Acute cardiovascular health effects in a panel study of personal exposure to traffic-related air pollutants and noise in Toronto, Canada.


Journal

Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288

Informations de publication

Date de publication:
07 10 2020
Historique:
received: 08 05 2020
accepted: 10 09 2020
entrez: 8 10 2020
pubmed: 9 10 2020
medline: 15 12 2020
Statut: epublish

Résumé

Urban populations are often simultaneously exposed to air pollution and environmental noise, which are independently associated with cardiovascular disease. Few studies have examined acute physiologic responses to both air and noise pollution using personal exposure measures. We conducted a repeated measures panel study of air pollution and noise in 46 non-smoking adults in Toronto, Canada. Data were analyzed using linear mixed-effects models and weighted cumulative exposure modeling of recent exposure. We examined acute changes in cardiovascular health effects of personal (ultrafine particles, black carbon) and regional (PM

Identifiants

pubmed: 33028877
doi: 10.1038/s41598-020-73412-6
pii: 10.1038/s41598-020-73412-6
pmc: PMC7541521
doi:

Substances chimiques

Air Pollutants 0
Vehicle Emissions 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

16703

Références

Naghavi, M. et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 390, 1151–1210. https://doi.org/10.1016/s0140-6736(17)32152-9 (2017).
doi: 10.1016/s0140-6736(17)32152-9
2WHO. Ambient Air Pollution: A Global Assessment of Exposure and Burden of Disease (Geneva, Switzerland, 2016).
Munzel, T., Gori, T., Babisch, W. & Basner, M. Cardiovascular effects of environmental noise exposure. Eur. Heart J. 35, 829–836. https://doi.org/10.1093/eurheartj/ehu030 (2014).
doi: 10.1093/eurheartj/ehu030 pubmed: 24616334 pmcid: 3971384
Munzel, T. et al. The adverse effects of environmental noise exposure on oxidative stress and cardiovascular risk. Antioxid. Redox Signal. 28, 873–908. https://doi.org/10.1089/ars.2017.7118 (2018).
doi: 10.1089/ars.2017.7118 pubmed: 29350061 pmcid: 5898791
Babisch, W. Cardiovascular effects of noise. Noise & health 13, 201–204. https://doi.org/10.4103/1463-1741.80148 (2011).
doi: 10.4103/1463-1741.80148
Sorensen, M. et al. Road traffic noise and incident myocardial infarction: a prospective cohort study. PLoS ONE 7, e39283. https://doi.org/10.1371/journal.pone.0039283 (2012).
doi: 10.1371/journal.pone.0039283 pubmed: 22745727 pmcid: 3380019
Sorensen, M. et al. Long-term exposure to road traffic noise and nitrogen dioxide and risk of heart failure: a cohort study. Environ. Health Perspect. 125, 097021. https://doi.org/10.1289/ehp1272 (2017).
doi: 10.1289/ehp1272 pubmed: 28953453 pmcid: 5915207
Gan, W. Q., Davies, H. W., Koehoorn, M. & Brauer, M. Association of long-term exposure to community noise and traffic-related air pollution with coronary heart disease mortality. Am. J. Epidemiol. 175, 898–906. https://doi.org/10.1093/aje/kwr424 (2012).
doi: 10.1093/aje/kwr424 pubmed: 22491084
Hoffmann, B. et al. Residential traffic exposure and coronary heart disease: results from the Heinz Nixdorf Recall Study. Biomark. Biochem. Indic. Exposure Response Susceptibility Chem. 14(Suppl 1), 74–78. https://doi.org/10.1080/13547500902965096 (2009).
doi: 10.1080/13547500902965096
Weichenthal, S. Selected physiological effects of ultrafine particles in acute cardiovascular morbidity. Environ. Res. 115, 26–36. https://doi.org/10.1016/j.envres.2012.03.001 (2012).
doi: 10.1016/j.envres.2012.03.001 pubmed: 22465230
Buteau, S. & Goldberg, M. S. A structured review of panel studies used to investigate associations between ambient air pollution and heart rate variability. Environ. Res. 148, 207–247. https://doi.org/10.1016/j.envres.2016.03.013 (2016).
doi: 10.1016/j.envres.2016.03.013 pubmed: 27085495
Magalhaes, S., Baumgartner, J. & Weichenthal, S. Impacts of exposure to black carbon, elemental carbon, and ultrafine particles from indoor and outdoor sources on blood pressure in adults: a review of epidemiological evidence. Environ. Res. 161, 345–353. https://doi.org/10.1016/j.envres.2017.11.030 (2018).
doi: 10.1016/j.envres.2017.11.030 pubmed: 29195183
Munzel, T. et al. Effects of gaseous and solid constituents of air pollution on endothelial function. Eur. Heart J. 39, 3543–3550. https://doi.org/10.1093/eurheartj/ehy481 (2018).
doi: 10.1093/eurheartj/ehy481 pubmed: 30124840 pmcid: 6174028
Zuurbier, M. et al. Commuters’ exposure to particulate matter air pollution is affected by mode of transport, fuel type, and route. Environ. Health Perspect. 118, 783–789. https://doi.org/10.1289/ehp.0901622 (2010).
doi: 10.1289/ehp.0901622 pubmed: 20185385 pmcid: 2898854
Peretz, A. et al. Diesel exhaust inhalation elicits acute vasoconstriction in vivo. Environ. Health Perspect. 116, 937–942. https://doi.org/10.1289/ehp.11027 (2008).
doi: 10.1289/ehp.11027 pubmed: 18629317 pmcid: 2453163
Pitchika, A. et al. Long-term associations of modeled and self-reported measures of exposure to air pollution and noise at residence on prevalent hypertension and blood pressure. Sci. Total Environ. 593–594, 337–346. https://doi.org/10.1016/j.scitotenv.2017.03.156 (2017).
doi: 10.1016/j.scitotenv.2017.03.156 pubmed: 28346907
Zijlema, W. et al. Road traffic noise, blood pressure and heart rate: pooled analyses of harmonized data from 88,336 participants. Environ. Res. 151, 804–813. https://doi.org/10.1016/j.envres.2016.09.014 (2016).
doi: 10.1016/j.envres.2016.09.014 pubmed: 27692672
Chang, L. T. et al. Short-term exposure to noise, fine particulate matter and nitrogen oxides on ambulatory blood pressure: a repeated-measure study. Environ. Res. 140, 634–640. https://doi.org/10.1016/j.envres.2015.06.004 (2015).
doi: 10.1016/j.envres.2015.06.004 pubmed: 26073201
Roswall, N. et al. Long-term residential road traffic noise and NO2 exposure in relation to risk of incident myocardial infarction—a Danish cohort study. Environ. Res. 156, 80–86. https://doi.org/10.1016/j.envres.2017.03.019 (2017).
doi: 10.1016/j.envres.2017.03.019 pubmed: 28334645
Tonne, C. et al. Long-term traffic air and noise pollution in relation to mortality and hospital readmission among myocardial infarction survivors. Int. J. Hyg. Environ. Health 219, 72–78. https://doi.org/10.1016/j.ijheh.2015.09.003 (2016).
doi: 10.1016/j.ijheh.2015.09.003 pubmed: 26454658
Heritier, H. et al. A systematic analysis of mutual effects of transportation noise and air pollution exposure on myocardial infarction mortality: a nationwide cohort study in Switzerland. Eur. Heart J. 40, 598–603. https://doi.org/10.1093/eurheartj/ehy650 (2019).
doi: 10.1093/eurheartj/ehy650 pubmed: 30357335
Boogaard, H., Borgman, F., Kamminga, J. & Hoek, G. Exposure to ultrafine and fine particles and noise during cycling and driving in 11 Dutch cities. Atmos. Environ. 43, 4234–4242 (2009).
doi: 10.1016/j.atmosenv.2009.05.035
Sears, C. G. et al. The association of traffic-related air and noise pollution with maternal blood pressure and hypertensive disorders of pregnancy in the HOME study cohort. Environ Int 121, 574–581. https://doi.org/10.1016/j.envint.2018.09.049 (2018).
doi: 10.1016/j.envint.2018.09.049 pubmed: 30300815 pmcid: 6252254
Peters, A. et al. Elevated particle number concentrations induce immediate changes in heart rate variability: a panel study in individuals with impaired glucose metabolism or diabetes. Particle Fibre Toxicol. 12, 7. https://doi.org/10.1186/s12989-015-0083-7 (2015).
doi: 10.1186/s12989-015-0083-7
Hampel, R. et al. Impact of personally measured pollutants on cardiac function. Int. J. Hyg. Environ. Health 217, 460–464. https://doi.org/10.1016/j.ijheh.2013.09.002 (2014).
doi: 10.1016/j.ijheh.2013.09.002 pubmed: 24231411
Gong, J. et al. Comparisons of ultrafine and fine particles in their associations with biomarkers reflecting physiological pathways. Environ. Sci. Technol. 48, 5264–5273. https://doi.org/10.1021/es5006016 (2014).
doi: 10.1021/es5006016 pubmed: 24666379 pmcid: 4015680
Kubesch, N. et al. Arterial blood pressure responses to short-term exposure to low and high traffic-related air pollution with and without moderate physical activity. Eur. J. Prev. Cardiol. 22, 548–557. https://doi.org/10.1177/2047487314555602 (2015).
doi: 10.1177/2047487314555602 pubmed: 25326542
Olsen, Y. et al. Vascular and lung function related to ultrafine and fine particles exposure assessed by personal and indoor monitoring: a cross-sectional study. Environ. Health 13, 112. https://doi.org/10.1186/1476-069x-13-112 (2014).
doi: 10.1186/1476-069x-13-112 pubmed: 25512042 pmcid: 4290094
Rich, D. Q. et al. Are ambient ultrafine, accumulation mode, and fine particles associated with adverse cardiac responses in patients undergoing cardiac rehabilitation?. Environ. Health Perspect. 120, 1162–1169. https://doi.org/10.1289/ehp.1104262 (2012).
doi: 10.1289/ehp.1104262 pubmed: 22542955 pmcid: 3440073
Weichenthal, S. et al. Traffic-related air pollution and acute changes in heart rate variability and respiratory function in urban cyclists. Environ. Health Perspect. 119, 1373–1378. https://doi.org/10.1289/ehp.1003321 (2011).
doi: 10.1289/ehp.1003321 pubmed: 21672679 pmcid: 3230442
Vora, R. et al. Inhalation of ultrafine carbon particles alters heart rate and heart rate variability in people with type 2 diabetes. Particle Fibre Toxicol. 11, 31. https://doi.org/10.1186/s12989-014-0031-y (2014).
doi: 10.1186/s12989-014-0031-y
Weichenthal, S., Hatzopoulou, M. & Goldberg, M. S. Exposure to traffic-related air pollution during physical activity and acute changes in blood pressure, autonomic and micro-vascular function in women: a cross-over study. Particle Fibre Toxicol. 11, 70. https://doi.org/10.1186/s12989-014-0070-4 (2014).
doi: 10.1186/s12989-014-0070-4
Weichenthal, S. et al. Personal exposure to specific volatile organic compounds and acute changes in lung function and heart rate variability among urban cyclists. Environ. Res. 118, 118–123. https://doi.org/10.1016/j.envres.2012.06.005 (2012).
doi: 10.1016/j.envres.2012.06.005 pubmed: 22776327
Mills, N. L. et al. Diesel exhaust inhalation causes vascular dysfunction and impaired endogenous fibrinolysis. Circulation 112, 3930–3936. https://doi.org/10.1161/circulationaha.105.588962 (2005).
doi: 10.1161/circulationaha.105.588962 pubmed: 16365212
Lee, M. S. et al. Effects of personal exposure to ambient fine particulate matter on acute change in nocturnal heart rate variability in subjects without overt heart disease. Am. J. Cardiol. 117, 151–156. https://doi.org/10.1016/j.amjcard.2015.10.015 (2016).
doi: 10.1016/j.amjcard.2015.10.015 pubmed: 26552502
Tornqvist, H. et al. Persistent endothelial dysfunction in humans after diesel exhaust inhalation. Am. J. Respir. Crit. Care Med. 176, 395–400. https://doi.org/10.1164/rccm.200606-872OC (2007).
doi: 10.1164/rccm.200606-872OC pubmed: 17446340
Devlin, R. B. et al. Controlled exposure of humans with metabolic syndrome to concentrated ultrafine ambient particulate matter causes cardiovascular effects. Toxicol. Sci. Off. J. Soc. Toxicol. 140, 61–72. https://doi.org/10.1093/toxsci/kfu063 (2014).
doi: 10.1093/toxsci/kfu063
Cole-Hunter, T. et al. Impact of traffic-related air pollution on acute changes in cardiac autonomic modulation during rest and physical activity: a cross-over study. J. Eposure Sci. Environ. Epidemiol. 26, 133–140. https://doi.org/10.1038/jes.2015.66 (2016).
doi: 10.1038/jes.2015.66
Sarnat, J. A. et al. Exposure to traffic pollution, acute inflammation and autonomic response in a panel of car commuters. Environ. Res. 133, 66–76. https://doi.org/10.1016/j.envres.2014.05.004 (2014).
doi: 10.1016/j.envres.2014.05.004 pubmed: 24906070 pmcid: 4807398
Morishita, M. et al. Acute blood pressure and cardiovascular effects of near-roadway exposures with and without N95 respirators. Am. J. Hypertens. 32, 1054–1065. https://doi.org/10.1093/ajh/hpz113 (2019).
doi: 10.1093/ajh/hpz113 pubmed: 31350540
Moshammer, H. et al. Acute effects of air pollution and noise from road traffic in a panel of young healthy adults. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph16050788 (2019).
doi: 10.3390/ijerph16050788 pubmed: 31877767 pmcid: 6981699
Rundell, K. W., Hoffman, J. R., Caviston, R., Bulbulian, R. & Hollenbach, A. M. Inhalation of ultrafine and fine particulate matter disrupts systemic vascular function. Inhalation Toxicol. 19, 133–140. https://doi.org/10.1080/08958370601051727 (2007).
doi: 10.1080/08958370601051727
Brook, R. D. et al. Extreme air pollution conditions adversely affect blood pressure and insulin resistance: the air pollution and cardiometabolic disease study. Hypertension (Dallas, Tx, 1979) 67, 77–85. https://doi.org/10.1161/hypertensionaha.115.06237 (2016).
doi: 10.1161/hypertensionaha.115.06237
Kraus, U. et al. Individual daytime noise exposure during routine activities and heart rate variability in adults: a repeated measures study. Environ. Health Perspect. 121, 607–612. https://doi.org/10.1289/ehp.1205606 (2013).
doi: 10.1289/ehp.1205606 pubmed: 23512292 pmcid: 3672128
Walker, E. D., Brammer, A., Cherniack, M. G., Laden, F. & Cavallari, J. M. Cardiovascular and stress responses to short-term noise exposures-a panel study in healthy males. Environ. Res. 150, 391–397. https://doi.org/10.1016/j.envres.2016.06.016 (2016).
doi: 10.1016/j.envres.2016.06.016 pubmed: 27371930 pmcid: 5003641
Chang, T. Y., Lai, Y. A., Hsieh, H. H., Lai, J. S. & Liu, C. S. Effects of environmental noise exposure on ambulatory blood pressure in young adults. Environ. Res. 109, 900–905. https://doi.org/10.1016/j.envres.2009.05.008 (2009).
doi: 10.1016/j.envres.2009.05.008 pubmed: 19559411
Chang, T. Y., Liu, C. S., Hsieh, H. H., Bao, B. Y. & Lai, J. S. Effects of environmental noise exposure on 24-h ambulatory vascular properties in adults. Environ. Res. 118, 112–117. https://doi.org/10.1016/j.envres.2012.06.008 (2012).
doi: 10.1016/j.envres.2012.06.008 pubmed: 22770860
Devlin, R. B., Ghio, A. J., Kehrl, H., Sanders, G. & Cascio, W. Elderly humans exposed to concentrated air pollution particles have decreased heart rate variability. Eur. Respir. J. Suppl. 40, 76s–80s. https://doi.org/10.1183/09031936.03.00402403 (2003).
doi: 10.1183/09031936.03.00402403 pubmed: 12762579
Cavallari, J. M. et al. Time course of heart rate variability decline following particulate matter exposures in an occupational cohort. Inhalation Toxicol. 20, 415–422. https://doi.org/10.1080/08958370801903800 (2008).
doi: 10.1080/08958370801903800
Peters, A. et al. Triggering of acute myocardial infarction by different means of transportation. Eur. J. Prev. Cardiol. 20, 750–758. https://doi.org/10.1177/2047487312446672 (2013).
doi: 10.1177/2047487312446672 pubmed: 22544548
Lavigne, E., Burnett, R. T. & Weichenthal, S. Association of short-term exposure to fine particulate air pollution and mortality: effect modification by oxidant gases. Sci. Rep. 8, 16097. https://doi.org/10.1038/s41598-018-34599-x (2018).
doi: 10.1038/s41598-018-34599-x pubmed: 30382168 pmcid: 6208424
Weichenthal, S., Pinault, L. L. & Burnett, R. T. Impact of oxidant gases on the relationship between outdoor fine particulate air pollution and nonaccidental, cardiovascular, and respiratory mortality. Sci. Rep. 7, 16401. https://doi.org/10.1038/s41598-017-16770-y (2017).
doi: 10.1038/s41598-017-16770-y pubmed: 29180643 pmcid: 5703979
Daiber, A. et al. Environmental noise induces the release of stress hormones and inflammatory signaling molecules leading to oxidative stress and vascular dysfunction-Signatures of the internal exposome. BioFactors (Oxf., Engl.) 45, 495–506. https://doi.org/10.1002/biof.1506 (2019).
doi: 10.1002/biof.1506
Brook, R. D. Cardiovascular effects of air pollution. Clin. Sci. (Lond., Engl) 115, 175–187. https://doi.org/10.1042/cs20070444 (2008).
doi: 10.1042/cs20070444
Laumbach, R. J. et al. A controlled trial of acute effects of human exposure to traffic particles on pulmonary oxidative stress and heart rate variability. Particle Fibre Toxicol. 11, 45. https://doi.org/10.1186/s12989-014-0045-5 (2014).
doi: 10.1186/s12989-014-0045-5
Wessels, A. et al. Oxidant generation and toxicity of size-fractionated ambient particles in human lung epithelial cells. Environ. Sci. Technol. 44, 3539–3545. https://doi.org/10.1021/es9036226 (2010).
doi: 10.1021/es9036226 pubmed: 20355702
Kinlay, S. & Ganz, P. Role of endothelial dysfunction in coronary artery disease and implications for therapy. Am. J. Cardiol. 80, 11i–16i. https://doi.org/10.1016/s0002-9149(97)00793-5 (1997).
doi: 10.1016/s0002-9149(97)00793-5 pubmed: 9375937
Anderson, T. J. Assessment and treatment of endothelial dysfunction in humans. J. Am. Coll. Cardiol. 34, 631–638 (1999).
doi: 10.1016/S0735-1097(99)00259-4
Ikeda, M. et al. Mechanism of pathophysiological effects of diesel exhaust particles on endothelial cells. Environ. Toxicol. Pharmacol. 6, 117–123 (1998).
doi: 10.1016/S1382-6689(98)00027-1
Lee, M. S. et al. Oxidative stress and systemic inflammation as modifiers of cardiac autonomic responses to particulate air pollution. Int. J. Cardiol. 176, 166–170. https://doi.org/10.1016/j.ijcard.2014.07.012 (2014).
doi: 10.1016/j.ijcard.2014.07.012 pubmed: 25074558 pmcid: 4134957
Stieb, D. M. et al. Cardio-respiratory effects of air pollution in a panel study of outdoor physical activity and health in rural older adults. J. Occup. Environ. Med. 59, 356–364. https://doi.org/10.1097/jom.0000000000000954 (2017).
doi: 10.1097/jom.0000000000000954 pubmed: 28628045 pmcid: 5374748
Stein, P. K. & Kleiger, R. E. Insights from the study of heart rate variability. Annu. Rev. Med. 50, 249–261. https://doi.org/10.1146/annurev.med.50.1.249 (1999).
doi: 10.1146/annurev.med.50.1.249 pubmed: 10073276
Weisskopf, M. G., Seals, R. M. & Webster, T. F. Bias amplification in epidemiologic analysis of exposure to mixtures. Environ. Health Perspect. 126, 047003. https://doi.org/10.1289/ehp2450 (2018).
doi: 10.1289/ehp2450 pubmed: 29624292 pmcid: 6071813
Weichenthal, S., Lavigne, E., Evans, G., Pollitt, K. & Burnett, R. T. Ambient PM2.5 and risk of emergency room visits for myocardial infarction: impact of regional PM2.5 oxidative potential: a case-crossover study. Environ. Health 15, 46. https://doi.org/10.1186/s12940-016-0129-9 (2016).
doi: 10.1186/s12940-016-0129-9 pubmed: 27012244 pmcid: 4806515
Bratsch, S. G. Standard electrode potentials and temperature coefficients in water. J. Phys. Chem. Ref. Data 18, 1–21 (1989).
doi: 10.1063/1.555839
Camm, A. J. et al. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93, 1043–1065 (1996).
doi: 10.1161/01.CIR.93.5.1043
Danieli, C., Sheppard, T., Costello, R., Dixon, W. G. & Abrahamowicz, M. Modeling of cumulative effects of time-varying drug exposures on within-subject changes in a continuous outcome. Stat. Methods Med. Res. 0, 0962280220902179, doi: https://doi.org/10.1177/0962280220902179 .
Douketis, J. D., Paradis, G., Keller, H. & Martineau, C. Canadian guidelines for body weight classification in adults: application in clinical practice to screen for overweight and obesity and to assess disease risk. Can. Med. Assoc. J. 172, 995–998. https://doi.org/10.1503/cmaj.045170 (2005).
doi: 10.1503/cmaj.045170

Auteurs

Rita Biel (R)

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada.

Coraline Danieli (C)

Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, 5252 de Maisonneuve Blvd. West, Montreal, QC, H4A 3S5, Canada.

Maryam Shekarrizfard (M)

Department of Civil Engineering, University of Toronto, Galbraith Building Room 305F, 35 George St, Toronto, ON, M5S 1A4, Canada.

Laura Minet (L)

Department of Civil Engineering, University of Toronto, Galbraith Building Room 305F, 35 George St, Toronto, ON, M5S 1A4, Canada.

Michal Abrahamowicz (M)

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada.
Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, 5252 de Maisonneuve Blvd. West, Montreal, QC, H4A 3S5, Canada.

Jill Baumgartner (J)

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada.
Institute for Health and Social Policy, McGill University, Charles Meredith House, 1130 Pine Ave West, Montreal, QC, H3A 1A3, Canada.

Rick Liu (R)

Department of Civil Engineering, University of Toronto, Galbraith Building Room 305F, 35 George St, Toronto, ON, M5S 1A4, Canada.

Marianne Hatzopoulou (M)

Department of Civil Engineering, University of Toronto, Galbraith Building Room 305F, 35 George St, Toronto, ON, M5S 1A4, Canada.

Scott Weichenthal (S)

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Ave West, Montreal, QC, H3A 1A2, Canada. scott.weichenthal@mcgill.ca.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH