Spatio-temporal analyses of the role of environmental factors on cystic fibrosis severity, with a focus on fungal infections

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Air pollution is a major environmental health problem worldwide. Subjects with lung diseases such as cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the negative effects of air pollution. Particulate matters (PM2.5 and PM10), NO2 and O3 have been identified as air pollutants which have a major impact on health reported by the World Health Organisation. There are over 12,000 people with CF in the UK. Despite growing evidence of the health impact of environmental factors (e.g. air pollution, exposure to second-hand smoke) and socio-economic status, there is limited evidence from the UK on the role of environmental factors in the severity of CF, including pulmonary exacerbations and other complications. Fungal infections, which are believed to be closely associated to local environmental characteristics, are also linked to a rapid decline in lung function. The aims of my Ph.D. are to fill in this important research gap, building on findings from the US and some European countries. First, I want to assess the short-term influence of air quality, climate, and housing properties (particularly humidity, dampness and molds) on disease severity in CF. Second, I would like to contribute to a better understanding of the influence of where individuals with CF live on the prevalence of fungal infections.My project will use data from the UK CF Registry (2007-2017), which includes data from every specialist centre and clinic across the UK, representing over 99% of people with CF. I will focus on using spatio-temporal analyses based on small-area methods to study environment-health associations and to rigorously quantify possible causative interactions. A better understanding of these interactions and the identification of possible environmental risk factors could have direct benefits for CF individuals.This project, conducted in the UK Small-Area Health Statistics Unit (SAHSU, https://www.sahsu.org), is funded by UK CF Trust (https://www.cysticfibrosis.org.uk/) and the MRC DTP at Imperial (https://www.imperial.ac.uk/mrc-dtp-studentships), in collaboration with the CF-EpiNet Strategic Research Centre (https://www.cysticfibrosis.org.uk/the-work-we-do/research/research-we-are-funding/strategic-research-centres/src-4-bilton-data).