Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2001 Mar;56(3):228–233. doi: 10.1136/thorax.56.3.228

Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales

P Aylin 1, A Bottle 1, J Wakefield 1, L Jarup 1, P Elliott 1
PMCID: PMC1758773  PMID: 11182017

Abstract

BACKGROUND—The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated.
METHODS—A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age.
RESULTS—At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma.
CONCLUSIONS—No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.



Full Text

The Full Text of this article is available as a PDF (158.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bhopal R. S., Moffatt S., Pless-Mulloli T., Phillimore P. R., Foy C., Dunn C. E., Tate J. A. Does living near a constellation of petrochemical, steel, and other industries impair health? Occup Environ Med. 1998 Dec;55(12):812–822. doi: 10.1136/oem.55.12.812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bhopal R. S., Phillimore P., Moffatt S., Foy C. Is living near a coking works harmful to health? A study of industrial air pollution. J Epidemiol Community Health. 1994 Jun;48(3):237–247. doi: 10.1136/jech.48.3.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cummins R. O., Jarman B., White P. M. Do general practitioners have different "referral thresholds"? Br Med J (Clin Res Ed) 1981 Mar 28;282(6269):1037–1039. doi: 10.1136/bmj.282.6269.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Diggle P., Elliott P. Disease risk near point sources: statistical issues for analyses using individual or spatially aggregated data. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S20–S27. doi: 10.1136/jech.49.suppl_2.s20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dockery D. W., Pope C. A., 3rd, Xu X., Spengler J. D., Ware J. H., Fay M. E., Ferris B. G., Jr, Speizer F. E. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993 Dec 9;329(24):1753–1759. doi: 10.1056/NEJM199312093292401. [DOI] [PubMed] [Google Scholar]
  6. Dolk H., Pattenden S., Vrijheid M., Thakrar B., Armstrong B. Perinatal and infant mortality and low birth weight among residents near cokeworks in Great Britain. Arch Environ Health. 2000 Jan-Feb;55(1):26–30. doi: 10.1080/00039890009603381. [DOI] [PubMed] [Google Scholar]
  7. Dolk H., Thakrar B., Walls P., Landon M., Grundy C., Sáez Lloret I., Wilkinson P., Elliott P. Mortality among residents near cokeworks in Great Britain. Occup Environ Med. 1999 Jan;56(1):34–40. doi: 10.1136/oem.56.1.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Elliott P., Shaddick G., Kleinschmidt I., Jolley D., Walls P., Beresford J., Grundy C. Cancer incidence near municipal solid waste incinerators in Great Britain. Br J Cancer. 1996 Mar;73(5):702–710. doi: 10.1038/bjc.1996.122. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Jones A. P., Bentham G. Health service accessibility and deaths from asthma in 401 local authority districts in England and Wales, 1988-92. Thorax. 1997 Mar;52(3):218–222. doi: 10.1136/thx.52.3.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Katsouyanni K., Touloumi G., Spix C., Schwartz J., Balducci F., Medina S., Rossi G., Wojtyniak B., Sunyer J., Bacharova L. Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Air Pollution and Health: a European Approach. BMJ. 1997 Jun 7;314(7095):1658–1663. doi: 10.1136/bmj.314.7095.1658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Majeed F. A., Chaturvedi N., Reading R., Ben-Shlomo Y. Equity in the NHS. Monitoring and promoting equity in primary and secondary care. BMJ. 1994 May 28;308(6941):1426–1429. doi: 10.1136/bmj.308.6941.1426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. McKee M. Routine data: a resource for clinical audit? Qual Health Care. 1993 Jun;2(2):104–111. doi: 10.1136/qshc.2.2.104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Michelozzi P., Fusco D., Forastiere F., Ancona C., Dell'Orco V., Perucci C. A. Small area study of mortality among people living near multiple sources of air pollution. Occup Environ Med. 1998 Sep;55(9):611–615. doi: 10.1136/oem.55.9.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Moffatt S., Phillimore P., Bhopal R., Foy C. 'If this is what it's doing to our washing, what is it doing to our lungs?' Industrial pollution and public understanding in north-east England. Soc Sci Med. 1995 Sep;41(6):883–891. doi: 10.1016/0277-9536(94)00380-c. [DOI] [PubMed] [Google Scholar]
  15. Payne J. N., Coy J., Patterson S., Milner P. C. Is use of hospital services a proxy for morbidity? A small area comparison of the prevalence of arthritis, depression, dyspepsia, obesity, and respiratory disease with inpatient admission rates for these disorders in England. J Epidemiol Community Health. 1994 Feb;48(1):74–78. doi: 10.1136/jech.48.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Phillimore P. R., Morris D. Discrepant legacies: premature mortality in two industrial towns. Soc Sci Med. 1991;33(2):139–152. doi: 10.1016/0277-9536(91)90174-b. [DOI] [PubMed] [Google Scholar]
  17. Pless-Mulloli T., Dunn C. E., Bhopal R., Phillimore P., Moffatt S., Edwards J. Is it feasible to construct a community profile of exposure to industrial air pollution? Occup Environ Med. 2000 Aug;57(8):542–549. doi: 10.1136/oem.57.8.542. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pless-Mulloli T., Phillimore P., Moffatt S., Bhopal R., Foy C., Dunn C., Tate J. Lung cancer, proximity to industry, and poverty in northeast England. Environ Health Perspect. 1998 Apr;106(4):189–196. doi: 10.1289/ehp.98106189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Pope C. A., 3rd, Bates D. V., Raizenne M. E. Health effects of particulate air pollution: time for reassessment? Environ Health Perspect. 1995 May;103(5):472–480. doi: 10.1289/ehp.95103472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Pope C. A., 3rd, Thun M. J., Namboodiri M. M., Dockery D. W., Evans J. S., Speizer F. E., Heath C. W., Jr Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):669–674. doi: 10.1164/ajrccm/151.3_Pt_1.669. [DOI] [PubMed] [Google Scholar]
  21. Royston G. H., Hurst J. W., Lister E. G., Stewart P. A. Modelling the use of health services by populations of small areas to inform the allocation of central resources to larger regions. Socioecon Plann Sci. 1992 Jul;26(3):169–180. doi: 10.1016/0038-0121(92)90008-s. [DOI] [PubMed] [Google Scholar]
  22. Schwartz J., Dockery D. W. Increased mortality in Philadelphia associated with daily air pollution concentrations. Am Rev Respir Dis. 1992 Mar;145(3):600–604. doi: 10.1164/ajrccm/145.3.600. [DOI] [PubMed] [Google Scholar]
  23. Schwartz J. Particulate air pollution and daily mortality in Detroit. Environ Res. 1991 Dec;56(2):204–213. doi: 10.1016/s0013-9351(05)80009-x. [DOI] [PubMed] [Google Scholar]
  24. Shaddick G., Elliott P. Use of Stone's method in studies of disease risk around point sources of environmental pollution. Stat Med. 1996 Sep 15;15(17-18):1927–1934. doi: 10.1002/(sici)1097-0258(19960930)15:18<1927::aid-sim405>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  25. Stedman J. R., Anderson H. R., Atkinson R. W., Maynard R. L. Emergency hospital admissions for respiratory disorders attributable to summer time ozone episodes in Great Britain. Thorax. 1997 Nov;52(11):958–963. doi: 10.1136/thx.52.11.958. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Walters S., Phupinyokul M., Ayres J. Hospital admission rates for asthma and respiratory disease in the West Midlands: their relationship to air pollution levels. Thorax. 1995 Sep;50(9):948–954. doi: 10.1136/thx.50.9.948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Whitehead A., Whitehead J. A general parametric approach to the meta-analysis of randomized clinical trials. Stat Med. 1991 Nov;10(11):1665–1677. doi: 10.1002/sim.4780101105. [DOI] [PubMed] [Google Scholar]
  28. Wilkinson P., Thakrar B., Walls P., Landon M., Falconer S., Grundy C., Elliott P. Lymphohaematopoietic malignancy around all industrial complexes that include major oil refineries in Great Britain. Occup Environ Med. 1999 Sep;56(9):577–580. doi: 10.1136/oem.56.9.577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Williams D. R., Anthony P., Young R. J., Tomlinson S. Interpreting hospital admissions data across the Körner divide: the example of diabetes in the north western region. Diabet Med. 1994 Mar;11(2):166–169. doi: 10.1111/j.1464-5491.1994.tb02014.x. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES