Sunday 19 March 2017

Altitude and health – three towns in East Lancashire.


East Lancashire, from the summit of`Pendle Hill

The sun and susceptibility to coronary heart disease – the experience of Lancashire, UK.


Previous Posts have described the well-defined epidemic of coronary heart disease (CHD) that  occurred during the mid and latter parts of the 20th century. Also the Posts have led to the conclusion that the only realistic (and therefore the most probable) cause of the epidemic appears to be an infection. The actual causative organism has not been defined, but it is usual that the recognition of a microbial cause of a disease precedes the identification of its causative organism.

The presence of a disease depends on a combination of its cause plus the susceptibility of an individual or population to  it. This is often a function of immunity.

However the identification of factors leading to susceptibility are of great importance. We need to determine the difference in the incidence of disease, death rates and life expectancy in various places.

A recent Post looked at the much higher incidence of illness and early death in Belfast in Northern Ireland compared to Toulouse in France. The only answer appeared to be a protective effect of the sun acting on the population of Toulouse, which is almost 1000km closer to the equator. Whereas Belfast is at sea level, Toulouse is a slightly higher altitude, 150m above sea level.

Health inequalities in England

A previous Post has looked at health inequalities in Three English Towns, demonstrating higher death rates those in the north of England. There was no explanation other than latitude. Dietary characteristics were the same in all towns. 

It is now well-known that standardised mortality rates are higher in the north-west of England than the UK average, shown in Figure 1. Mortality rates are lowest in the south, and this conforms to a latitude effect. However London has higher mortality rates than the surrounding rural locations.



Figure 1. Mortality rates in England and Wales

Burnley, Nelson and Colne

Burnley is one of the major towns of Lancashire, and Nelson and Colne are smaller towns just 10 and 20 km to the north-east. All grew during the 19th century as cotton and textile manufacturing towns, an industry undergoing major decline during the second half of the 20th century. Like all industrial towns, they have been characterised by significant but relative socio-economic deprivation, with low incomes, poor housing, low average educational achievement and bad health profiles.


Figure 2. The north-west of England, Burnley Nelson & Colne shaded

The particularly interesting aspects of the health profiles are the differences between theses three towns that are geographically so close together and so similar in respect of employment patterns. This is shown in the infant mortality rates in the early years of the 20th century.


Figure 3. Burnley, Nelson and Colne

With the standardised average England & Wales mortality rate (SMR) of 100, that of Burnley was one of the nation’s highest infant mortality rates at 160. But it was significantly lower at 117 in Nelson, and well below the national average at 78 in Colne. The difference is remarkable and no explanation was offered when the data were first published.


Figure 4. Infant mortality rates, 1911-1913

The study was revisited later in the 20th century, this time looking at adult health profiles. During the years 1968–1978, the SMR for “all cause” mortality was high at 121 in Burnley. Nelson was better at 109, and the SMR in Cone was on the national average at 100. So we see the same pattern as was present more than 50 years earlier.


Figure 5. Mortality rates, all causes

When we look at deaths from “bronchitis” we see an overall high mortality rate in Lancashire, a remarkably high SMR of 188 in Burnley. The populations of Nelson and Colne also show high mortality rates, but once again much less than Burnley, with Colne lowest of the three.


Figure 6. Mortality rates, bronchitis

Deaths from pneumonia show the same pattern, Burnley highest of all at 174, Nelson lower at 125, and Colne lower still at 108, just above the national average.


Figure 7. Mortality rates, pneumonia

Deaths from coronary heart disease (CHD) show the same pattern. All are above the national average, but is this expected for towns in the north-west of England. Again, the highest mortality rate of the three is Burnley, Nelson in the middle and the lowest is Colne.


Figure 8. Mortality rates, coronary heart disease

The importance of geography

So how do we explain this? There is no obvious socio-economic difference between the three towns. No formal research has been undertaken in this respect but no significant population  differences can be anticipated, nothing to account for such major differences in death rates. 


Perhaps it is the geography that is important. We saw this in the comparison between Belfast and Toulouse: geography was the only realistic explanation of the much higher mortality rates in Belfast, the higher latitude with a lower intensity of sunlight being the important factor.

As with Belfast and Toulouse, in Burnley, Nelson and Colne, we are looking not at a case of a disease but of a factor that increases susceptibility to a number of illnesses and results in premature death.

Burnley is located in the valley of the River Calder, a tributary of the River Ribble. The Ribble enters the Irish Sea between Blackpool and Southport. In Burnley the River Calder is joined by the Rivers Brun and Don, and also by Pendle Water. This was an advantage in the pre-steam era, when motive power for factories was provided by gravity acting via running water. 


Figure 9. Burnley

Burnley is therefore relatively low-lying. It is in a valley where four rivers meet, and it is known to be damp. In the industrial era the smoke from domestic and factory chimneys would accumulate in Burnley. When coal and steam came into industrial use, the newer industrial towns of Nelson and Colne could be built away from the rivers. 


Figure 10. Coal mine in Burnley, now closed

Altitude

Burnley lies at 105 metres above sea level. 
Figure 11. Burnley

Nelson is further up the valley of Pendle Water, and is built on higher round above the valley. It lies at 160 metres above sea level. 


Figure 12. Nelson
Colne is even further up the valley and was originally (in the pre-industrial era) a hilltop town, lying at 190 meters above sea level.


Figure 13. Colne

And so here we have the most obvious and the most likely explanation of the variation of indices of health of the populations of the three towns: altitude.


Figure 14. Altitude variation of Burnley, Nelson and Colne

Altitude in the USA

We have seen this phenomenon in a previous post, which described the same feature in the USA. At a latitude of 37–38 degrees north of the equator, between Washington DC and San Fransisco, there is a convincing inverse relationship between altitude and standardised death rates from coronary heart disease (CHD) and cerebro-vascular disease (CVD).
Figure 15: Land mass profile of the USA at 37–38 degrees north, and inverse  CHD/CVD mortality rates

Higher altitude means higher intensity of sunlight at ground level. Of more importance is being above the pollution that is inevitable in an urban environment. An increased altitude of even 30 metres can make a significant difference: the polluted layer of atmosphere is heavier than the atmosphere, and is thus low-lying.

Atmospheric pollution

In a city such as London the polluted layer of atmosphere is only thin, perhaps 20 metres. 


Figure 16. London, looking north from Greenwich

In many cities in China and other rapidly industrialising countries, the atmospheric pollution is very great and its removal by wind and rain is infrequent. The layer of pollution becomes so thick that the sun is totally obscured, despite no natural cloud.


Figure 17. Xian, China, mid-day 

Atmospheric pollution is both chemical and physical. Oxides of nitrogen and sulphur cause irritation to eyes and lungs. These give the chemical component of damage.

The most damaging component is particulate material, tiny particles of dust and unoxidised carbon, giving a physical rather than or as well as a chemical effect. It is the particles that are responsible for the obstruction to the passage of sunlight to ground level.

City versus countryside

It has been known for more than two hundred years that death rates are much higher in people living in industrial cities compared to those living in a rural environment. 


Figure 18. Thomas Percival 1740–1804

It was first demonstrated in a monograph written in 1773 by the Manchester physician Thomas Percival. The monograph was entitled “Observations on the state of the populations of Manchester and other adjacent places”. It recorded that in Manchester (population 27,246) and in Liverpool the death rates were one in 28 of the population each year. This was twice the death rate in surrounding villages in rural locations, one in 56 per year.

It is the same today, standardised death rates being higher in the cities (polluted air) than in rural locations (clean air).


Figure 19. Cloud but clean air in the Ribble Valley, where I live

Conclusion

Life expectancy is greater and death rates lower in the countries of southern Europe compared to countries in northern Europe.

Death rates from a number of diseases are lower with residence at a higher altitude. This demonstrated in the USA and in East Lancashire, UK.

Death rates are lower in rural villages than urban cities.

Pollution blocks the sun much more continuously and much more effectively than natural cloud.

The common factor is that a major determinant of good health and long life is good exposure to the sun. 





72 comments:

  1. Naughton cited this chart from the American Heart Association on the incidence of cardiovascular illness and death in selected countries:
    The first thing that jumped out at me was the very tight association of related groups. Roughly, we see a pattern that goes like this (in descending order of illness rates):

    Slavs and Eastern Europeans
    Celtic groups
    Germanic and Anglo groups

    Notice the apparent Northeast to Southwest cline.

    While there are some irregularities (i.e., China, Australia, and Greece), the general pattern is strong. This strongly suggests that genetic factors are involved.


    http://www.unz.com/jman/a-fat-problem-with-heart-health-wisdom/


    ReplyDelete
    Replies
    1. Interesting comment but I cannot imagine many genetic differences between populations of three Lancashire towns

      Delete
  2. hey Dr david thanks for sharing this useful piece of information it is very informative I must admit val essay service review has amazing offers for writers looking to post their story on their page I would advise you go check it out

    ReplyDelete
  3. Thanks for a wonderful share. Your article has proved your hard work and experience you have got in this field. Brilliant .i love it reading. wholesale medical disposables

    ReplyDelete
  4. I'm constantly searching on the internet for posts that will help me. Too much is clearly to learn about this. I believe you created good quality items in Functions also. Keep working, congrats! visit here

    ReplyDelete
  5. We are really grateful for your blog post. You will find a lot of approaches after visiting your post. I was exactly searching for. Thanks for such post and please keep it up. Great work. best under eye concealer for wrinkles

    ReplyDelete
  6. There are people looking relatively OK, but terribly sick. This is because not all diseases are physical. Body sicknesses can be easily diagnosed, but sicknesses of the soul and of the spirit can not be diagnosed through any medical means.koktale

    ReplyDelete
  7. Indeed, even your vehicle is likewise overhauled twice in a year. Nobody inquires as to why time, exertion, and cash are spent on guaranteeing that their vehicle is being overhauled with all the important checks, all the time.
    Natural Supplement Ingredient Manufacturer

    ReplyDelete
  8. Thank you again for all the knowledge you distribute,Good post. I was very interested in the article, it's quite inspiring I should admit. I like visiting you site since I always come across interesting articles like this one.Great Job, I greatly appreciate that.Do Keep sharing! Regards, Naturopath

    ReplyDelete
  9. We are really grateful for your blog post. You will find a lot of approaches after visiting your post. I was exactly searching for. Thanks for such post and please keep it up. Great work. Treadmill

    ReplyDelete
  10. Thanks for sharing nice information with us. I like your post and all you share with us is up to date and quite informative, I would like to bookmark the page so I can come here again to read you, as you have done a wonderful job. visita il sito

    ReplyDelete
  11. I really appreciate the kind of topics you post here. Thanks for sharing us a great information that is actually helpful. Good day! Ugyen Dorji

    ReplyDelete
  12. I have read all the comments and suggestions posted by the visitors for this article are very fine,We will wait for your next article so only.Thanks! get me private health insurance

    ReplyDelete
  13. This is going to assist them with settling on the correct decision on the degree of inclusion to buy, and on how much protection and medicinal inclusion they will need to buy with their health care coverage strategy organization. buyprovigilmodafinil.com

    ReplyDelete
  14. Hello I am so delighted I located your blog, I really located you by mistake, while I was watching on google for something else, Anyways I am here now and could just like to say thank for a tremendous post and a all round entertaining website. Please do keep up the great work. podiatry drill

    ReplyDelete
  15. There is so much in this article that I would never have thought of on my own. Your content gives readers things to think about in an interesting way. Thank you for your clear information. goodtime 2 banjo review

    ReplyDelete
  16. I have read all the comments and suggestions posted by the visitors for this article are very fine,We will wait for your next article so only.Thanks! Health tips

    ReplyDelete
  17. Fat misfortune 4 simpletons additionally has an on line dinner generator which lets you select the nourishments you like from the rundown that has a wide assortment of solid food sources. This quick weight reduction online program is exceptionally easy to follow and the strategies that are laid out inside the program itself are demonstrated to work. best quick weight loss products

    ReplyDelete
  18. I have read all the comments and suggestions posted by the visitors for this article are very fine,We will wait for your next article so only.Thanks! ghee white label

    ReplyDelete
  19. I am definitely enjoying your website. You definitely have some great insight and great stories. Ghee manufacturing process

    ReplyDelete
  20. i never know the use of adobe shadow until i saw this post. thank you for this! this is very helpful. Viagra Super Active

    ReplyDelete
  21. When looking around the Internet for womens health information, either about conventional or alternative treatments, make sure you find a site you can trust, and always double check the data to make sure it's accurate.Raquel Welch

    ReplyDelete
  22. Nice blog, I will keep visiting this blog very often. learn more

    ReplyDelete
  23. Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon. Big thanks for the useful info. livre le programme de reconstruction capillaire

    ReplyDelete
  24. Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon. Big thanks for the useful info. avis le miracle de la grossesse

    ReplyDelete
  25. I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often. learn more

    ReplyDelete
  26. I have read all the comments and suggestions posted by the visitors for this article are very fine,We will wait for your next article so only.Thanks! https://www.losenows.com/

    ReplyDelete
  27. Love to read it,Waiting For More new Update and I Already Read your Recent Post its Great Thanks. livre guerir du diabete type 2

    ReplyDelete
  28. A very awesome blog post. We are really grateful for your blog post. You will find a lot of approaches after visiting your post. glycemie apres repas taux

    ReplyDelete
  29. i never know the use of adobe shadow until i saw this post. thank you for this! this is very helpful. berberine hypertension

    ReplyDelete
  30. Replenish 360 offers one of the most affordable wellness and preventative services that are personalized and one of the most activating one-of-a-kind IV drip and infusions, vitamin and antioxidant supplementation, micronutrient therapy, and other additional supplementary wellness services to “renew your body, refresh your mind, and restore performance.” Coachella IV Drips

    ReplyDelete
  31. This is a great article thanks for sharing this informative information. I will visit your blog regularly for some latest post. I will visit your blog regularly for Some latest post. comment faire descendre son diabete rapidement

    ReplyDelete
  32. I would like to say that this blog really convinced me to do it! Thanks, very good post. https://speakerdeck.com/abodykr

    ReplyDelete
  33. There are some little cost decrease parts in ObamaCare, however the genuine accentuation is on managing health protection. N95 Face Mask

    ReplyDelete
  34. It is better that you simply do this for yourself basically in light of the fact that you need a healthier and better you contrasted with do it for others' acknowledgment. Marijuana Seeds

    ReplyDelete
  35. This is such a great resource that you are providing and you give it away for free. I love seeing blog that understand the value of providing a quality resource for free. best feminine wash for yeast infection

    ReplyDelete
  36. Thanks for every other informative site. The place else may just I get that kind of information written in such an ideal means? I have a venture that I’m just now operating on, and I have been on the look out for such information. Grass fed ghee

    ReplyDelete
  37. Normally, understudies who have an enthusiasm for taking an interest in home grown investigations at one of a few home grown medicine schools ought to have achieved some instruction in physiology or potentially life systems before enlistment.more here

    ReplyDelete
  38. Massage loosens up you, assuages strain through touch and, generally significant, makes you aware of your own body and its latent capacity.
    아로마마사지 샵정보

    ReplyDelete
  39. You make so many great points here that I read your article a couple of times. Your views are in accordance with my own for the most part. This is great content for your readers. counselling

    ReplyDelete
  40. Thank you for some other informative blog. Where else could I get that type of information written in such an ideal means? I have a mission that I’m just now working on, and I have been at the look out for such information. Herbal Supplement

    ReplyDelete
  41. You learn about yourself as a person, how you face challenges, and which obstacles are blocking your road to health. The journey toward health involves more than regimens for diet, exercise, and sleep. The journey is unique to who you are and where you're at in life too. nutraceutical manufacture

    ReplyDelete
  42. The concept of health means to perceive himself as a positive and independent individual in development, best health watch to feel hope and meaning in life and fellowship with others.

    ReplyDelete
  43. The high medical cost makes them lose a major part of their savings. Thus the uninsured gets under the monetary stress whenever fallen in need of health care. 여성형유방증

    ReplyDelete
  44. Herbs and natural ingredients had been a part of the medicinal system of the Orient for ages. Now their kratom wholesale reincarnation as supplements has added a whole new dimension to the medicinal industry. These supplements have been a boon for the health conscious.

    ReplyDelete
  45. Utilizing a term like earned health may remind individuals that health can be significantly more than non-ailment. pills for sexual improvement

    ReplyDelete
  46. This comment has been removed by the author.

    ReplyDelete
  47. Wow, What a Excellent post. I really found this to much informatics. It is what i was searching for.I would like to suggest you that please keep sharing such type of info.Thanks CBD Oil for Tourette Syndrome : Benefits, Dosage & How to Use

    ReplyDelete
  48. This is a method of taking great consideration of your kidneys and lungs. If it's not too much trouble be cautious about what you eat and keep your diabetic eating regimen in your sound judgment, evade exorbitant and indiscreet admission of over the counter drugs and get yourself far from the pesticides and lead containing items.
    acupuncture commack NY

    ReplyDelete
  49. Basic and Essential Health Plans - It provides a Buy Bulk Marijuana In Nanaimo, BC limited health insurance benefit at a considerably low insurance cost.

    ReplyDelete
  50. There is likewise a high likelihood amongst females from ages 25 and more established to create melanoma or skin disease. misoprostol comprar

    ReplyDelete
  51. Sometimes, indemnity health insurance plans impose restrictions on services covered and may require prior authorization for hospital care and other expensive services. http://educationly.bravesites.com/entries/general/wie-man-ein-besserer-basketballspieler-ist

    ReplyDelete
  52. Considering genuine general health hazards, the Government has restricted smoking out in the open spots from second October, 2008. where to buy cbd

    ReplyDelete
  53. Infection is somewhat less hard to characterize than Health. surface testing kit

    ReplyDelete
  54. I haven’t any word to appreciate this post.....Really i am impressed from this post....the person who create this post it was a great human..thanks for shared this with us. Skinnytabs

    ReplyDelete
  55. A very awesome blog post. We are really grateful for your blog post. You will find a lot of approaches after visiting your post. Tops health Info

    ReplyDelete
  56. For lucidity, the term move work can allude to turning shifts, working for the time being, evening shifts and other adaptable move designs wanted or organized by the business that additionally addresses the test of psychological wellness in move work stages. In other to help move laborers, medical aid boxes can be saved convenient and loaded up with wellbeing items for move laborers.
    Men's Health

    ReplyDelete
  57. Knowing these three towns well your figures do seem to add up and you do make a convincing argument but I feel there is a much better answer in this case.

    The three town do vary in size with Burnley the largest and Colne the smallest, but your figures will have allowed for this.

    Now the size of these towns do hold the answer and that is the amount of historic industry which does relate to the different town sizes as shown in your figures, and that meant more employment in the bigger towns and a portion of that met with immigrant labour coming in from places like Pakistan and other similar locations.

    A lot of this immigrant labour was housed in very poor housing leading to a higher mortality rate than the local average, it was common for these people to be housed with a high occupancy rate often 2 or 3 times the normal rate, which meant that diseases were more ready transmitted.

    This immigrant labour force did have a higher birth rate that also meant a higher infant mortality rate, another factor that has become apparent is that this labour force has an naturally increased rate of heart disease than the local native population.

    So when you add up the effects from this immigrant labour force on a town like Burnley and compare it to Colne you will see figures like those that you stated, and you will find that altitude has nothing to do with it.

    Interestingly research has been carried out of the mortality rate for these areas and when you separate out immigrants for these three towns you find that rates are infact very similar, studies on the Covid pandemic showed that people from an immigrant back ground were at a greater risk of dying, again due to poor housing and cramped living condtions.

    ReplyDelete
  58. Knowing these three towns well your figures do seem to add up and you do make a convincing argument but I feel there is a much better answer in this case.

    The three town do vary in size with Burnley the largest and Colne the smallest, but your figures will have allowed for this.

    Now the size of these towns do hold the answer and that is the amount of historic industry which does relate to the different town sizes as shown in your figures, and that meant more employment in the bigger towns and a portion of that met with immigrant labour coming in from places like Pakistan and other similar locations.

    A lot of this immigrant labour was housed in very poor housing leading to a higher mortality rate than the local average, it was common for these people to be housed with a high occupancy rate often 2 or 3 times the normal rate, which meant that diseases were more ready transmitted.

    This immigrant labour force did have a higher birth rate that also meant a higher infant mortality rate, another factor that has become apparent is that this labour force has an naturally increased rate of heart disease than the local native population.

    So when you add up the effects from this immigrant labour force on a town like Burnley and compare it to Colne you will see figures like those that you stated, and you will find that altitude has nothing to do with it.

    Interestingly research has been carried out of the mortality rate for these areas and when you separate out immigrants for these three towns you find that rates are infact very similar, studies on the Covid pandemic showed that people from an immigrant back ground were at a greater risk of dying, again due to poor housing and cramped living condtions

    ReplyDelete
  59. Individuals that have grandfathered health protection plans won't be straightforwardly influenced by health care change. nmn powder manufacturer

    ReplyDelete
  60. Certainty - Depression isn't something an individual can simply dispose of. Individuals regularly advise the discouraged one to perk up or shake it off. Nonetheless, it isn't only the blues that can be willed away. It is a genuine mental health problem which requires medicine and treatment for legitimate administration.alpha-gpc benefits

    ReplyDelete
  61. Great blog. Really looking forward to read more. Cool. products made with black seed oil

    ReplyDelete
  62. The alternative is for an American universal health care system to surrender to the fact that there is no order in the population registry and just provide health care for everyone who shows up. healthcare software development services

    ReplyDelete
  63. Cool stuff you have got and you keep update all of us. Canada Visa Talosaga

    ReplyDelete
  64. very interesting post.this is my first time visit here.i found so mmany interesting stuff in your blog especially its discussion..thanks for the post! ساهه-طبي-ميزا-ويزا

    ReplyDelete
  65. Children are particularly vulnerable. Caring for and protecting a child's mental health is a major part of helping that child to grow into a normal adult, accepted into society. artvigil info

    ReplyDelete
  66. Health coaches provide patients/clients a sounding board for their issues and a platform to express their personal health goals and intentions, that normally are not found in most doctor's practices. occupational therapy

    ReplyDelete
  67. PROMO SBOBET 💸💸💸 Bonus 20% Member Baru & Extra Bonus Deposit 💸💸💸
    PERMAINAN JUDI ONLINE TERPOPULER ⚽️ Sportsbook, 🎮 Virtual Sports, 🎲 Casino, 🎰 Slot
    JENIS TARUHAN JUDI BOLA TERBAIK ⚽️Mix Parlay, 1X2, Football Strike, Asian Handicap⚽️
    SUPPORTS DENGAN PELAYANAN TERCANGGIH ⚡️ CS 24JAM - Deposit Bank & Pulsa 🆚 Real Player sbobet mobile

    ReplyDelete
  68. I really enjoyed reading your article. I found this as an informative and interesting post, so i think it is very useful and knowledgeable. I would like to thank you for the effort you made in writing this article. WW2 Bomber Jacket

    ReplyDelete
  69. Genuine health issues don't by and large follow a similar time table as health nerves do.
    morrisvillecounselingandconsultingpllc.com

    ReplyDelete