nose, throat and lungs and cause coughing, sneezing or shortness of breath. Long-term, this dirty air can also cause lasting damage and lead to health conditions like obesity, cancer, stroke, heart problems, asthma, depression, anxiety and even premature death.
In 2019 alone, long-term exposure to particle pollution contributed to 4 million deaths worldwide.
For the new study, researchers analyzed Medicare data from 73 million people who were 65 or older from 2000 through 2016. They estimated the associations between annual PM2.5 exposure and mortality in communities defined by racial identity (Black vs. White) and income level (Medicaid-eligible vs. ineligible).
Everyone would benefit from cleaner air, they found, but higher- and lower-income Black people and low-income White people may benefit more from lower PM2.5 levels than higher-income White people.
The EPA is trying to determine how much stricter US air pollution safety standards should be. It’s considering lowering the standards from 12 micrograms per cubic meter to between 9 and 10 micrograms per cubic meter.
This study suggests that if the EPA were to go even further and lower the standard to 8 micrograms, the US would have a 4% reduction in overall mortality rate, study co-author Dr. Francesca Dominici, a professor of biostatistics, population and data science at the Harvard T.H. Chan School of Public Health, said.
These stricter standards would have even more advantage for Black people. The mortality rate would be 7% lower among Black people who have what the researchers defined as a “higher” income, meaning anyone who was not eligible for Medicaid, and a 6% rate reduction among Black people with a lower income. Medicaid eligibility requires earnings below the federal poverty level, which was $13,590 for a single adult and $27,750 for a family of four in 2022.
“So you’ve doubled the mortality rate rate reduction by putting more stringent standards for marginalized communities,” Dominici said. “To me, that was surprising, how much more benefit you’re going to get.”
The study can’t specifically get at the reasons for this difference, but Dominici has a few ideas.
“It’s potentially due to the social structure forces that lead to discrimination and social exclusion,” she said, rather than to biological differences.
Other studies have shown that, regardless of income or region, decades of segregation mean Black people tend to live in areas where there is greater exposure to air pollution.
This study is looking at an older population, Dominici said, meaning its participants were born when segregated neighborhoods were common.
“I think that it could be the combined effect of living through these times of being denied an equal opportunity to be healthy,” she said.
In general, Black Americans have less access to health care and higher rates of health problems, and they breathe a higher level of pollution.
“There is enormous evidence of environmental inequities in the United States, and so with more stringent pollution standards, there will be more equity,” Dominici said. “We are at a crucial time when the EPA is thinking about more stringent standards, so it will be important to think about the context involved and to really think through these decisions with regard to environmental justice, race and social class.”
by tyler | Mar 24, 2023 | CNN, health
Renee Martray of South Carolina has severe and permanent corneal scarring resulting in vision loss. She says it’s like trying to peer through eyeglasses that have been dipped in oil.
Nancy Montz of Ohio developed a corneal ulcer, spent three weeks in the hospital and lost vision in her left eye.
Carla Oliva of Florida developed a severe eye infection and, when treatment failed, had to have her right eye removed. She’s now legally blind.
The women said their problems began after they used EzriCare Artificial Tears, which is part of a US Centers for Disease Control and Prevention and US Food and Drug Administration investigation into a multistate outbreak of a rare strain of bacteria.
EzriCare said in a statement last month that when it learned of the investigation January 20, it was not aware of any testing that definitively linked the outbreak to its product.
“Nonetheless, we immediately took action to stop any further distribution or sale of EzriCare Artificial Tears. To the greatest extent possible, we have been contacting customers to advise them against continued use of the product.”
EzriCare did not respond to CNN’s request for comment this week. The artificial tears are made by India-based Global Pharma Healthcare, which issued a recall of both EzriCare and Delsam Pharma artificial tears.
Delsam Pharma’s product has not been linked to infections, but the CDC and US Food and Drug Administration have advised patients to stop using eye drops from either company pending additional guidance.
Since the start of its investigation, the CDC has identified 68 people in 16 states with infections of a rare strain of multidrug-resistant Pseudomonas aeruginosa that had never before been reported in the United States.
There have been three deaths, eight cases of vision loss and four surgical eye removals reported, according to the CDC.
The investigation started with three distinct outbreaks and no apparent connection, said Dr. Maroya Walters, public health service officer and the CDC’s lead investigator on the outbreak.
The agency was initially notified in late June 2022 about eye infections among four people at an ophthalmology clinic in California, and tests revealed the unexpected bacteria behind them, Walters said.
The bacteria had a mutation that makes it highly resistant to drugs designed to treat it. This type of drug-resistant Pseudomonas had never been associated with an eye infection, Walters said.
Walters told CNN two other infection outbreaks were reported at long-term care facilities. One involved 21 people in Connecticut in late July and another included three people in Utah in August.
Genetic sequencing in September revealed that the three bacterial strains were nearly identical, Walters said.
“The patients had very, very few overarching commonalities. They were from different kinds of facilities that had different kinds of infections,” Walters said. “We were really looking comprehensively at products that patients received but not finding a lot of commonalities.”
As the investigators were searching for a common source, eye drop users searched for answers.
Oliva, 68, says she was given EzriCare artificial tears for dry eyes from a medical center in Hialeah, Florida, in May. After using the drops for two months, she woke up August 1 with burning, itchiness, redness and tearing in her right eye.
She went to an ophthalmologist, who said she had a corneal scratch and prescribed antibiotics, but her symptoms just got worse. She then went to Bascom Palmer Eye Institute, where physicians discovered a large ulcer associated with Pseudomonas aeruginosa.
Oliva says she went to Bascom Palmer every day from August 4 to September 1 to receive topical antibiotics. They also tried stronger and stronger medications, but the infection persisted.
Doctors attempted to do a cornea transplant August 29, but the infection was too severe to save the eye. It was surgically removed September 1 and replaced with a plastic implant at the end of December.
She spent months wondering what happened.
“I cried constantly, asking why this happened to me. How could this have happened to me? I was searching for an answer: What happened to me? At what moment? How? When? What did I do?” she told CNN in Spanish. “And to not have an answer, that is the most terrible thing.”
But because she didn’t know about the investigation until after she lost her eye, she continued to use the drops.
Martray, 48, also had dry eyes and bought the artificial tears at a store in South Carolina last summer. After using them for about a month, she began having pain, swelling, burning, blurry vision, watering and redness.
She went to an eye doctor and got antibiotics to try to treat the infection. But she continued to use the drops until October.
In December, the infection returned. She says she went to the clinic every day, including Christmas Eve and Christmas Day. She was eventually diagnosed with severe, permanent corneal scarring.
She says her condition left her “very depressed.”
“When it first came about, I just didn’t even want to leave the house. I just laid around and cried. I just wanted to get better,” she said.
Similar cases were being reported across the country. According to a statement released January 20 from the CDC, from May 17 to January 19, the agency, in partnership with state and local health departments, identified the bacteria in 50 people across 11 states, with 38 cases linked to four health care facility outbreaks.
Most of the people reported using artificial tears, the CDC said, and EzriCare Artificial Tears was the brand most commonly reported.
The agency’s lab testing confirmed the presence of the outbreak strain in opened eye drop bottles. Researchers are now testing unopened bottles for the same bacteria.
Walters attributes the discovery in large part to sequencing and reporting done at state and local health departments.
“I think without that, we never would have found this outbreak, and we need to really keep those programs strong, because I’m sure this is not the last time,” she said. “We need to maintain these activities to be able to detect future outbreaks and to be even faster at detecting them and finding the source.”
Walters says the CDC continues to receive reports of “catastrophic and life-altering infections,” many of them months old.
Oliva said she learned about the eye drop recall on the news early this year. At first, she felt relieved.
“On the other hand, I felt anger and indignation, because how could they be so negligent, so careless to make a product that could cost someone’s life?” said Oliva, who has filed a lawsuit against several companies including EzriCare and Global Pharma.
She says she’s had to learn how to walk again due to new issues with stability. She has trouble driving, working or doing everyday tasks like going to the grocery store.
“Everything has changed. I feel useless.”
Martray, who has also filed a lawsuit against several companies including EzriCare and Global Pharma, said she learned about the bacteria from news articles her daughter sent her.
“I’m really shocked, because I’ve always just – I just trusted,” she said. “I feel that if they’re made for the eyes and the box is sealed and everything, it’s good. I never thought that something like that could happen. They were sealed bottle drops. You just grab them, you put them in your eyes, you don’t even think twice about it. Especially when you’ve been wearing contacts since sixth grade.”
EzriCare and Global Pharma did not respond to requests for comment on the lawsuits or the ongoing investigation. CNN initially reached out to EzriCare on March 17.
Montz, 72, had used EzriCare tears for about a week in November when she started noticing blurry vision. One morning, she woke to find yellow discharge on her pillow. She went to the emergency room, where doctors discovered a large ulcer on her left cornea, involving nearly the entire eye.
She spent three weeks in the hospital, where she got antibiotics and multiple surgeries. Her case was complicated by a serous choroidal detachment, an abnormal accumulation of fluid, which ultimately led to vision loss in the left eye.
She said she’s learning to accept her situation and feels “pretty good” despite weeks of treatment.
“It is what it is. Me being crabby is not going to change anything, I have to make the best of it, accept it and go on,” she said.
Martray says she’s been having frequent migraines from straining her eyes and can no longer do many things she previously enjoyed, like baking or crafts.
“You don’t realize how much you rely on your vision for, I mean, just everything. Your vision is everything,” she said.
Oliva wants accountability for what happened to her and others.
“I want those responsible for doing this to me and other people to pay for their negligence, because they were negligent. They marketed something that was contaminated,” she said. “They played with my life and my family’s life.”
by tyler | Mar 23, 2023 | CNN, health
The rate of children diagnosed with autism in the United States has been growing steadily since 2000, but two new reports from the US Centers for Disease Control and Prevention highlight disparities in the types of children identified to have autism spectrum disorder and setbacks in early detection.
In 2020, about 1 in 36 children had been diagnosed with autism by age 8, according to the CDC – about 2.8%. That’s up from a prevalence of 1 in 44 children in 2018 and 1 in 150 children in 2000.
But according to the CDC, this long-term trend has “largely been interpreted as improvements in more equitable identification of (autism spectrum disorder), particularly for children in groups that have less access or face greater barriers in obtaining services.”
For the first time, diagnosis was more common among Asian, Black and Hispanic children than it was among White children. The CDC researchers note that this shift “may reflect improved screening, awareness, and access to services among historically underserved groups.” In fact, between 2018 and 2020, autism prevalence rose more than twice as fast among Asian, Black and Hispanic children than it did among White children.
These findings are based on surveillance data from 11 communities that participate in the CDC’s Autism and Developmental Disabilities Monitoring Network. The data are not nationally representative and vary widely by location – from a prevalence of 1 in 22 children in California to about half as many in Maryland. The CDC says more research is needed to understand this variation, which could be related to differences in the strategies used to identify and diagnose the condition.
Still, some trends have stayed consistent.
Autism prevalence is significantly higher among boys than girls – in 2020, there was about a four-fold difference. But it was the first year that more than 1% of 8-year-old girls had been diagnosed with autism.
Also, disparities persist in identifying autism in children who also have an intellectual disability. In 2020, more than half of Black children diagnosed with autism also had an intellectual disability, compared with less than a third of White children. According to the researchers, this finding suggests a need to better detect and evaluate developmental concerns beyond cognitive ability.
Generally, children who have intellectual disabilities are more likely to be diagnosed with autism earlier. But early detection is important for all children with autism, as it helps connect them with helpful resources and interventions.
In recent years, good progress had been made in early detection of autism – an earlier CDC report found that children born in 2014 were 50% more likely to receive an autism diagnosis or special education by age 4 than those born in 2010.
Another new report published by the CDC on Thursday shows that there was evidence of continued improvement in these trends through February 2020, but the trends reversed as the Covid-19 pandemic hit with “sustained lower levels” of evaluations and identification of autism across most of the surveillance network.
In first six months of the pandemic, there were 217 fewer evaluations for every 1,000 children at age 4 than there were four years earlier. There were also nearly three fewer identifications for every 10,000 children, according to the CDC report.
“Disruptions due to the pandemic in the timely evaluation of children and delays in connecting children to the services and support they need could have long-lasting effects,” said Dr. Karen Remley, director of CDC’s National Center on Birth Defects and Developmental Disabilities. “The data in this report can help communities better understand how the pandemic impacted early identification of autism in young children and anticipate future needs as these children get older.”
