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The neighborhoods in which people live play a major role in their wellness and well-being. Many people in the United States and across the globe live in communities that have health and safety risks, such as high rates of violence, inadequate access to health care or nutritious foods, and unsafe air and water due to pollutants. In the US, people with low incomes and people of color are more likely to live in neighborhoods with these risks.1,2 Specific to toxicant exposures, approximately 73 million people in the US live within three miles of a Superfund site,3 which is a polluted location that requires a long-term response to clean up contamination. Reporting from the Environmental Protection Agency states that residents living near the sites are disproportionately communities of color or those with a lower socioeconomic status.3 In addition, according to 2010 data, more than eight million people in the US live within 1.8 miles of commercial hazardous waste facilities.4
Multiple neighborhoods are situated close to major roadways, industrial and agricultural operations, and other potential pollutant sources that may influence an individual’s daily toxicant exposure level.
According to the American Lung Association’s 2022 State of the Air report, more than 40% of people in the US live in places with unhealthy levels of air pollution, and people of color are 61% more likely than white counterparts to live in a county with a failing grade for ozone air pollution, short-term particle pollution, or year-round particle pollution.5
Studies continue to illustrate environmental exposure disparities, with certain communities and locations disproportionately exposed to toxic chemicals that increase chronic disease risk and development.6-9 How does awareness of a patient’s physical environment and their neighborhood’s health help to inform a personalized therapeutic plan or treatment approach?
Residential Location, Exposure to Pollutants, and Disease Risk
Assessing the “health” of a patient’s neighborhood may indicate their potential level of exposure to toxic chemicals and provide vital health story information to help determine root causes of chronic conditions. Observational studies have suggested that people who live close to brownfield sites (i.e., former industrial or commercial sites that may be polluted) or close to major roadways may have higher amounts of environmental toxicants in their body.10 The studies also suggest that people who live close to petrochemical industrial complexes and other industrial pollutant sources, agricultural operations, or areas with increased highway and traffic density may be at increased risk for developing certain cancers such as lung,11 breast,12 blood,13 and colorectal cancer14 as well as other chronic conditions such as respiratory, metabolic, and cardiovascular diseases.15-18
A 2022 observational study with data from 774 adult participants from the Detroit Neighborhood Health Study investigated the effect of residential proximity to brownfields, highways, and traffic on blood serum levels of heavy metals such as lead, mercury, manganese, and copper.10 Researchers found that closer proximity to brownfield sites was associated with increased serum lead and mercury, while living closer to increased highway and traffic density was positively associated with serum lead and manganese.10
In 2021, an umbrella review of meta-analyses evaluated the associations between environmental risk factors and health outcomes and included the impacts of residential location and surroundings on disease development.16 Among the reported results, living near major roadways or locations with increased traffic exposure was a suggested risk factor for type 2 diabetes in adults and leukemia in children.16 Further, residential proximity to petrochemical industrial complexes (PICs) was associated with risk of leukemia development, with one 2020 meta-analysis finding that within a maximum distance of eight kilometers, residential exposure to PICs increased leukemia risk by 36% (pooled RR=1.36, 95% CI=1.14-1.62) compared to controls, regardless of sex and age.13 A 2018 meta-analysis that included five cohort studies and one case-control study covering approximately 466,066 individuals found that residents living near PICs had a 19% higher risk of lung cancer compared to those who lived farther away (95% CI=1.06-1.32).11 Researchers noted that subgroup analyses stratified by location showed that only groups in Europe had a significantly greater risk of lung cancer with exposure to PICs; however, groups in other locations, including the US, showed positive risks, but these trends were not statistically significant.11
Recent observational studies have connected other residential locations with potential pollutant exposures and health outcome disparities. Data from the 2008-2013 Survey of the Health of Wisconsin suggested that compared to those living farther away, adults living within 35 kilometers of a coal-fired power plant may have an increased odds of worse pulmonary function as measured by an expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) ratio below 80%.19 The analysis also found that while Black individuals were 4.8% of the total sample population, they accounted for 13.3% of those living within the 35-kilometer distance.19
Potential exposure to pollutants based on residential location is a vital component to consider when receiving a patient’s health story and reflecting timeline details that may influence disease development or progression. In addition, considering the impact of a patient’s physical environment and possible toxicant exposure levels may help focus or prioritize therapeutic treatments.
A 2022 Gallup poll publication found that US adults have substantial worries about specific environmental issues such as exposure to contaminated drinking water and air pollution.20 Yet, even if patients do not immediately recognize their daily surroundings as contributors to their health, collaborative patient-practitioner conversations may help to identify potential pollutant sources and to understand a patient’s toxic exposure level and their individual circumstances. For IFM members, the Toxin Exposure Questionnaire in the IFM Toolkit is used to screen a patient’s exposure to toxicants, helps clinicians discover and assess relevant toxic exposures, and tracks a patient’s response to environment and therapeutic interventions. Public online tools such as the EPA’s Toxic Release Inventory Fact Sheet21 may help to correlate a patient’s neighborhood to pollution and exposure levels.
Assessment of a patient’s total toxic load and recognizing ongoing exposures are essential pieces of practical therapeutic treatments that prioritize the avoidance of toxicant exposures as much as possible while implementing lifestyle modifications to enhance biotransformation pathways and elimination processes. Optimizing a patient’s nutritional status, ensuring adequate fiber and water intake, eating more phytonutrient-dense and diverse foods, and supporting liver function through targeted, nutrient-dense diets such as IFM’s Detox Therapeutic Food Plan are all dietary treatment approaches that help to improve the elimination of toxic compounds and alleviate toxic burden. Supplements such as probiotics have also been highlighted in human and animal studies for their potential protective effect against the toxicity of some pollutants such as heavy metals.22-24
At IFM’s Environmental Health Advanced Practice Module (APM), learn more about how your patient’s physical environment and toxicant exposure levels may impact their health outcomes and what lifestyle-based tools may benefit their wellness path.
- Office of Disease Prevention and Health Promotion. Healthy People 2030: neighborhood and built environment. US Department of Health and Human Services. Accessed September 26, 2022. https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment
- US Environmental Protection Agency Office of Air Quality Planning and Standards Health and Environmental Impacts Division. Policy assessment for the review of the National Ambient Air Quality Standards for Particulate Matter. EPA-452/R-20-002. Environmental Protection Agency. Published January 1, 2020. Accessed September 26, 2022. https://www.epa.gov/system/files/documents/2021-10/final-policy-assessment-for-the-review-of-the-pm-naaqs-01-2020.pdf
- US Environmental Protection Agency Office of Land and Emergency Management. Population surrounding 1,857 Superfund remedial sites. Environmental Protection Agency. Updated September 2020. Accessed September 21, 2022. https://www.epa.gov/sites/default/files/2015-09/documents/webpopulationrsuperfundsites9.28.15.pdf
- Mascarenhas M, Grattet R, Mege K. Toxic waste and race in twenty-first century America: neighborhood poverty and racial composition in the siting of hazardous waste facilities. Environ Soc. 2021;12(1):108-126. doi:3167/ares.2021.120107
- American Lung Association. State of the Air 2022: key findings. Published 2022. Accessed September 21, 2022. https://www.lung.org/research/sota/key-findings#:~:text=The%20%E2%80%9CState%20of%20the%20Air,of%20particle%20pollution%20or%20ozone
- American Lung Association. Disparities in the impact of air pollution. Published April 20, 2020. Accessed September 26, 2022. https://www.lung.org/clean-air/outdoors/who-is-at-risk/disparities
- Ruiz D, Becerra M, Jagai JS, Ard K, Sargis RM. Disparities in environmental exposures to endocrine-disrupting chemicals and diabetes risk in vulnerable populations. Diabetes Care. 2018;41(1):193-205. doi:2337/dc16-2765
- Nardone A, Casey JA, Morello-Frosch R, Mujahid M, Balmes JR, Thakur N. Associations between historical residential redlining and current age-adjusted rates of emergency department visits due to asthma across eight cities in California: an ecological study. Lancet Planet Health. 2020;4(1):E24-E31. doi:1016/S2542-5196(19)30241-4
- Uche UI, Evans S, Rundquist S, Campbell C, Naidenko OV. Community-level analysis of drinking water data highlights the importance of drinking water metrics for the state, federal environmental health justice priorities in the United States. Int J Environ Res Public Health. 2021;18(19):10401. doi:3390/ijerph181910401
- Lodge EK, Guseh NS, Martin CL, et al. The effect of residential proximity to brownfields, highways, and heavy traffic on serum metal levels in the Detroit Neighborhood Health Study. Environ Adv. 2022;9:100278. doi:1016/j.envadv.2022.100278
- Lin CK, Hsu YT, Christiani DC, Hung HY, Lin RT. Risks and burden of lung cancer incidence for residential petrochemical industrial complexes: a meta-analysis and application. Environ Int. 2018;121(Pt 1):404-414. doi:1016/j.envint.2018.09.018
- VoPham T, Bertrand KA, Jones RR, et al. Dioxin exposure and breast cancer risk in a prospective cohort study. Environ Res. 2020;186:109516. doi:1016/j.envres.2020.109516
- Lin CK, Hsu YT, Brown KD, Pokharel B, Wei Y, Chen ST. Residential exposure to petrochemical industrial complexes and the risk of leukemia: a systematic review and exposure-response meta-analysis. Environ Pollut. 2020;258:113476. doi:1016/j.envpol.2019.113476
- García-Pérez J, Fernández de Larrea-Baz N, Lope V, et al. Residential proximity to industrial pollution sources and colorectal cancer risk: a multicase-control study (MCC-Spain). Environ Int. 2020;144:106055. doi:10.1016/j.envint.2020.106055
- Schultz AA, Peppard P, Gangnon RE, Malecki KMC. Residential proximity to concentrated animal feeding operations and allergic and respiratory disease. Environ Int. 2019;130:104911. doi:1016/j.envint.2019.104911
- Rojas-Rueda D, Morales-Zamora E, Alsufyani WA, et al. Environmental risk factors and health: an umbrella review of meta-analyses. Int J Environ Res Public Health. 2021;18(2):704. doi:3390/ijerph18020704
- Kulick ER, Wellenius GA, Boehme AK, Sacco RL, Elkind MS. Residential proximity to major roadways and risk of incident ischemic stroke in NOMAS (The Northern Manhattan Study). Stroke. 2018;49(4):835-841. doi:1161/STROKEAHA.117.019580
- Pang Y, Liu S, Yan L, et al. Associations of long-term exposure to traffic-related air pollution with risk of valvular heart disease based on a cross-sectional study. Ecotoxicol Environ Saf. 2021;209:111753. doi:1016/j.ecoenv.2020.111753
- Hii M, Beyer K, Namin S, Malecki K, Rublee C. Respiratory function and racial health disparities with residential proximity to coal power plants in Wisconsin. WMJ. 2022;121(2):94-105.
- Saad L. A seven-year stretch of elevated environmental concern. Gallup. Published April 5, 2022. Accessed September 21, 2022. https://news.gallup.com/poll/391547/seven-year-stretch-elevated-environmental-concern.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication
- Environmental Protection Agency. TRI national analysis: where you live. US Environmental Protection Agency. Published March 2, 2022. Accessed October 6, 2022. https://www.epa.gov/trinationalanalysis/where-you-live
- Feng P, Yang J, Zhao S, et al. Human supplementation with Pediococcus acidilactici GR-1 decreases heavy metals levels through modifying the gut microbiota and metabolome. NPJ Biofilms Microbiomes. 2022;8(1):63. doi:1038/s41522-022-00326-8
- Orisakwe OE, Amadi CN, Frazzoli C, Dokubo A. Nigerian foods of probiotics relevance and chronic metal exposure: a systematic review. Environ Sci Pollut Res Int. 2020;27(16):19285-19297. doi:1007/s11356-020-08537-2
- Feng P, Ye Z, Kakade A, Virk AK, Li X, Liu P. A review on gut remediation of selected environmental contaminants: possible roles of probiotics and gut microbiota. Nutrients. 2018;11(1):22. doi:3390/nu11010022