Risk of nonaccidental and cardiovascular mortality in relation to long-term exposure to low concentrations of fine particulate matter: a Canadian national-level cohort study

Effect Modification of Long-Term Air Pollution Exposures and the Risk of Incident Cardiovascular Disease in US Women

Background

Ambient air pollution exposures have been frequently linked to cardiovascular disease (CVD) morbidity and mortality. However, less is known about the populations most susceptible to these adverse effects.

Methods and Results

We assessed the associations of long‐term particulate matter (PM) exposures with incident CVD in a nationwide cohort of 114 537 women in the Nurses’ Health Study, and performed analyses to identify subpopulations at the greatest risk. Residential address level time‐varying monthly exposures to PM_2.5, PM₁₀, and PM_{2.5 to 10} microns in diameter were estimated from spatio‐temporal prediction models. In multivariable models, increases in all size fractions of PM were associated with small, but not statistically significant, increased risks of total CVD, coronary heart disease, and stroke. PM‐associated CVD risks were statistically significantly higher among women with diabetes as compared to those without (P‐for‐interaction <0.0001 for PM₁₀ and PM_2.5 and 0.007 for PM_{2.5 to 10}). For each 10 μg/m³ increase in 12‐month average PM_2.5, PM_{2.5 to 10}, and PM_10, the multivariable adjusted hazard ratios were 1.44 (95% CI: 1.23 to 1.68), 1.17 (95% CI: 1.05 to 1.30), and 1.19 (95% CI: 1.10 to 1.28) among women with diabetes. There were also suggestions of higher risks among older (≥70 years) women, the obese, and those living in the Northeast and South. Smoking status and family history did not consistently modify the association between PM and CVD, and risks were most elevated with exposures in the previous 12 months.

Conclusions

In this nationwide cohort, women with diabetes were identified as the subpopulation most sensitive to the adverse cardiovascular health effects of PM.

Extreme Air Pollution Conditions Adversely Affect Blood Pressure and Insulin Resistance: The Air Pollution and Cardiometabolic Disease Study

Mounting evidence supports that fine particulate matter adversely affects cardiometabolic diseases particularly in susceptible individuals; however, health effects induced by the extreme concentrations within megacities in Asia are not well described. We enrolled 65 nonsmoking adults with metabolic syndrome and insulin resistance in the Beijing metropolitan area into a panel study of 4 repeated visits across 4 seasons since 2012. Daily ambient fine particulate matter and personal black carbon levels ranged from 9.0 to 552.5 µg/m(3) and 0.2 to 24.5 µg/m(3), respectively, with extreme levels observed during January 2013. Cumulative fine particulate matter exposure windows across the prior 1 to 7 days were significantly associated with systolic blood pressure elevations ranging from 2.0 (95% confidence interval, 0.3-3.7) to 2.7 (0.6-4.8) mm Hg per SD increase (67.2 µg/m(3)), whereas cumulative black carbon exposure during the previous 2 to 5 days were significantly associated with ranges in elevations in diastolic blood pressure from 1.3 (0.0-2.5) to 1.7 (0.3-3.2) mm Hg per SD increase (3.6 µg/m(3)). Both black carbon and fine particulate matter were significantly associated with worsening insulin resistance (0.18 [0.01-0.36] and 0.22 [0.04-0.39] unit increase per SD increase of personal-level black carbon and 0.18 [0.02-0.34] and 0.22 [0.08-0.36] unit increase per SD increase of ambient fine particulate matter on lag days 4 and 5). These results provide important global public health warnings that air pollution may pose a risk to cardiometabolic health even at the extremely high concentrations faced by billions of people in the developing world today.

Urban-rural differences in daily time-activity patterns, occupational activity and housing characteristics

BACKGROUND

There is evidence that rural residents experience a health disadvantage compared to urban residents, associated with a greater prevalence of health risk factors and socioeconomic differences. We examined differences between urban and rural Canadians using data from the Canadian Human Activity Pattern Survey (CHAPS) 2.

METHODS

Data were collected from 1460 respondents in two rural areas (Haldimand-Norfolk, Ontario and Annapolis Valley-Kings County, Nova Scotia) and 3551 respondents in five urban areas (Vancouver, Edmonton, Toronto, Montreal, and Halifax) using a 24-h recall diary and supplementary questionnaires administered using computer-assisted telephone interviews. We evaluated differences in time-activity patterns, occupational activity, and housing characteristics between rural and urban populations using multivariable linear and logistic regression models adjusted for design as well as demographic and socioeconomic covariates. Taylor linearization method and design-adjusted Wald tests were used to test statistical significance.

RESULTS

After adjustment for demographic and socioeconomic covariates, rural children, adults and seniors spent on average 0.7 (p < 0.05), 1.2 (p < 0.001), and 0.9 (p < 0.001) more hours outdoors per day respectively than urban counterparts. 23.1% (95% CI: 19.0-27.2%) of urban and 37.8% (95% CI: 31.2-44.4%) of rural employed populations reported working outdoors and the distributions of job skill level and industry differed significantly (p < 0.001) between urban and rural residents. In particular, 11.4% of rural residents vs. 4.9% of urban residents were employed in unskilled jobs, and 11.5% of rural residents vs. <0.5% of urban residents were employ in primary industry. Rural residents were also more likely than urban residents to report spending time near gas or diesel powered equipment other than vehicles (16.9% vs. 5.2%, p < 0.001), more likely to report wood as a heating fuel (9.8% vs. <0.1%; p < 0.001 for difference in distribution of heating fuels), less likely to have an air conditioner (43.0% vs. 57.2%, p < 0.001), and more likely to smoke (29.1% vs. 19.0 %, p < 0.001). Private wells were the main water source in rural areas (68.6%) in contrast to public water systems (97.6%) in urban areas (p < 0.001). Despite these differences, no differences in self-reported health status were observed between urban and rural residents.

CONCLUSIONS

We identified a number of differences between urban and rural residents, which provide evidence pertinent to the urban-rural health disparity.

Ambient PM2.5, O₃, and NO₂ Exposures and Associations with Mortality over 16 Years of Follow-Up in the Canadian Census Health and Environment Cohort (CanCHEC)

BACKGROUND

Few studies examining the associations between long-term exposure to ambient air pollution and mortality have considered multiple pollutants when assessing changes in exposure due to residential mobility during follow-up.

OBJECTIVE

We investigated associations between cause-specific mortality and ambient concentrations of fine particulate matter (≤ 2.5 μm; PM2.5), ozone (O3), and nitrogen dioxide (NO2) in a national cohort of about 2.5 million Canadians.

METHODS

We assigned estimates of annual concentrations of these pollutants to the residential postal codes of subjects for each year during 16 years of follow-up. Historical tax data allowed us to track subjects' residential postal code annually. We estimated hazard ratios (HRs) for each pollutant separately and adjusted for the other pollutants. We also estimated the product of the three HRs as a measure of the cumulative association with mortality for several causes of death for an increment of the mean minus the 5th percentile of each pollutant: 5.0 μg/m3 for PM2.5, 9.5 ppb for O3, and 8.1 ppb for NO2.

RESULTS

PM2.5, O3, and NO2 were associated with nonaccidental and cause-specific mortality in single-pollutant models. Exposure to PM2.5 alone was not sufficient to fully characterize the toxicity of the atmospheric mix or to fully explain the risk of mortality associated with exposure to ambient pollution. Assuming additive associations, the estimated HR for nonaccidental mortality corresponding to a change in exposure from the mean to the 5th percentile for all three pollutants together was 1.075 (95% CI: 1.067, 1.084). Accounting for residential mobility had only a limited impact on the association between mortality and PM2.5 and O3, but increased associations with NO2.

CONCLUSIONS

In this large, national-level cohort, we found positive associations between several common causes of death and exposure to PM2.5, O3, and NO2.

CITATION

Crouse DL, Peters PA, Hystad P, Brook JR, van Donkelaar A, Martin RV, Villeneuve PJ, Jerrett M, Goldberg MS, Pope CA III, Brauer M, Brook RD, Robichaud A, Menard R, Burnett RT. 2015. Ambient PM2.5, O3, and NO2 exposures and associations with mortality over 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC). Environ Health Perspect 123:1180-1186; http://dx.doi.org/10.1289/ehp.1409276.

Satellite-Based Estimates of Long-Term Exposure to Fine Particles and Association with Mortality in Elderly Hong Kong Residents

BACKGROUND

A limited number of studies on long-term effects of particulate matter with aerodynamic diameter < 2.5 μm (PM2.5) on health suggest it can be an important cause of morbidity and mortality. In Asia where air quality is poor and deteriorating, local data on long-term effects of PM2.5 to support policy on air quality management are scarce.

OBJECTIVES

We assessed long-term effects of PM2.5 on the mortality in a single Asian city.

METHODS

For 10-13 years, we followed up a cohort of 66,820 participants ≥ 65 years of age who were enrolled and interviewed in all 18 Elderly Health Centres of the Department of Health, Hong Kong, in 1998-2001. Their residential addresses were geocoded into x- and y-coordinates, and their proxy exposures to PM2.5 at their addresses in 1 × 1 km grids were estimated from the U.S. National Aeronautics and Space Administration (NASA) satellite data. We used Cox regression models to calculate hazard ratios (HRs) of mortality associated with PM2.5.

RESULTS

Mortality HRs per 10-μg/m3 increase in PM2.5 were 1.14 (95% CI: 1.07, 1.22) for all natural causes, 1.22 (95% CI: 1.08, 1.39) for cardiovascular causes, 1.42 (95% CI: 1.16, 1.73) for ischemic heart disease, 1.24 (95% CI: 1.00, 1.53) for cerebrovascular disease, and 1.05 (95% CI: 0.90, 1.22) for respiratory causes.

CONCLUSIONS

Our methods in using NASA satellite data provide a readily accessible and affordable approach to estimation of a sufficient range of individual PM2.5 exposures in a single city. This approach can expand the capacity to conduct environmental accountability studies in areas with few measurements of fine particles.

CITATION

Wong CM, Lai HK, Tsang H, Thach TQ, Thomas GN, Lam KB, Chan KP, Yang L, Lau AK, Ayres JG, Lee SY, Chan WM, Hedley AJ, Lam TH. 2015. Satellite-based estimates of long-term exposure to fine particles and association with mortality in elderly Hong Kong residents. Environ Health Perspect 123:1167-1172; http://dx.doi.org/10.1289/ehp.1408264.

The health benefits of reducing air pollution in Sydney, Australia

Among industrialised countries, fine particle (PM2.5) and ozone levels in the Sydney metropolitan area of Australia are relatively low. Annual mean PM2.5 levels have historically remained below 8 μg/m(3) while warm season (November-March) ozone levels occasionally exceed the Australian guideline value of 0.10 ppm (daily 1 h max). Yet, these levels are still below those seen in the United States and Europe. This analysis focuses on two related questions: (1) what is the public health burden associated with air pollution in Sydney; and (2) to what extent would reducing air pollution reduce the number of hospital admissions, premature deaths and number of years of life lost (YLL)? We addressed these questions by applying a damage function approach to Sydney population, health, PM2.5 and ozone data for 2007 within the BenMAP-CE software tool to estimate health impacts and economic benefits. We found that 430 premature deaths (90% CI: 310-540) and 5800 YLL (95% CI: 3900-7600) are attributable to 2007 levels of PM2.5 (about 2% of total deaths and 1.8% of YLL in 2007). We also estimate about 630 (95% CI: 410-840) respiratory and cardiovascular hospital admissions attributable to 2007 PM2.5 and ozone exposures. Reducing air pollution levels by even a small amount will yield a range of health benefits. Reducing 2007 PM2.5 exposure in Sydney by 10% would, over 10 years, result in about 650 (95% CI: 430-850) fewer premature deaths, a gain of 3500 (95% CI: 2300-4600) life-years and about 700 (95% CI: 450-930) fewer respiratory and cardiovascular hospital visits. These results suggest that substantial health benefits are attainable in Sydney with even modest reductions in air pollution.

Environmental factors in cardiovascular disease

Environmental exposure is an important but underappreciated risk factor contributing to the development and severity of cardiovascular disease (CVD). The heart and vascular system are highly vulnerable to a number of environmental agents--ambient air pollution and the metals arsenic, cadmium, and lead are widespread and the most-extensively studied. Like traditional risk factors, such as smoking and diabetes mellitus, these exposures advance disease and mortality via augmentation or initiation of pathophysiological processes associated with CVD, including blood-pressure control, carbohydrate and lipid metabolism, vascular function, and atherogenesis. Although residence in highly polluted areas is associated with high levels of cardiovascular risk, adverse effects on cardiovascular health also occur at exposure levels below current regulatory standards. Considering the widespread prevalence of exposure, even modest contributions to CVD risk can have a substantial effect on population health. Evidence-based clinical and public-health strategies aimed at reducing environmental exposures from current levels could substantially lower the burden of CVD-related death and disability worldwide.

Health impacts of anthropogenic biomass burning in the developed world

Climate change policies have stimulated a shift towards renewable energy sources such as biomass. The economic crisis of 2008 has also increased the practice of household biomass burning as it is often cheaper than using oil, gas or electricity for heating. As a result, household biomass combustion is becoming an important source of air pollutants in the European Union.This position paper discusses the contribution of biomass combustion to pollution levels in Europe, and the emerging evidence on the adverse health effects of biomass combustion products.Epidemiological studies in the developed world have documented associations between indoor and outdoor exposure to biomass combustion products and a range of adverse health effects. A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40 000 deaths per year.We conclude that emissions from current biomass combustion products negatively affect respiratory and, possibly, cardiovascular health in Europe. Biomass combustion emissions, in contrast to emissions from most other sources of air pollution, are increasing. More needs to be done to further document the health effects of biomass combustion in Europe, and to reduce emissions of harmful biomass combustion products to protect public health.

Within- and between-city contrasts in nitrogen dioxide and mortality in 10 Canadian cities; a subset of the Canadian Census Health and Environment Cohort (CanCHEC)

The independent and joint effects of within- and between-city contrasts in air pollution on mortality have been investigated rarely. To examine the differential effects of between- versus within-city contrasts in pollution exposure, we used both ambient measurements and land use regression models to assess associations with mortality and exposure to nitrogen dioxide (NO2) among ~735,600 adults in 10 of the largest Canadian cities. We estimated exposure contrasts partitioned into within- and between-city contrasts, and the sum of these as overall exposures, for every year from 1984 to 2006. Residential histories allowed us to follow subjects annually during the study period. We calculated hazard ratios (HRs) adjusted for many personal and contextual variables. In fully-adjusted, random-effects models, we found positive associations between overall NO2 exposures and mortality from non-accidental causes (HR per 5 p.p.b.: 1.05; 95% confidence interval (CI): 1.03-1.07), cardiovascular disease (HR per 5 p.p.b.: 1.04; 95% CI: 1.01-1.06), ischaemic heart disease (HR per 5 p.p.b.: 1.05; 95% CI: 1.02-1.08) and respiratory disease (HR per 5 p.p.b.: 1.04; 95% CI: 0.99-1.08), but not from cerebrovascular disease (HR per 5 p.p.b.: 1.01; 95% CI: 0.96-1.06). We found that most of these associations were determined by within-city contrasts, as opposed to by between-city contrasts in NO2. Our results suggest that variation in NO2 concentrations within a city may represent a more toxic mixture of pollution than variation between cities.

High-Resolution Satellite-Derived PM2.5 from Optimal Estimation and Geographically Weighted Regression over North America

We used a geographically weighted regression (GWR) statistical model to represent bias of fine particulate matter concentrations (PM2.5) derived from a 1 km optimal estimate (OE) aerosol optical depth (AOD) satellite retrieval that used AOD-to-PM2.5 relationships from a chemical transport model (CTM) for 2004-2008 over North America. This hybrid approach combined the geophysical understanding and global applicability intrinsic to the CTM relationships with the knowledge provided by observational constraints. Adjusting the OE PM2.5 estimates according to the GWR-predicted bias yielded significant improvement compared with unadjusted long-term mean values (R(2) = 0.82 versus R(2) = 0.62), even when a large fraction (70%) of sites were withheld for cross-validation (R(2) = 0.78) and developed seasonal skill (R(2) = 0.62-0.89). The effect of individual GWR predictors on OE PM2.5 estimates additionally provided insight into the sources of uncertainty for global satellite-derived PM2.5 estimates. These predictor-driven effects imply that local variability in surface elevation and urban emissions are important sources of uncertainty in geophysical calculations of the AOD-to-PM2.5 relationship used in satellite-derived PM2.5 estimates over North America, and potentially worldwide.

Approximations for Estimating Change in Life Expectancy Attributable to Air Pollution in Relation to Multiple Causes of Death Using a Cause Modified Life Table

There is considerable debate as to the most appropriate metric for characterizing the mortality impacts of air pollution. Life expectancy has been advocated as an informative measure. Although the life-table calculus is relatively straightforward, it becomes increasingly cumbersome when repeated over large numbers of geographic areas and for multiple causes of death. Two simplifying assumptions were evaluated: linearity of the relation between excess rate ratio and change in life expectancy, and additivity of cause-specific life-table calculations. We employed excess rate ratios linking PM2.5 and mortality from cerebrovascular disease, chronic obstructive pulmonary disease, ischemic heart disease, and lung cancer derived from a meta-analysis of worldwide cohort studies. As a sensitivity analysis, we employed an integrated exposure response function based on the observed risk of PM2.5 over a wide range of concentrations from ambient exposure, indoor exposure, second-hand smoke, and personal smoking. Impacts were estimated in relation to a change in PM2.5 from 19.5 μg/m(3) estimated for Toronto to an estimated natural background concentration of 1.8 μg/m(3) . Estimated changes in life expectancy varied linearly with excess rate ratios, but at higher values the relationship was more accurately represented as a nonlinear function. Changes in life expectancy attributed to specific causes of death were additive with maximum error of 10%. Results were sensitive to assumptions about the air pollution concentration below which effects on mortality were not quantified. We have demonstrated valid approximations comprising expression of change in life expectancy as a function of excess mortality and summation across multiple causes of death.

Air pollution and public health: emerging hazards and improved understanding of risk

Despite past improvements in air quality, very large parts of the population in urban areas breathe air that does not meet European standards let alone the health-based World Health Organisation Air Quality Guidelines. Over the last 10 years, there has been a substantial increase in findings that particulate matter (PM) air pollution is not only exerting a greater impact on established health endpoints, but is also associated with a broader number of disease outcomes. Data strongly suggest that effects have no threshold within the studied range of ambient concentrations, can occur at levels close to PM2.5 background concentrations and that they follow a mostly linear concentration-response function. Having firmly established this significant public health problem, there has been an enormous effort to identify what it is in ambient PM that affects health and to understand the underlying biological basis of toxicity by identifying mechanistic pathways-information that in turn will inform policy makers how best to legislate for cleaner air. Another intervention in moving towards a healthier environment depends upon the achieving the right public attitude and behaviour by the use of optimal air pollution monitoring, forecasting and reporting that exploits increasingly sophisticated information systems. Improving air quality is a considerable but not an intractable challenge. Translating the correct scientific evidence into bold, realistic and effective policies undisputedly has the potential to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

Association of long-term PM2.5 exposure with mortality using different air pollution exposure models: impacts in rural and urban California

Most PM2.5-associated mortality studies are not conducted in rural areas where mortality rates may differ when population characteristics, health care access, and PM2.5 composition differ. PM2.5-associated mortality was investigated in the elderly residing in rural-urban zip codes. Exposure (2000-2006) was estimated using different models and Poisson regression was performed using 2006 mortality data. PM2.5 models estimated comparable exposures, although subtle differences were observed in rate ratios (RR) within areas by health outcomes. Cardiovascular disease (CVD), ischemic heart disease (IHD), and cardiopulmonary disease (CPD), mortality was significantly associated with rural, urban, and statewide chronic PM2.5 exposures. We observed larger effect sizes in RRs for CVD, CPD, and all-cause (AC) with similar sizes for IHD mortality in rural areas compared to urban areas. PM2.5 was significantly associated with AC mortality in rural areas and statewide; however, in urban areas, only the most restrictive exposure model showed an association. Given the results seen, future mortality studies should consider adjusting for differences with rural-urban variables.

Addressing Global Mortality from Ambient PM2.5

Ambient fine particulate matter (PM2.5) has a large and well-documented global burden of disease. Our analysis uses high-resolution (10 km, global-coverage) concentration data and cause-specific integrated exposure-response (IER) functions developed for the Global Burden of Disease 2010 to assess how regional and global improvements in ambient air quality could reduce attributable mortality from PM2.5. Overall, an aggressive global program of PM2.5 mitigation in line with WHO interim guidelines could avoid 750 000 (23%) of the 3.2 million deaths per year currently (ca. 2010) attributable to ambient PM2.5. Modest improvements in PM2.5 in relatively clean regions (North America, Europe) would result in surprisingly large avoided mortality, owing to demographic factors and the nonlinear concentration-response relationship that describes the risk of particulate matter in relation to several important causes of death. In contrast, major improvements in air quality would be required to substantially reduce mortality from PM2.5 in more polluted regions, such as China and India. Moreover, forecasted demographic and epidemiological transitions in India and China imply that to keep PM2.5-attributable mortality rates (deaths per 100 000 people per year) constant, average PM2.5 levels would need to decline by ∼20-30% over the next 15 years merely to offset increases in PM2.5-attributable mortality from aging populations. An effective program to deliver clean air to the world's most polluted regions could avoid several hundred thousand premature deaths each year.

Air Pollution and Mortality in Seven Million Adults: The Dutch Environmental Longitudinal Study (DUELS)

BACKGROUND

Long-term exposure to air pollution has been associated with mortality in urban cohort studies. Few studies have investigated this association in large-scale population registries, including non-urban populations.

OBJECTIVES

The aim of the study was to evaluate the associations between long-term exposure to air pollution and nonaccidental and cause-specific mortality in the Netherlands based on existing national databases.

METHODS

We used existing Dutch national databases on mortality, individual characteristics, residence history, neighborhood characteristics, and national air pollution maps based on land use regression (LUR) techniques for particulates with an aerodynamic diameter ≤ 10 μm (PM10) and nitrogen dioxide (NO2). Using these databases, we established a cohort of 7.1 million individuals ≥ 30 years of age. We followed the cohort for 7 years (2004-2011). We applied Cox proportional hazard models adjusting for potential individual and area-specific confounders.

RESULTS

After adjustment for individual and area-specific confounders, for each 10-μg/m3 increase, PM10 and NO2 were associated with nonaccidental mortality [hazard ratio (HR) = 1.08; 95% CI: 1.07, 1.09 and HR = 1.03; 95% CI: 1.02, 1.03, respectively], respiratory mortality (HR = 1.13; 95% CI: 1.10, 1.17 and HR = 1.02; 95% CI: 1.01, 1.03, respectively), and lung cancer mortality (HR = 1.26; 95% CI: 1.21, 1.30 and HR = 1.10 95% CI: 1.09, 1.11, respectively). Furthermore, PM10 was associated with circulatory disease mortality (HR = 1.06; 95% CI: 1.04, 1.08), but NO2 was not (HR = 1.00; 95% CI: 0.99, 1.01). PM10 associations were robust to adjustment for NO2; NO2 associations remained for nonaccidental mortality and lung cancer mortality after adjustment for PM10.

CONCLUSIONS

Long-term exposure to PM10 and NO2 was associated with nonaccidental and cause-specific mortality in the Dutch population of ≥ 30 years of age.

Estimated public health impacts of changes in concentrations of fine particle air pollution in Canada, 2000 to 2011

OBJECTIVES

To estimate the public health impacts of changes in fine particle air pollution in Canada between 2000 and 2011, employing nationally comprehensive exposure estimates and quantifying the impacts on life expectancy, mortality and morbidity.

METHODS

We employed spatially comprehensive exposure estimates derived from satellite remote sensing to estimate the effects of actual observed changes in concentrations of fine particulate matter (PM), of median aerodynamic diameter <2.5 μm (i.e., PM2.5), from 2000 to 2011. We estimated changes in life expectancy using standard life table methods and changes in frequency of health outcomes as the product of population, baseline rate of the health outcome and the proportional change in health outcome per specified change in PM2.5 concentration.

RESULTS

A population weighted average decrease in PM2.5 of nearly 25% (2.0 μg/m³) was observed between 2000 and 2011. This was estimated to result in a national population weighted average increase in life expectancy of 0.10 years (95% confidence interval 0.03-0.23; up to 0.34 years in specific census divisions) and reductions in the frequency of mortality and morbidity of up to 3.6%. Increases in PM2.5 up to 3.5 μg/m³ were observed in some census divisions, particularly in the prairies.

CONCLUSION

At the national level, changes in PM2.5 concentrations between 2000 and 2011 were associated with an estimated improvement in national population weighted average life expectancy and a net reduction in mortality and morbidity. Areas that failed to improve or that worsened during this period warrant additional scrutiny to identify options for reducing PM2.5 concentrations.

Health benefits of air pollution abatement policy: Role of the shape of the concentration-response function

There is strong evidence that fine particulate matter (aerodynamic diameter<2.5 μm; PM2.5) air pollution contributes to increased risk of disease and death. Estimates of the burden of disease attributable to PM2.5 pollution and benefits of reducing pollution are dependent upon the shape of the concentration response (C-R) functions. Recent evidence suggests that the C-R function between PM2.5 air pollution and mortality risk may be supralinear across wide ranges of exposure. Such results imply that incremental pollution abatement efforts may yield greater benefits in relatively clean areas than in highly polluted areas. The role of the shape of the C-R function in evaluating and understanding the costs and health benefits of air pollution abatement policy is explored. There remain uncertainties regarding the shape of the C-R function, and additional efforts to more fully understand the C-R relationships between PM2.5 and adverse health effects are needed to allow for more informed and effective air pollution abatement policies. Current evidence, however, suggests that there are benefits both from reducing air pollution in the more polluted areas and from continuing to reduce air pollution in cleaner areas.

IMPLICATIONS

Estimates of the benefits of reducing PM2.5 air pollution are highly dependent upon the shape of the PM2.5-mortality concentration-response (C-R) function. Recent evidence indicates that this C-R function may be supralinear across wide ranges of exposure, suggesting that incremental pollution abatement efforts may yield greater benefits in relatively clean areas than in highly polluted areas. This paper explores the role of the shape of the C-R function in evaluating and understanding the costs and health benefits of PM2.5 air pollution abatement.

Associations of Ozone and PM2.5 Concentrations With Parkinson's Disease Among Participants in the Agricultural Health Study

OBJECTIVE

This study describes associations of ozone and fine particulate matter with Parkinson's disease observed among farmers in North Carolina and Iowa.

METHODS

We used logistic regression to determine the associations of these pollutants with self-reported, doctor-diagnosed Parkinson's disease. Daily predicted pollutant concentrations were used to derive surrogates of long-term exposure and link them to study participants' geocoded addresses.

RESULTS

We observed positive associations of Parkinson's disease with ozone (odds ratio = 1.39; 95% CI: 0.98 to 1.98) and fine particulate matter (odds ratio = 1.34; 95% CI: 0.93 to 1.93) in North Carolina but not in Iowa.

CONCLUSIONS

The plausibility of an effect of ambient concentrations of these pollutants on Parkinson's disease risk is supported by experimental data demonstrating damage to dopaminergic neurons at relevant concentrations. Additional studies are needed to address uncertainties related to confounding and to examine temporal aspects of the associations we observed.

Impact of Atmospheric Microparticles on the Development of Oxidative Stress in Healthy City/Industrial Seaport Residents

Atmospheric microsized particles producing reactive oxygen species can pose a serious health risk for city residents. We studied the responses of organisms to microparticles in 255 healthy volunteers living in areas with different levels of microparticle air pollution. We analyzed the distribution of microparticles in snow samples by size and content. ELISA and flow cytometry methods were employed to determine the parameters of the thiol-disulfide metabolism, peroxidation and antioxidant, genotoxicity, and energy state of the leukocytes. We found that, in the park areas, microparticles with a size of 800 μm or more were predominant (96%), while in the industrial areas, they tended to be less than 50 μm (93%), including size 200-300 nm (7%). In the industrial areas, we determined the oxidative modification of proteins (21% compared to the park areas, p ≤ 0.05) and DNA (12%, p ≤ 0.05), as well as changes in leukocytes' energy potential (53%, p ≤ 0.05). An increase in total antioxidant activity (82%, p ≤ 0.01) and thiol-disulfide system response (thioredoxin increasing by 33%, p ≤ 0.01; glutathione, 30%, p ≤ 0.01 with stable reductases levels) maintains a balance of peroxidation-antioxidant processes, protecting cellular and subcellular structures from significant oxidative damage.

Understanding Air Pollution and Cardiovascular Diseases: Is It Preventable?

Fine particulate matter (<2.5 µm, PM_2.5) air pollution is a leading risk factor for morbidity and mortality worldwide. The largest portion of adverse health effects is from cardiovascular diseases. In North America, PM_2.5 concentrations have shown a steady decline over the past several decades; however, the opposite trend has occurred throughout much of the developing world whereby daily concentrations commonly reach extraordinarily high levels. While air quality regulations can reduce air pollution at a societal level, what individuals can do to reduce their personal exposures remains an active field of investigation. Here, we review the emerging evidence that several interventions (e.g., air filters) and/or behavioral changes can lower PM pollution exposure and as such, may be capable of mitigating the ensuing adverse cardiovascular health consequences. Air pollution remains a worldwide epidemic and a multi-tiered prevention strategy is required in order to optimally protect global public health.

Epigallocatechin-3-gallate protects HUVECs from PM2.5-induced oxidative stress injury by activating critical antioxidant pathways

Endothelial dysfunction and oxidative stress likely play roles in PM_2.5-induced harmful effects. Epigallocatechin-3-gallate (EGCG), the major polyphenolic constituent of green tea, is a potent antioxidant that exerts protective effects on cardiovascular diseases (CVDs) in part by scavenging free radicals. The exposure to ambient fine particulate matter (PM_2.5) is responsible for certain CVDs. The aim of the present study was to investigate whether EGCG could also inhibit PM_2.5-induced oxidative stress by activating the nuclear factor E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) pathway in human umbilical vein endothelial cells (HUVECs). PM_2.5 (200 μg/mL) increased both cell death and intracellular ROS levels significantly, whereas EGCG (50–400 μM) inhibited these effects in a concentration-dependent manner. Western blotting and PCR demonstrated that EGCG increased Nrf2 and HO-1 expression in HUVECs that had been exposed to PM_2.5. PD98059 (a selective inhibitor of extracellular signal regulated kinase [ERK]-1/2) and SB203580 (a selective inhibitor of p38 MAPK), but not SP600125 (a selective inhibitor of c-jun N-terminal kinase [JNK]), attenuated the EGCG-induced Nrf2 and HO-1 expression. In addition, silencing Nrf2 abolished EGCG-induced Nrf2 and HO-1 upregulation and enhancement of cell viability. The present study suggests that EGCG protects HUVECs from PM_2.5-induced oxidative stress injury by upregulating Nrf2/HO-1 via activation of the p38 MAPK and the ERK1/2 signaling pathways.

Response of global particulate-matter-related mortality to changes in local precursor emissions

Recent Global Burden of Disease (GBD) assessments estimated that outdoor fine-particulate matter (PM2.5) is a causal factor in over 5% of global premature deaths. PM2.5 is produced by a variety of direct and indirect, natural and anthropogenic processes that complicate PM2.5 management. This study develops a proof-of-concept method to quantify the effects on global premature mortality of changes to PM2.5 precursor emissions. Using the adjoint of the GEOS-Chem chemical transport model, we calculated sensitivities of global PM2.5-related premature mortality to emissions of precursor gases (SO2, NOx, NH3) and carbonaceous aerosols. We used a satellite-derived ground-level PM2.5 data set at approximately 10 × 10 km(2) resolution to better align the exposure with population density. We used exposure-response functions from the GBD project to relate mortality to exposure in the adjoint calculation. The response of global mortality to changes in local anthropogenic emissions varied spatially by several orders of magnitude. The largest reductions in mortality for a 1 kg km(-2) yr(-1) decrease in emissions were for ammonia and carbonaceous aerosols in Eastern Europe. The greatest reductions in mortality for a 10% decrease in emissions were found for secondary inorganic sources in East Asia. In general, a 10% decrease in SO2 emissions was the most effective source to control, but regional exceptions were found.

Commuting behaviors and exposure to air pollution in Montreal, Canada

BACKGROUND

Vehicular traffic is a major source of outdoor air pollution in urban areas, and studies have shown that air pollution is worse during hours of commuting to and from work and school. However, it is unclear to what extent different commuting behaviors are a source of air pollution compared to non-commuters, and if air pollution exposure actually differs by the mode of commuting. This study aimed to examine the relationships between commuting behaviors and air pollution exposure levels measured by urinary 1-OHP (1-hydroxypyrene), a biomarker of exposure to polycyclic aromatic hydrocarbons (PAHs).

METHODS

A cross-sectional study of 174 volunteers living in Montreal, 92 females and 82 males, aged 20 to 53 years was conducted in 2011. Each participant completed a questionnaire regarding demographic factors, commuting behaviors, home and workplace addresses, and potential sources of PAH exposure, and provided a complete first morning void urine sample for 1-OHP analysis. Multivariable general linear regression models were used to examine the relationships between different types of commuting and urinary 1-OHP levels.

RESULTS

Compared to non-commuters, commuters traveling by foot or bicycle and by car or truck had a significantly higher urinary 1-OHP concentration in urine (p=0.01 for foot or bicycle vs. non-commuters; p=0.02 for car or truck vs. non-commuters); those traveling with public transportation and combinations of two or more types of modes tended to have an increased 1-OHP level in urine (p=0.06 for public transportation vs. non-commuters; p=0.05 for commuters with combinations of two or more types of modes vs. non-commuters). No significant difference in urinary 1-OHP variation was found by mode of commuting.

CONCLUSION

This preliminary study suggests that despite the mode of commuting, all types of commuting during rush hours increase exposure to air pollution as measured by a sensitive PAH metabolite biomarker, and mode of commuting did not explain exposure variation.

Use of satellite observations for long-term exposure assessment of global concentrations of fine particulate matter

BACKGROUND

More than a decade of satellite observations offers global information about the trend and magnitude of human exposure to fine particulate matter (PM2.5).

OBJECTIVE

In this study, we developed improved global exposure estimates of ambient PM2.5 mass and trend using PM2.5 concentrations inferred from multiple satellite instruments.

METHODS

We combined three satellite-derived PM2.5 sources to produce global PM2.5 estimates at about 10 km × 10 km from 1998 through 2012. For each source, we related total column retrievals of aerosol optical depth to near-ground PM2.5 using the GEOS-Chem chemical transport model to represent local aerosol optical properties and vertical profiles. We collected 210 global ground-based PM2.5 observations from the literature to evaluate our satellite-based estimates with values measured in areas other than North America and Europe.

RESULTS

We estimated that global population-weighted ambient PM2.5 concentrations increased 0.55 μg/m3/year (95% CI: 0.43, 0.67) (2.1%/year; 95% CI: 1.6, 2.6) from 1998 through 2012. Increasing PM2.5 in some developing regions drove this global change, despite decreasing PM2.5 in some developed regions. The estimated proportion of the population of East Asia living above the World Health Organization (WHO) Interim Target-1 of 35 μg/m3 increased from 51% in 1998-2000 to 70% in 2010-2012. In contrast, the North American proportion above the WHO Air Quality Guideline of 10 μg/m3 fell from 62% in 1998-2000 to 19% in 2010-2012. We found significant agreement between satellite-derived estimates and ground-based measurements outside North America and Europe (r = 0.81; n = 210; slope = 0.68). The low bias in satellite-derived estimates suggests that true global concentrations could be even greater.

CONCLUSIONS

Satellite observations provide insight into global long-term changes in ambient PM2.5 concentrations. Satellite-derived estimates and ground-based PM2.5 observations from this study are available for public use.

Using Machine Learning to Estimate Global PM2.5 for Environmental Health Studies

With the increasing awareness of health impacts of particulate matter, there is a growing need to comprehend the spatial and temporal variations of the global abundance of ground-level airborne particulate matter (PM2.5). Here we use a suite of remote sensing and meteorological data products together with ground based observations of PM2.5 from 8,329 measurement sites in 55 countries taken between 1997 and 2014 to train a machine learning algorithm to estimate the daily distributions of PM2.5 from 1997 to the present. We demonstrate that the new PM2.5 data product can reliably represent global observations of PM2.5 for epidemiological studies. An analysis of Baltimore schizophrenia emergency room admissions is presented in terms of the levels of ambient pollution. PM2.5 appears to have an impact on some aspects of mental health.

Estimating the global abundance of ground level presence of particulate matter (PM2.5)

With the increasing awareness of the health impacts of particulate matter, there is a growing need to comprehend the spatial and temporal variations of the global abundance of ground level airborne particulate matter with a diameter of 2.5 microns or less (PM2.5). Here we use a suite of remote sensing and meteorological data products together with ground-based observations of particulate matter from 8,329 measurement sites in 55 countries taken 1997-2014 to train a machine-learning algorithm to estimate the daily distributions of PM2.5 from 1997 to the present. In this first paper of a series, we present the methodology and global average results from this period and demonstrate that the new PM2.5 data product can reliably represent global observations of PM2.5 for epidemiological studies.

Relationships between fine particulate air pollution, cardiometabolic disorders, and cardiovascular mortality

RATIONALE

Growing evidence suggests that long-term exposure to fine particulate matter (PM2.5) air pollution contributes to risk of cardiovascular disease (CVD) morbidity and mortality. There is uncertainty about who are most susceptible. Individuals with underlying cardiometabolic disorders, including hypertension, diabetes mellitus, and obesity, may be at greater risk. PM2.5 pollution may also contribute to cardiometabolic disorders, augmenting CVD risk.

OBJECTIVE

This analysis evaluates relationships between long-term PM2.5 exposure and cardiometabolic disease on risk of death from CVD and cardiometabolic conditions.

METHODS AND RESULTS

Data on 669 046 participants from the American Cancer Society Cancer Prevention Study II cohort were linked to modeled PM2.5 concentrations at geocoded home addresses. Cox proportional hazards regression models were used to estimate adjusted hazards ratios for death from CVD and cardiometabolic diseases based on death-certificate information. Effect modification by pre-existing cardiometabolic risk factors on the PM2.5-CVD mortality association was examined. PM2.5 exposure was associated with CVD mortality, with the hazards ratios (95% confidence interval) per 10 μg/m(3) increase in PM2.5 equal to 1.12 (1.10-1.15). Deaths linked to hypertension and diabetes mellitus (mentioned on death certificate as either primary or contributing cause of death) were also associated with PM2.5. There was no consistent evidence of effect modification by cardiometabolic disease risk factors on the PM2.5-CVD mortality association.

CONCLUSIONS

Pollution-induced CVD mortality risk is observed for those with and without existing cardiometabolic disorders. Long-term exposure may also contribute to the development or exacerbation of cardiometabolic disorders, increasing risk of CVD, and cardiometabolic disease mortality.

Fifteen-year global time series of satellite-derived fine particulate matter

Ambient fine particulate matter (PM2.5) is a leading environmental risk factor for premature mortality. We use aerosol optical depth (AOD) retrieved from two satellite instruments, MISR and SeaWiFS, to produce a unified 15-year global time series (1998-2012) of ground-level PM2.5 concentration at a resolution of 1° x 1°. The GEOS-Chem chemical transport model (CTM) is used to relate each individual AOD retrieval to ground-level PM2.5. Four broad areas showing significant, spatially coherent, annual trends are examined in detail: the Eastern U.S. (-0.39 ± 0.10 μg m(-3) yr(-1)), the Arabian Peninsula (0.81 ± 0.21 μg m(-3) yr(-1)), South Asia (0.93 ± 0.22 μg m(-3) yr(-1)) and East Asia (0.79 ± 0.27 μg m(-3) yr(-1)). Over the period of dense in situ observation (1999-2012), the linear tendency for the Eastern U.S. (-0.37 ± 0.13 μg m(-3) yr(-1)) agrees well with that from in situ measurements (-0.38 ± 0.06 μg m(-3) yr(-1)). A GEOS-Chem simulation reveals that secondary inorganic aerosols largely explain the observed PM2.5 trend over the Eastern U.S., South Asia, and East Asia, while mineral dust largely explains the observed trend over the Arabian Peninsula.

Indirect adjustment for multiple missing variables applicable to environmental epidemiology

OBJECTIVES

Develop statistical methods for survival models to indirectly adjust hazard ratios of environmental exposures for missing risk factors.

METHODS

A partitioned regression approach for linear models is applied to time to event survival analyses of cohort study data. Information on the correlation between observed and missing risk factors is obtained from ancillary data sources such as national health surveys. The relationship between the missing risk factors and survival is obtained from previously published studies. We first evaluated the methodology using simulations, by considering the Weibull survival distribution for a proportional hazards regression model with varied baseline functions, correlations between an adjusted variable and an adjustment variable as well as selected censoring rates. Then we illustrate the method in a large, representative Canadian cohort of the association between concentrations of ambient fine particulate matter and mortality from ischemic heart disease.

RESULTS

Indirect adjustment for cigarette smoking habits and obesity increased the fine particulate matter-ischemic heart disease association by 3%-123%, depending on the number of variables considered in the adjustment model due to the negative correlation between these two risk factors and ambient air pollution concentrations in Canada. The simulations suggested that the method yielded small relative bias (<40%) for most cohort designs encountered in environmental epidemiology.

CONCLUSIONS

This method can accommodate adjustment for multiple missing risk factors simultaneously while accounting for the associations between observed and missing risk factors and between missing risk factors and health endpoints.

Long-term exposure to ambient air pollution and incidence of cerebrovascular events: results from 11 European cohorts within the ESCAPE project

BACKGROUND

Few studies have investigated effects of air pollution on the incidence of cerebrovascular events.

OBJECTIVES

We assessed the association between long-term exposure to multiple air pollutants and the incidence of stroke in European cohorts.

METHODS

Data from 11 cohorts were collected, and occurrence of a first stroke was evaluated. Individual air pollution exposures were predicted from land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE). The exposures were: PM2.5 [particulate matter (PM) ≤ 2.5 μm in diameter], coarse PM (PM between 2.5 and 10 μm), PM10 (PM ≤ 10 μm), PM2.5 absorbance, nitrogen oxides, and two traffic indicators. Cohort-specific analyses were conducted using Cox proportional hazards models. Random-effects meta-analysis was used for pooled effect estimation.

RESULTS

A total of 99,446 study participants were included, 3,086 of whom developed stroke. A 5-μg/m3 increase in annual PM2.5 exposure was associated with 19% increased risk of incident stroke [hazard ratio (HR) = 1.19, 95% CI: 0.88, 1.62]. Similar findings were obtained for PM10. The results were robust to adjustment for an extensive list of cardiovascular risk factors and noise coexposure. The association with PM2.5 was apparent among those ≥ 60 years of age (HR = 1.40, 95% CI: 1.05, 1.87), among never-smokers (HR = 1.74, 95% CI: 1.06, 2.88), and among participants with PM2.5 exposure < 25 μg/m3 (HR = 1.33, 95% CI: 1.01, 1.77).

CONCLUSIONS

We found suggestive evidence of an association between fine particles and incidence of cerebrovascular events in Europe, even at lower concentrations than set by the current air quality limit value.

Structured expert judgment to characterize uncertainty between PM2.5 exposure and mortality in Chile

To further the understanding and implementation of expert elicitation methods in the evaluation of public policies related to air pollution, the present study's main goal was to explore the potential strengths and weaknesses of structured expert judgment (SEJ) methodology as a way to derive a C-R function for chronic PM(2.5) exposure and premature mortality in Chile. Local experts were classified in two groups according to background and experience: physicians (Group 1) and engineers (Group 2). Experts were required to provide an estimate of the true percent change in nonaccidental mortality resulting from a permanent 1 μg/m(3) reduction in PM2.5 annual average ambient concentration across the entire Chilean territory. Cooke's Classical Model was used to combine the individual experts' assessments. Experts' mortality estimations varied markedly across groups: while experts in Group 1 delivered higher estimations than those reported in major international cohort studies, estimations from Group 2 were, to varying degrees, anchored to previous studies. Accordingly, combined distributions for each group and all experts were significantly different, due to the high sensitivity of the weighted distribution to experts' performance in calibration variables. Results of this study suggest that, while the use of SEJ has great potential for estimating C-R functions for chronic exposure to PM2.5 and premature mortality and its major sources of uncertainty in countries where no studies are available, its successful implementation is conditioned by a number of factors, which are analyzed and discussed.

Long-term exposure to traffic-related air pollution and cardiovascular health in a Greek cohort study

Our objective is to evaluate the association of exposure to traffic-related air pollution with the incidence of fatal and non-fatal ischemic heart disease (IHD), stroke and total cardiovascular disease (CVD) events in a Greek cohort. We used data from the European Prospective Investigation on Nutrition and Cancer (EPIC) for 2752 subjects followed from 1997 to 2011, whose residence was in 10 municipalities of the Greater Athens area. Air pollution exposure estimation was based on a spatio-temporal land use regression model linking geo-coded residential addresses to long-term average NO2 and PM10 concentrations. We conducted Cox proportional hazards regression analysis, adjusting for potential confounders. Hazard ratios (HR) above 1 (not all statistically significant) were associated with higher PM10 exposure for all outcomes. Weaker associations were found with NO2 exposure. Specifically, the estimated HR for a CVD event associated with 10 μg/m(3) increase in long-term exposure to PM10 was 1.50 (1.05-2.16, p-value: 0.027). The relationship was more evident for subjects ≤50 years old at recruitment. Associations of PM10 and NO2 exposure with IHD events were found only among women with HRs respectively of 2.24 (0.89-5.64, p-value: 0.086) and 1.54 (1.01-2.37, p-value: 0.046) associated with 10 μg/m(3) increase in the corresponding pollutant. In conclusion, the present study suggests that long-term exposure to traffic-related air pollution has an impact on CVD and IHD morbidity, particularly among women and younger subjects.

Trends of non-accidental, cardiovascular, stroke and lung cancer mortality in Arkansas are associated with ambient PM2.5 reductions

The cardiovascular and stroke mortality rates in Arkansas are among the highest in the USA. The annual trends of stroke and cardiovascular mortality are barely correlated to smoking cessation; while the prevalence of risk factors such as obesity; cholesterol and hypertension increased over the 1979–2007 period. The study determined the effect of chronic exposure to PM_2.5 on non-accidental; cardiovascular; stroke and lung cancer mortality in Arkansas over the 2000–2010 period using the World Health Organization’s log-linear health impact model. County chronic exposures to PM_2.5 were computed by averaging spatially-resolved gridded concentrations using PM_2.5 observations. A spatial uniformity was observed for PM_2.5 mass levels indicating that chronic exposures were comparable throughout the state. The reduction of PM_2.5 mass levels by 3.0 μg/m³ between 2000 and 2010 explained a significant fraction of the declining mortality. The effect was more pronounced in southern and eastern rural Arkansas as compared to the rest of the state. This study provides evidence that the implementation of air pollution regulations has measurable effects on mortality even in regions with high prevalence of major risk factors such as obesity and smoking. These outcomes are noteworthy as efforts to modify the major risk factors require longer realization times.

Metal composition of fine particulate air pollution and acute changes in cardiorespiratory physiology

BACKGROUND

Studying the physiologic effects of components of fine particulate mass (PM2.5) could contribute to a better understanding of the nature of toxicity of air pollution.

OBJECTIVES

We examined the relation between acute changes in cardiovascular and respiratory function, and PM2.5-associated-metals.

METHODS

Using generalized linear mixed models, daily changes in ambient PM2.5-associated metals were compared to daily changes in physiologic measures in 59 healthy subjects who spent 5-days near a steel plant and 5-days on a college campus.

RESULTS

Interquartile increases in calcium, cadmium, lead, strontium, tin, vanadium and zinc were associated with statistically significant increases in heart rate of 1-3 beats per minute, increases of 1-3 mmHg in blood pressure and/or lung function decreases of up to 4% for total lung capacity.

CONCLUSION

Metals contained in PM2.5 were found to be associated with acute changes in cardiovascular and respiratory physiology.

Long-term exposure to fine particulate matter: association with nonaccidental and cardiovascular mortality in the agricultural health study cohort

BACKGROUND

Few studies have examined the relationship between long-term exposure to ambient fine particulate matter (PM2.5) and nonaccidental mortality in rural populations.

OBJECTIVE

We examined the relationship between PM2.5 and nonaccidental and cardiovascular mortality in the U.S. Agricultural Health Study cohort.

METHODS

The cohort (n = 83,378) included farmers, their spouses, and commercial pesticide applicators residing primarily in Iowa and North Carolina. Deaths occurring between enrollment (1993-1997) and 30 December 2009 were identified by record linkage. Six-year average (2001-2006) remote-sensing derived estimates of PM2.5 were assigned to participants' residences at enrollment, and Cox proportional hazards models were used to estimate hazard ratios (HR) in relation to a 10-μg/m(3) increase in PM2.5 adjusted for individual-level covariates.

RESULTS

In total, 5,931 nonaccidental and 1,967 cardiovascular deaths occurred over a median follow-up time of 13.9 years. PM2.5 was not associated with nonaccidental mortality in the cohort as a whole (HR = 0.95; 95% CI: 0.76, 1.20), but consistent inverse relationships were observed among women. Positive associations were observed between ambient PM2.5 and cardiovascular mortality among men, and these associations were strongest among men who did not move from their enrollment address (HR = 1.63; 95% 0.94, 2.84). In particular, cardiovascular mortality risk in men was significantly increased when analyses were limited to nonmoving participants with the most precise exposure geocoding (HR = 1.87; 95% CI: 1.04, 3.36).

CONCLUSIONS

Rural PM2.5 may be associated with cardiovascular mortality in men; however, similar associations were not observed among women. Further evaluation is required to explore these sex differences.

Long-term exposure to air pollution and cardiovascular mortality: an analysis of 22 European cohorts

BACKGROUND

Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.

METHODS

Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.

RESULTS

The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.

CONCLUSION

In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

Prioritizing environmental justice and equality: diesel emissions in southern California

Existing environmental policies aim to reduce emissions but lack standards for addressing environmental justice. Environmental justice research documents disparities in exposure to air pollution; however, little guidance currently exists on how to make improvements or on how specific emission-reduction scenarios would improve or deteriorate environmental justice conditions. Here, we quantify how emission reductions from specific sources would change various measures of environmental equality and justice. We evaluate potential emission reductions for fine diesel particulate matter (DPM) in Southern California for five sources: on-road mobile, off-road mobile, ships, trains, and stationary. Our approach employs state-of-the-science dispersion and exposure models. We compare four environmental goals: impact, efficiency, equality, and justice. Results indicate potential trade-offs among those goals. For example, reductions in train emissions produce the greatest improvements in terms of efficiency, equality, and justice, whereas off-road mobile source reductions can have the greatest total impact. Reductions in on-road emissions produce improvements in impact, equality, and justice, whereas emission reductions from ships would widen existing population inequalities. Results are similar for complex versus simplified exposure analyses. The approach employed here could usefully be applied elsewhere to evaluate opportunities for improving environmental equality and justice in other locations.

An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure

BACKGROUND

Estimating the burden of disease attributable to long-term exposure to fine particulate matter (PM2.5) in ambient air requires knowledge of both the shape and magnitude of the relative risk (RR) function. However, adequate direct evidence to identify the shape of the mortality RR functions at the high ambient concentrations observed in many places in the world is lacking.

OBJECTIVE

We developed RR functions over the entire global exposure range for causes of mortality in adults: ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), and lung cancer (LC). We also developed RR functions for the incidence of acute lower respiratory infection (ALRI) that can be used to estimate mortality and lost-years of healthy life in children < 5 years of age.

METHODS

We fit an integrated exposure-response (IER) model by integrating available RR information from studies of ambient air pollution (AAP), second hand tobacco smoke, household solid cooking fuel, and active smoking (AS). AS exposures were converted to estimated annual PM2.5 exposure equivalents using inhaled doses of particle mass. We derived population attributable fractions (PAFs) for every country based on estimated worldwide ambient PM2.5 concentrations.

RESULTS

The IER model was a superior predictor of RR compared with seven other forms previously used in burden assessments. The percent PAF attributable to AAP exposure varied among countries from 2 to 41 for IHD, 1 to 43 for stroke, < 1 to 21 for COPD, < 1 to 25 for LC, and < 1 to 38 for ALRI.

CONCLUSIONS

We developed a fine particulate mass-based RR model that covered the global range of exposure by integrating RR information from different combustion types that generate emissions of particulate matter. The model can be updated as new RR information becomes available.

Toxicological and epidemiological studies of cardiovascular effects of ambient air fine particulate matter (PM2.5) and its chemical components: coherence and public health implications

Recent investigations on PM2.5 constituents' effects in community residents have substantially enhanced our knowledge on the impacts of specific components, especially the HEI-sponsored National Particle Toxicity Component (NPACT) studies at NYU and UW-LRRI that addressed the impact of long-term PM2.5 exposure on cardiovascular disease (CVD) effects. NYU's mouse inhalation studies at five sites showed substantial variations in aortic plaque progression by geographic region that was coherent with the regional variation in annual IHD mortality in the ACS-II cohort, with both the human and mouse responses being primarily attributable to the coal combustion source category. The UW regressions of associations of CVD events and mortality in the WHI cohort, and of CIMT and CAC progression in the MESA cohort, indicated that [Formula: see text] had stronger associations with CVD-related human responses than OC, EC, or Si. The LRRI's mice had CVD-related biomarker responses to [Formula: see text]. NYU also identified components most closely associated with daily hospital admissions (OC, EC, Cu from traffic and Ni and V from residual oil). For daily mortality, they were from coal combustion ([Formula: see text], Se, and As). While the recent NPACT research on PM2.5 components that affect CVD has clearly filled some major knowledge gaps, and helped to define remaining uncertainties, much more knowledge is needed on the effects in other organ systems if we are to identify and characterize the most effective and efficient means for reducing the still considerable adverse health impacts of ambient air PM. More comprehensive speciation data are needed for better definition of human responses.

Health impact assessment of exposure to fine particulate matter based on satellite and meteorological information

Air pollution in China, especially in the Pearl River Delta (PRD) region, has drastically increased in recent years. We modelled annual mean ground-level PM2.5 concentrations based on worldwide satellite information and meteorological data from 40 cities outside the PRD. The model of PM2.5 concentration (R = 0.845) was best explained by aerosol optical thickness (43.8%). We validated the spatial-temporal dimensions of the model and estimated that the annual mean PM2.5 concentration in PRD ranged between 22 and 65 μg m(-3). Then we used meta-analysis to obtain the pooled excess risks of mortality in China and assessed the health impacts. We found an inverse association between short-term excess risks of mortality and annual mean PM2.5 concentrations. Based on the above models and analyses, the associated excess deaths for all-cause and cardiopulmonary diseases were 3386 and 2639 respectively. The corresponding risk-standardized excess death rates were 2006 and 1069 per million people.

Heat waves and health outcomes in Alabama (USA): the importance of heat wave definition

BACKGROUND

A deeper understanding of how heat wave definition affects the relationship between heat exposure and health, especially as a function of rurality, will be useful in developing effective heat wave warning systems.

OBJECTIVE

We compared the relationships between different heat wave index (HI) definitions and preterm birth (PTB) and nonaccidental death (NAD) across urban and rural areas.

METHODS

We used a time-stratified case-crossover design to estimate associations of PTB and NAD with heat wave days (defined using 15 HIs) relative to non-heat wave control days in Alabama, USA (1990-2010). ZIP code-level HIs were derived using data from the North American Land Data Assimilation System. Associations with heat wave days defined using different HIs were compared by bootstrapping. We also examined interactions with rurality.

RESULTS

Associations varied depending on the HI used to define heat wave days. Heat waves defined as having at least 2 consecutive days with mean daily temperatures above the 98th percentile were associated with 32.4% (95% CI: 3.7, 69.1%) higher PTB, and heat waves defined as at least 2 consecutive days with mean daily temperatures above the 90th percentile were associated with 3.7% (95% CI: 1.1, 6.3%) higher NAD. Results suggest that significant positive associations were more common when relative-compared with absolute-HIs were used to define exposure. Both positive and negative associations were found in each rurality stratum. However, all stratum-specific significant associations were positive, and NAD associations with heat waves were consistently positive in urban strata but not in middle or rural strata.

CONCLUSIONS

Based on our findings, we conclude that a relative mean-temperature-only heat wave definition may be the most effective metric for heat wave warning systems in Alabama.

Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project

OBJECTIVES

To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).

DESIGN

Prospective cohort studies and meta-analysis of the results.

SETTING

Cohorts in Finland, Sweden, Denmark, Germany, and Italy.

PARTICIPANTS

100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline.

MAIN OUTCOME MEASURES

Modelled concentrations of particulate matter <2.5 μm (PM2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios.

RESULTS

5157 participants experienced incident events. A 5 μg/m(3) increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m(3) increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m(3) for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m(3) increase in PM2.5) and below 40 μg/m(3) for PM10 (1.12, 1.00 to 1.27, for 10 μg/m(3) increase in PM10). Positive but non-significant associations were found with other pollutants.

CONCLUSIONS

Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.

Air quality modeling and mortality impact of fine particles reduction policies in Spain

BACKGROUND

In recent years, Spain has implemented a number of air quality control measures that are expected to lead to a future reduction in fine particle concentrations and an ensuing positive impact on public health.

OBJECTIVES

We aimed to assess the impact on mortality attributable to a reduction in fine particle levels in Spain in 2014 in relation to the estimated level for 2007.

METHODS

To estimate exposure, we constructed fine particle distribution models for Spain for 2007 (reference scenario) and 2014 (projected scenario) with a spatial resolution of 16×16km(2). In a second step, we used the concentration-response functions proposed by cohort studies carried out in Europe (European Study of Cohorts for Air Pollution Effects and Rome longitudinal cohort) and North America (American Cancer Society cohort, Harvard Six Cities study and Canadian national cohort) to calculate the number of attributable annual deaths corresponding to all causes, all non-accidental causes, ischemic heart disease and lung cancer among persons aged over 25 years (2005-2007 mortality rate data). We examined the effect of the Spanish demographic shift in our analysis using 2007 and 2012 population figures.

RESULTS

Our model suggested that there would be a mean overall reduction in fine particle levels of 1µg/m(3) by 2014. Taking into account 2007 population data, between 8 and 15 all-cause deaths per 100,000 population could be postponed annually by the expected reduction in fine particle levels. For specific subgroups, estimates varied from 10 to 30 deaths for all non-accidental causes, from 1 to 5 for lung cancer, and from 2 to 6 for ischemic heart disease. The expected burden of preventable mortality would be even higher in the future due to the Spanish population growth. Taking into account the population older than 30 years in 2012, the absolute mortality impact estimate would increase approximately by 18%.

CONCLUSIONS

Effective implementation of air quality measures in Spain, in a scenario with a short-term projection, would amount to an appreciable decline in fine particle concentrations, and this, in turn, would lead to notable health-related benefits. Recent European cohort studies strengthen the evidence of an association between long-term exposure to fine particles and health effects, and could enhance the health impact quantification in Europe. Air quality models can contribute to improved assessment of air pollution health impact estimates, particularly in study areas without air pollution monitoring data.

Integrating health on air quality assessment--review report on health risks of two major European outdoor air pollutants: PM and NO₂

Quantifying the impact of air pollution on the public's health has become an increasingly critical component in policy discussion. Recent data indicate that more than 70% of the world population lives in cities. Several studies reported that current levels of air pollutants in urban areas are associated with adverse health risks, namely, cardiovascular diseases and lung cancer. IARC recently classified outdoor air pollution and related particulate matter (PM) as carcinogenic to humans. Despite the air quality improvements observed over the last few years, there is still continued widespread exceedance within Europe, particularly regarding PM and nitrogen oxides (NOx). The European Air Quality Directive 2008/50/EC requires Member States to design appropriate air quality plans for zones where air quality does not comply with established limit values. However, in most cases, air quality is only quantified using a combination of monitored and modeled data and no health impact assessment is carried out. An integrated approach combining the effects of several emission abatement measures on air quality, impacts on human health, and associated implementation costs enables an effective cost-benefit analysis and an added value to the decision-making process. Hence, this review describes the basic steps and tools for integrating health into air quality assessment (health indicators, exposure-response functions). In addition, consideration is given to two major outdoor pollutants: PM and NO2. A summary of the health metrics used to assess the health impact of PM and NO2 and recent epidemiologic data are also described.

Long-term exposure to high particulate matter pollution and cardiovascular mortality: a 12-year cohort study in four cities in northern China

Epidemiologic studies have demonstrated that long-term exposure to relatively low levels of particulate air pollution is associated with adverse cardiovascular outcomes in Europe and North America. However, few studies have assessed the association with high level air pollutants. We aimed to assess the cardiovascular effects of long-term exposure to high level concentrations of inhalable particulate and to identify the characteristics of the Chinese population that are susceptible to the health effects. A retrospective cohort, containing 39,054 subjects from four cities in northern China, was followed for mortality of all cause and specific cardiovascular diseases from 1998 to 2009. Information on concentrations of PM10 (particulate matter<10 μm in aerodynamic diameter) was collected from the local Environmental Monitoring Centers. The estimated exposure for the study participants was the mean concentration of PM10 over their surviving years during the cohort period. Relative risk values were obtained using Cox proportional hazards regression models after adjusting for potential confounding factors. For each 10 μg/m(3) increase in PM10, the relative risk ratios (RRs) of all-cause mortality, cardiovascular disease mortality, ischemic heart disease mortality, heart failure disease mortality, and cerebrovascular disease mortality were 1.24 (95% CI, 1.22-1.27), 1.23 (95% CI, 1.19-1.26), 1.37 (95% CI, 1.28-1.47), 1.11(95% CI, 1.05-1.17), and 1.23(95% CI:1.18-1.28), respectively. Results from stratified analyses suggest that the effects of PM10 on cardiovascular mortality were more pronounced in males, smokers and people with a higher socioeconomic status. Long-term exposure to PM10 increases mortality from cardiovascular disease, especially from ischemic heart disease and this association seemed to be modified by other factors. Further research that focuses on exploring dose-response relationship and inter-population comparisons is warranted.

10-year spatial and temporal trends of PM2.5 concentrations in the southeastern US estimated using high-resolution satellite data

Long-term PM_2.5 exposure has been associated with various adverse health outcomes. However, most ground monitors are located in urban areas, leading to a potentially biased representation of true regional PM_2.5 levels. To facilitate epidemiological studies, accurate estimates of the spatiotemporally continuous distribution of PM_2.5 concentrations are important. Satellite-retrieved aerosol optical depth (AOD) has been increasingly used for PM_2.5 concentration estimation due to its comprehensive spatial coverage. Nevertheless, previous studies indicated that an inherent disadvantage of many AOD products is their coarse spatial resolution. For instance, the available spatial resolutions of the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Multiangle Imaging SpectroRadiometer (MISR) AOD products are 10 and 17.6 km, respectively. In this paper, a new AOD product with 1 km spatial resolution retrieved by the multi-angle implementation of atmospheric correction (MAIAC) algorithm based on MODIS measurements was used. A two-stage model was developed to account for both spatial and temporal variability in the PM_2.5-AOD relationship by incorporating the MAIAC AOD, meteorological fields, and land use variables as predictors. Our study area is in the southeastern US centered at the Atlanta metro area, and data from 2001 to 2010 were collected from various sources. The model was fitted annually, and we obtained model fitting R² ranging from 0.71 to 0.85, mean prediction error (MPE) from 1.73 to 2.50 μg m^-3, and root mean squared prediction error (RMSPE) from 2.75 to 4.10 μg m^-3. In addition, we found cross-validation R² ranging from 0.62 to 0.78, MPE from 2.00 to 3.01 μgm^-3, and RMSPE from 3.12 to 5.00 μgm^-3, indicating a good agreement between the estimated and observed values. Spatial trends showed that high PM_2.5 levels occurred in urban areas and along major highways, while low concentrations appeared in rural or mountainous areas. Our time-series analysis showed that, for the 10-year study period, the PM_2.5 levels in the southeastern US have decreased by ∼20 %. The annual decrease has been relatively steady from 2001 to 2007 and from 2008 to 2010 while a significant drop occurred between 2007 and 2008. An observed increase in PM_2.5 levels in year 2005 is attributed to elevated sulfate concentrations in the study area in warm months of 2005.

Long-term residential exposure to air pollution and lung cancer risk

BACKGROUND

There is accumulating evidence that air pollution causes lung cancer. Still, questions remain about exposure misclassification, the components of air pollution responsible, and the histological subtypes of lung cancer that might be produced.

METHODS

We investigated lung cancer incidence in relation to long-term exposure to three ambient air pollutants and proximity to major roads, using a Canadian population-based case-control study. We compared 2,390 incident, histologically confirmed lung cancer cases with 3,507 population controls in eight Canadian provinces from 1994 to 1997. We developed spatiotemporal models for the whole country to estimate annual residential exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) over a 20-year exposure period. We carried out a subanalysis in urban centers, using exposures derived from fixed-site air pollution monitors, and also examined traffic proximity measures. Hierarchical logistic regression models incorporated a comprehensive set of individual and geographic covariates.

RESULTS

The increase in lung cancer incidence (expressed as fully adjusted odds ratios [ORs]) was 1.29 (95% confidence interval = 0.95-1.76) with a ten-unit increase in PM2.5 (μg/m), 1.11 (1.00-1.24) with a ten-unit increase in NO2 (ppb), and 1.09 (0.85-1.39) with a ten-unit increase in O3 (ppb). The urban monitor-based subanalyses generally supported the national results, with larger associations for NO2 (OR = 1.34; 1.07-1.69) per 10 ppb increase. No dose-response trends were observed, and no clear relationships were found for specific histological cancer subtypes. There was the suggestion of increased risk among those living within 100 m of highways, but not among those living near major roads.

CONCLUSIONS

Lung cancer incidence in this Canadian study was increased most strongly with NO2 and PM2.5 exposure. Further investigation is needed into possible effects of O3 on development of lung cancer.