Five epidemiological studies on transport and asthma: objectives, design and descriptive results

A review on the role of dispersion and receptor models in asthma research

There is substantial evidence that air pollution exposure is associated with asthma prevalence that affects millions of people worldwide. Air pollutant exposure can be determined using dispersion models and refined with receptor models. Dispersion models offer the advantage of giving spatially distributed outdoor pollutants concentration while the receptor models offer the source apportionment of specific chemical species. However, the use of dispersion and/or receptor models in asthma research requires a multidisciplinary approach, involving experts on air quality and respiratory diseases. Here, we provide a literature review on the role of dispersion and receptor models in air pollution and asthma research, their limitations, gaps and the way forward. We found that the methodologies used to incorporate atmospheric dispersion and receptor models in human health studies may vary considerably, and several of the studies overlook features such as indoor air pollution, model validation and subject pathway between indoor spaces. Studies also show contrasting results of relative risk or odds ratio for a health outcome, even using similar methodologies. Dispersion models are mostly used to estimate air pollution levels outside the subject's home, school or workplace; however, very few studies addressed the subject's routines or indoor/outdoor relationships. Conversely, receptor models are employed in regions where asthma incidence/prevalence is high or where a dispersion model has been previously used for this assessment. Road traffic (vehicle exhaust) and NOx are found to be the most targeted source and pollutant, respectively. Other key findings were the absence of a standard indicator, shortage of studies addressing VOC and UFP, and the shift toward chemical speciation of exposure.

Semi-volatile organic compounds in the air and dust of 30 French schools: a pilot study

The contamination of indoor environments with chemical compounds released by materials and furniture, such as semi-volatile organic compounds (SVOCs), is less documented in schools than in dwellings-yet children spend 16% of their time in schools, where they can also be exposed. This study is one of the first to describe the contamination of the air and dust of 90 classrooms from 30 nursery and primary schools by 55 SVOCs, including pesticides, phosphoric esters, musks, polycyclic aromatic hydrocarbons (PAHs), polychlorobiphenyls (PCBs), phthalates, and polybromodiphenylethers (PBDEs). Air samples were collected using an active sampling method, and dust samples were collected via two sampling methods (wiping and vacuum cleaning). In air, the highest concentrations (median >100 ng/m³ ) were measured for diisobutyl phthalate (DiBP), dibutyl phthalate (DBP), diethyl phthalate (DEP), bis(2-ethylhexyl) phthalate (DEHP), and galaxolide. In dust, the highest concentrations (median >30 μg/g) were found for DEHP, diisononyl phthalate (DiNP), DiBP, and DBP. An attempt to compare two floor dust sampling methods using a single unit (ng/m²) was carried out. SVOC concentrations were higher in wiped dust, but frequencies of quantification were greater in vacuumed dust.

Mobile phone tracking: in support of modelling traffic-related air pollution contribution to individual exposure and its implications for public health impact assessment

We propose a new approach to assess the impact of traffic-related air pollution on public health by mapping personal trajectories using mobile phone tracking technology in an urban environment. Although this approach is not based on any empirical studies, we believe that this method has great potential and deserves serious attention. Mobile phone tracking technology makes it feasible to generate millions of personal trajectories and thereby cover a large fraction of an urban population. Through analysis, personal trajectories are not only associated to persons, but it can also be associated with vehicles, vehicle type, vehicle speed, vehicle emission rates, and sources of vehicle emissions. Pollution levels can be estimated by dispersion models from calculated traffic emissions. Traffic pollution exposure to individuals can be estimated based on the exposure along the individual human trajectories in the estimated pollution concentration fields by utilizing modelling tools. By data integration, one may identify trajectory patterns of particularly exposed human groups. The approach of personal trajectories may open a new paradigm in understanding urban dynamics and new perspectives in population-wide empirical public health research. This new approach can be further applied to individual commuter route planning, land use planning, urban traffic network planning, and used by authorities to formulate air pollution mitigation policies and regulations.

ESTIMATING DAILY NITROGEN DIOXIDE LEVEL: EXPLORING TRAFFIC EFFECTS

Data used to assess acute health effects from air pollution typically have good temporal but poor spatial resolution or the opposite. A modified longitudinal model was developed that sought to improve resolution in both domains by bringing together data from three sources to estimate daily levels of nitrogen dioxide (NO₂) at a geographic location. Monthly NO₂ measurements at 316 sites were made available by the Study of Traffic, Air quality and Respiratory health (STAR). Four US Environmental Protection Agency monitoring stations have hourly measurements of NO₂. Finally, the Connecticut Department of Transportation provides data on traffic density on major roadways, a primary contributor to NO₂ pollution. Inclusion of a traffic variable improved performance of the model, and it provides a method for estimating exposure at points that do not have direct measurements of the outcome. This approach can be used to estimate daily variation in levels of NO₂ over a region.

[Health risk assessment of traffic-related air pollution near busy roads]

BACKGROUND

Although ambient urban air pollution has well-established health effects, epidemiology faces many difficulties in estimating the risks due to exposure to traffic pollutants near busy roads. This review aims to summarize how exposure to traffic-related air pollution near busy roads is assessed in epidemiological studies and main findings regarding health effects.

METHOD

After presenting the specificity of emissions due to traffic road, this review identifies the key methods and main results found in epidemiologic studies seeking to measure the influence of exposure to nearby traffic on health published over the past decade.

RESULTS

The characterization and measurement of population exposure to traffic pollution faces many difficulties. Thus, epidemiological studies have used two broad categories of surrogates to assess exposure: direct measures of traffic itself such as distance of the residence to the nearest road and traffic volume and modeled concentrations of pollutant surrogates. Studies that implemented these methods showed that people living near heavy traffic road or exposed to near-road air pollution tend to report more health outcomes.

DISCUSSION

Traffic-related air pollution near busy roads is the subject of increasing attention, and tends to be better characterized. However, its health impacts remain difficult to grasp, especially because of the vast diversity of approaches used in epidemiological studies. Greater consistency in the protocols would be desirable to provide better understanding of the health issue of traffic in urban areas and thus to better implement policies to protect those most at risk.

Estimation of personal NO2 exposure in a cohort of pregnant women

There is a growing concern about the possible adverse effects of exposure to air pollution on health during pregnancy. Therefore, a priority of the INMA (environment and childhood) study was to estimate personal exposure to traffic-related air pollution. In the cohort from Valencia (n=855), ambient levels of NO(2) were measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. Multiple regression models were used to map ambient NO(2) over the area. Geographical data and predictions from kriging obtained by the "let one out" procedure were used as predictors. Individual exposure was assigned as 1) the estimated ambient NO(2) level at the home address and 2) the average of estimated ambient NO(2) levels at home and work addresses, weighted by the time spent in each environment. Estimations were temporally customized using the NO(2) levels registered daily by the regional Air Pollution Monitoring Network. The entire pregnancy and each trimester were taken as exposure windows. The model for the mean levels of NO(2) during the sampling periods explained 81% of the variation in NO(2) levels. Relative percent differences between the two models of personal exposure assignment were less than 9% for more than 90% of the participants; however the rest of them showed marked differences. Personal exposure estimates were slightly higher in the second model. In both cases, exposure during the whole pregnancy was strongly correlated with exposure in the second trimester. Considering periods shorter than the entire pregnancy will provide us the opportunity to identify specific windows of susceptibility.

Validity of a traffic air pollutant dispersion model to assess exposure to fine particles

INTRODUCTION

Fine particles (PM(2.5)) are an important component of air pollution. Epidemiological studies have shown health effects due to ambient air particles, particularly allergies in children. Since the main difficulty is to determine exposure to such pollution, traffic air pollutant (TAP) dispersions models have been developed to improve the estimation of individual exposure levels. One such model, the ExTra index, has been validated for nitrogen oxide concentrations but not for other pollutants. The purpose of this study was to assess the validity of the ExTra index to assess PM(2.5) exposure.

METHODS

We compared PM(2.5) concentrations calculated by the ExTra index to reference measures (passive samplers situated under the covered part of the playground), in 15 schools in Bordeaux, in 2000. First, we collected the input data required by the ExTra index: background and local pollution depending on traffic, meteorology and topography. Second, the ExTra index was calculated for each school. Statistical analysis consisted of a graphic description; then, we calculated an intraclass correlation coefficient.

RESULTS

Concentrations calculated with the ExTra index and the reference method were similar. The ExTra index underestimated exposure by 2.2 microg m(-3) on average compared to the reference method. The intraclass correlation coefficient was 0.85 and its 95% confidence interval was [0.62; 0.95].

CONCLUSIONS

The results suggest that the ExTra index provides an assessment of PM(2.5) exposure similar to that of the reference method. Although caution is required in interpreting these results owing to the small number of sites, the ExTra index could be a useful epidemiological tool for reconstructing individual exposure, an important challenge in epidemiology.

Spatial analysis of air pollution and childhood asthma in Hamilton, Canada: comparing exposure methods in sensitive subgroups

BACKGROUND

Variations in air pollution exposure within a community may be associated with asthma prevalence. However, studies conducted to date have produced inconsistent results, possibly due to errors in measurement of the exposures.

METHODS

A standardized asthma survey was administered to children in grades one and eight in Hamilton, Canada, in 1994-95 (N approximately 1467). Exposure to air pollution was estimated in four ways: (1) distance from roadways; (2) interpolated surfaces for ozone, sulfur dioxide, particulate matter and nitrous oxides from seven to nine governmental monitoring stations; (3) a kriged nitrogen dioxide (NO2) surface based on a network of 100 passive NO2 monitors; and (4) a land use regression (LUR) model derived from the same monitoring network. Logistic regressions were used to test associations between asthma and air pollution, controlling for variables including neighbourhood income, dwelling value, state of housing, a deprivation index and smoking.

RESULTS

There were no significant associations between any of the exposure estimates and asthma in the whole population, but large effects were detected the subgroup of children without hayfever (predominately in girls). The most robust effects were observed for the association of asthma without hayfever and NO2LUR OR = 1.86 (95%CI, 1.59-2.16) in all girls and OR = 2.98 (95%CI, 0.98-9.06) for older girls, over an interquartile range increase and controlling for confounders.

CONCLUSION

Our findings indicate that traffic-related pollutants, such as NO2, are associated with asthma without overt evidence of other atopic disorders among female children living in a medium-sized Canadian city. The effects were sensitive to the method of exposure estimation. More refined exposure models produced the most robust associations.

[Allergic respiratory diseases and outdoor air pollution]

INTRODUCTION

After having increased for some time, the prevalence of allergic diseases may have reached a plateau. During this increase, considerable concomitant changes in air pollution have occurred. Photo-oxidant air pollution, related to traffic, has become preponderant. The implication of air pollution in the epidemic of allergies is still debated.

BACKGROUND

Experimental studies have suggested that the effect of air pollutants, including particulates and ozone, on the worsening and even the induction of allergies is biologically plausible. In addition, epidemiological studies have shown a short term impact of the peaks of air pollution on exacerbations of asthma. On the other hand, the results of epidemiological studies dealing with the long-term effects of chronic exposure to air pollution on the prevalence of allergies are less consistent.

VIEWPOINTS

The implementation of new-born cohorts, the use of dispersion models to improve exposure assessment and the study of gene-environment correlations, should increase our knowledge of the role of traffic-related air pollutants in the development of allergies and identify subjects more sensitive to their effects.

CONCLUSIONS

Some traffic-related air pollutants may have played a more important role in the increase in the prevalence of allergies than was assumed from the first epidemiological studies.

Effects of nitrogen dioxide on human health: systematic review of experimental and epidemiological studies conducted between 2002 and 2006

In order to assess health effects in humans caused by environmental nitrogen dioxide (NO(2)) a systematic review of studies in humans was conducted. MEDLINE database was searched for epidemiological studies and experiments on adverse effects of NO(2) published between 2002 and 2006. The evidence with regard to NO(2) exposure limits was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) grading system and the modified three star system. Of the 214 articles retrieved 112 fulfilled the inclusion criteria. There was limited evidence that short-term exposure to a 1-h mean value below 200 microg NO(2)/m(3) is associated with adverse health effects provided by only one study on mortality in patients with severe asthma (*2+). The effect remained after adjusting for other air pollutants. There was moderate evidence that short-term exposure below a 24-h mean value of 50 microg NO(2)/m(3) at monitor stations increases hospital admissions and mortality (**2+). Evidence was also moderate when the search was restricted to susceptible populations (children, adolescents, elderly, and asthmatics). There was moderate evidence that long-term exposure to an annual mean below 40 microg NO(2)/m(3) was associated with adverse health effects (respiratory symptoms/diseases, hospital admissions, mortality, and otitis media) provided by generally consistent findings in five well-conducted cohort and case-control studies with some shortcomings in the study quality (**2+). Evidence was also moderate when the search was restricted to studies in susceptible populations (children and adolescents) and for the combination with other air pollutants. The most frequent reasons for decreased study quality were potential misclassification of exposure and selection bias. None of the high-quality observational studies evaluated was informative for the key questions due to the choice of the dose parameter (e.g., 1-week mean) and exposure levels above the limit values. Inclusion of study designs unlisted in the SIGN grading system did not bring additional evidence regarding exposures below the current air quality limit values for NO(2). As several recent studies reported adverse health effects below the current exposure limits for NO(2) particularly among susceptible populations regarding long-term exposure further research is needed. Apart from high-quality epidemiological studies on causality and the interaction of NO(2) with other air pollutants there is a need for double-blinded randomized cross-over studies among susceptible populations for further evaluation of the short-term exposure limits.

Comparison of regression models with land-use and emissions data to predict the spatial distribution of traffic-related air pollution in Rome

Spatial modeling of traffic-related air pollution typically involves either regression modeling of land-use and traffic data or dispersion modeling of emissions data, but little is known to what extent land-use regression models might be improved by incorporating emissions data. The aim of this study was to develop a land-use regression model to predict nitrogen dioxide (NO2) concentrations and compare its performance with a model including emissions data. The association between each land-use variable and NO2 concentrations at 68 locations in Rome in 1995 and 1996 was assessed by univariate linear regression and a multiple linear regression model that was constructed based on the importance of each variable. Traffic emissions (particulate matter, carbon monoxide, nitrogen oxides, and benzene) were estimated for 164 areas of the city based on vehicle type, traffic counts and driving patterns. Mean NO2 concentration across the 68 sites was 46.8 microg/m3 (SD 9.8 microg/m3; inter-quartile range 11.5 microg/m3; min 24 microg/m3; max 73 microg/m3). The most important predicting variables were the circular traffic zones (main ring road, green strip, inner ring road, traffic-limited zone), distance from busy streets, size of the census block, the inverse population density, and altitude. A multiple regression model including these variables resulted in an R2 of 0.686. The best-fitting model adding an emission term of benzene resulted in an R2 of 0.690, but was not significantly different from the model without emissions (P=0.147). In conclusion, these results suggest that a land-use regression model explains the traffic-related air pollution levels with reasonable accuracy and that emissions data do not significantly improve the model.

Retrospective assessment of exposure to traffic air pollution using the ExTra index in the VESTA French epidemiological study

This study applies a traffic exhaust air dispersion model (the ExTra index) to 403 children enrolled in a French multicentric case-control study, the VESTA study (Five [V] Epidemiological Studies on Transport and Asthma). The ExTra index (previously validated by our team) was used to assess lifelong average traffic-related air pollutant (TAP) concentrations (nitrogen oxides) children in the study were exposed to in front of their living places. ExTra index took into account traffic density, topographical parameters (building height, road and pavement width), weather conditions (wind direction and strength) and background pollution levels. Topographical and traffic data were collected, using a specific questionnaire for each home, school or nursery address, attended by children. The assessment of time-weighted NOx levels in front of the children's living places highlighted significant disparities: mean ExTra index values and share attributable to proximity traffic were, respectively, 70+/-42 and 14+/-22 microg/m3 NOx equivalent NO2 for the 403 children in our study. Not only would this diversity not have been revealed using urban background pollution data provided by air quality networks, it would have resulted in 40% of the children being misclassified with regard to their TAP exposure by underestimating it in half of the cases and overestimating it in the other half. Such errors of classification, which are highly prejudicial in epidemiology, argue strongly for the use of an index such as the ExTra, which enables TAP exposure to be reconstructed within the framework of retrospective or prospective epidemiological studies.

Geographies of risk in studies linking chronic air pollution exposure to health outcomes

This article addresses the question of how to incorporate spatial processes into the assessment of chronic health effects from air pollution exposure. An analytic framework is developed around three related concepts: (1) the geography of susceptibility; (2) the geography of exposure; and (3) points of intersection between these two, termed the geography of risk. The article discusses how each concept encompasses many lower level issues such as meteorological dispersion of pollutants, time-space activity patterns, and population distributions of susceptible individuals in time and space. A key premise is that researchers should target studies with high degrees of overlap between geographies of exposure and susceptibility. Instances where the overlap remains incomplete, or systematically biased, usually produce attenuated or unreliable risk estimates, and some of this discordance may find expression in spatially autocorrelated residuals.

A review and evaluation of intraurban air pollution exposure models

The development of models to assess air pollution exposures within cities for assignment to subjects in health studies has been identified as a priority area for future research. This paper reviews models for assessing intraurban exposure under six classes, including: (i) proximity-based assessments, (ii) statistical interpolation, (iii) land use regression models, (iv) line dispersion models, (v) integrated emission-meteorological models, and (vi) hybrid models combining personal or household exposure monitoring with one of the preceding methods. We enrich this review of the modelling procedures and results with applied examples from Hamilton, Canada. In addition, we qualitatively evaluate the models based on key criteria important to health effects assessment research. Hybrid models appear well suited to overcoming the problem of achieving population representative samples while understanding the role of exposure variation at the individual level. Remote sensing and activity-space analysis will complement refinements in pre-existing methods, and with expected advances, the field of exposure assessment may help to reduce scientific uncertainties that now impede policy intervention aimed at protecting public health.

Spatial variation in nitrogen dioxide in three European areas

In order to estimate the spatial variation within well-defined study areas, nitrogen dioxide was measured with diffusion samplers (Palmes tube) in 40-42 sites each in Germany (Munich), the Netherlands and Sweden (Stockholm County). Each site was measured over four 2-week periods during 1 year (spring 1999 to summer 2000). In each country, one reference site was measured during all periods and the results were used to adjust for seasonal variability, to improve the estimates of the annual average. Comparisons between the chemiluminescence method (European reference method) and Palmes tube measurement indicated a good agreement in Germany (with a ratio of 1.0 for Palmes tube/chemiluminescence) but underestimation for Palmes tube measurement in the Netherlands and Sweden (0.8 for both countries). The r2 values were between 0.86 and 0.90 for all three countries. The annual average values for NO2 for different sampling sites were between 15.9 and 50.6 (mean 28.8 microg/m3) in Germany, between 12.1 and 50.8 (mean 28.9 microg/m3) in the Netherlands and between 6.1 and 44.7 (mean 18.5 microg/m3) in Sweden. Comparing spatial variation between similar sites in the three countries, we did not find any significant differences between annual average levels for urban traffic sites. In Sweden, annual average levels in urban background and suburban backgrounds sites were about 8 microg/m3 lower than comparable sites in Germany and the Netherlands. Comparing site types within each country only urban traffic sites and suburban background sites differed in Germany. In the Netherlands and Sweden, the urban traffic sites differed from all other sites and in Sweden also the urban background sites differed from the other background sites. The observed contribution from local traffic was similar in the Netherlands and Sweden (10 and 8 microg/m3, corresponding to 26-27% of the NO2 concentration found in the urban traffic sites). In Germany, the contribution from local traffic was only 3 microg/m3, corresponding to 9% of the NO2 concentration found in the urban traffic sites. The spatial variation was substantially larger for NO2 than the variation for PM2.5 and similar to PM2.5 absorbance, measured in the same locations.

Évaluation de l’exposition à la pollution atmosphérique liée au trafic routier dans les études épidémiologiques : une revue de littérature

BACKGROUND

Automobile exhaust is a major source of air pollution in urban areas. To study health effects of traffic exhaust fumes epidemiologists need specific tools in order to achieve a precise assessment of human exposure to traffic air pollution (TAP) and avoid misclassification. The aim of this review is to study the different ways of assessing human exposure to TAP in epidemiological studies dealing with short-term or long-term health effects of TAP.

METHODS

After presenting the different designs and goals of the studies mentioned above, this review focuses on methods of assessing exposure to TAP and their different associated health endpoints.

RESULTS

To assess exposure to TAP, most published studies have used more or less complex exposure indices. Several teams have used residence location and its proximity to traffic, traffic counts, or a combination of both. More recently, some authors have developed mathematical dispersion models and statistical regression models.

DISCUSSION

Our analysis shows that reliable and validated tools would be needed to assess accurately human exposure to TAP. This can only be achieved with statistical regression models and mathematical dispersion models. Although such methods may be difficult to implement, their use can be facilitated by adding a geographic information system.

Traffic related air pollution and incidence of childhood asthma: results of the Vesta case-control study

STUDY OBJECTIVE

The Vesta project aims to assess the role of traffic related air pollution in the occurrence of childhood asthma.

DESIGN AND SETTING

Case-control study conducted in five French metropolitan areas between 1998 and 2000. A set of 217 pairs of matched 4 to 14 years old cases and controls were investigated. An index of lifelong exposure to traffic exhausts was constructed, using retrospective information on traffic density close to all home and school addresses since birth; this index was also calculated for the 0-3 years age period to investigate the effect of early exposures.

MAIN RESULTS

Adjusted on environmental tobacco smoke, personal and parental allergy, and several confounders, lifelong exposure was not associated with asthma. In contrast, associations before age of 3 were significant: odds ratios for tertiles 2 and 3 of the exposure index, relative to tertile 1, exhibited a positive trend (1.48 (95%CI = 0.7 to 3.0) and 2.28 (1.1 to 4.6)), with greater odds ratios among subjects with positive skin prick tests.

CONCLUSIONS

These results suggest that traffic related pollutants might have contributed to the asthma epidemic that has taken place during the past decades among children.

Assessment of exposure to traffic pollution using the ExTra index: study of validation

The ExTra index, produced by the French Scientific Center for Building Physics, evaluates ambient concentrations of transport-related pollutants in front of the work and living places of urban dwellers. This study contributes to the validation of the ExTra index by carrying out measurements in four French cities. It compares nitrogen oxide concentrations (NOx) measured over 6 weeks with passive samplers, and NOx calculated concentrations using the ExTra index. The study takes into account traffic density, topographical parameters (building height, road, and pavement width), weather conditions (wind direction and strength), and background pollution levels. The model was tested at 100 street canyons sites. There were highly significant correlations (0.90 in Grenoble, 0.95 in Nice, 0.89 in Paris, and 0.89 in Toulouse) and good intraclass correlation coefficients (0.75 in Grenoble, 0.91 in Nice, 0.89 in Paris, and 0.86 in Toulouse) between the two series of values. These results suggest that if the ExTra index were to be applied to all the different residences and workplaces of a subject throughout his (her) life, it could be a useful epidemiological tool for studying the long-term health effects of transport-related emissions and for reconstructing individual exposure to such pollution in order to avoid misclassification.

Questionnaire or objective assessment for studying exposure to tobacco smoke among asthmatic and healthy children: The French VESTA Study

BACKGROUND

The underreporting of environmental tobacco smoke (ETS) exposure by parents of study children may depend on the instrument used and population studied, underlining the need for questionnaire validation in specific study settings. This study explores the validity of parent-reported ETS exposure in a French multicenter study on asthma.

METHODS

The study population was composed of 313 children ages 4 to 14 years. Exposure to ETS was evaluated both by questionnaires on recent ETS exposure and by assessment of urinary cotinine by an enzyme immunoassay.

RESULTS

According to parents' reports, about one-third of children were exposed to ETS within the past 2 days before cotinine measurement, and on average 14.9 +/- 15.4 cigarette-equivalent were smoked in their homes. The mean urinary cotinine was 435 +/- 530 nmol/mol creatinine and increased with the reported number of cigarette-equivalents smoked at home but it did not differ between children registered as being exposed to 1-10 cigarettes and children registered as unexposed. Agreement between questionnaire and urinary cotinine was moderate to poor according to our correlation coefficient (0.22) and kappa coefficient (0.09).

CONCLUSION

These results show that our questionnaire is not discriminating enough to distinguish between nonexposure and mild exposure, but reveals gradients of higher exposure.