Background/Purpose: The etiology of many IMD is largely unknown; however, available data suggest that environmental contaminants could play a role in their origin. Industrial facilities are sources of exposure to pollutants in general population. Their possible association with IMD has not been studied.

Our purpose was to study whether mortality due to SSc/SLE/Systemic Vasculitis is related to the exposure to environmental pollutants of industrial origin in Spain.

Methods: We obtained mortality due to SSc/SLE/Vasculitis & population data (2005-2014) for each municipality in Spain (8097 towns) from the National Institute of Statistics, & estimated the sex-specific age-adjusted expected deaths with Spain as reference. We collected the coordinates of a) the center of each town; and b) the industrial facilities included in the Spanish Register of Emissions and Pollutant Sources (https://prtr-es.es/). Then, we created concentric sectors of different radius (2-10 km) around the pollutant sources to define municipalities’ exposure to industrial pollution based on the distance of their population centers to the facilities. Relative risks (RR) between exposed & unexposed municipalities were estimated with Bayesian conditional autoregressive models, using the “Integrated nested approximations” method as inference method (R-INLA library, R statistical program)

Results: SYSTEMIC SCLEROSIS (Figure 1): In both sexes, the highest risks of death due to SSc were found in the vicinity of chemical industries (RR_men at 2 km:1.82; 95%CI:1.13-2.94, RR_women:1.31;95%CI: 0.98-1.77) and near of paper and wood processing facilities (RR_men at 2 km:2.92; 95%CI:1.42-6.00, RR_women:2.00; 95%CI:1.28-3.14). In addition, they decreased with increasing distance of the pollutant sources. A less marked association was also found for males with mining industry (RR at 2km:1.21; 95%CI:0.73-2.02).

SYSTEMIC LUPUS (Figure 2): In women we did not observe any association; however, in men, there were three sectors with high risks in the closeness of the industries that decreased progressively when moving away: mining facilities (RR at 3 km: 1.50; 95%CI:0.87-2.59), those related to resource and wastewater management (RR at 2 km: 2.23; 95%CI:1.18-4.19) and food industry (RR at 2 km 1.51;95%CI: 0.82-2.78).

SYSTEMIC VASCULITIS (Figure 3): In women, high risk of death was found in the industries of energy & combustion (RR at 2 km:1.38; 95%CI:0.87-2.23), metal processing (RR:1.39; 95%CI:1.10-1.76), chemical (RR:1.36; 95%CI:0.99-1.89) & “other activities” (related to use of organic solvents) (RR: 1.44; 95%CI: 1.01-2.06), but they did not decrease clearly with the distance. For men, there were high RR in the metal (RR:1.32;95%CI:1.00-1.73) and food industries (RR:1.51; 95%CI:1.08-2.14), which decreased with distance from the emitting source.

Conclusion: Residing in the vicinity of certain industries might be a risk factor for dying due to SSc/SLE/Systemic Vasculitis. These results support the possible role of environmental pollution in the origin of these diseases. However, these ecological studies are only exploratory; their results should be confirmed with other studies.

Figure 1. Mortality due to SSc related to distance of industries

Figure 2. Mortality due to SLE related to distance of industries

Figure 3. Mortality due to Vasculitis related to distance of industries

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/exposure-to-industrial-pollutants-and-mortality-due-to-inmune-mediated-inflammatory-systemic-diseases-imd-in-spain/