Particulate matter and daily mortality and hospital admissions in the west midlands conurbation of the United Kingdom: associations with fine and coarse particles, black smoke and sulphate

Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project

OBJECTIVE

To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities

METHODS

The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed.

RESULTS

Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0-1), except in the case of ozone where there was a more delayed relation (lag 2-3). For combined estimates an increase of 10 microg/m3 in the PM10 levels in lag 0-1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2-3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m3 in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models

CONCLUSIONS

A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.

Black smoke air pollution and daily non-accidental mortality in Nis, Serbia

The short-term effects of ambient black smoke concentrations on total non-accidental, cardiovascular and respiratory mortalities in Nis, during the 2000-2003 period, were investigated.

Daily measurements for black smoke (BS), as well as the daily number of deaths have been collected. Generalised linear models extending Poisson regression were applied. The e.ects of time trend, seasonal variations, days of the week, temperature, humidity and air pressure were adjusted.

The per cent increase in the daily number of total deaths associated with a 10 μg/m3 increase in BS was 1.13% (0.08–2.20%). The e.ect size was slightly higher for cardiovascular mortality (1.25%, 95% CI: 0.53–1.97%). There was no signi.cant association between air pollution and respiratory mortality.

These results indicate that current levels of ambient BS have signi.cant e.ects on total and cardiovascular mortalities in Nis.

Ozone and daily mortality in Shanghai, China

BACKGROUND

Controversy remains regarding the relationship between ambient ozone and mortality worldwide. In mainland China, the largest developing country, there has been no prior study investigating the acute effect of O3 on death risk. Given the changes in types of air pollution from conventional coal combustion to the mixed coal combustion/motor vehicle emissions in China's large cities, it is worthwhile to investigate the acute effect of O3 on mortality outcomes in the country.

OBJECTIVES

We conducted a time-series study to investigate the relation between O3 and daily mortality in Shanghai using 4 years of daily data (2001-2004).

METHODS

We used the generalized additive model with penalized splines to analyze mortality, O3 pollution, and covariate data in warm and cold seasons. We considered daily counts of all-cause mortality and several cause-specific subcategories (respiratory and cardiovascular). We also examined these associations among several subpopulations based on age and sex.

RESULTS

O3 was significantly associated with total and cardiovascular mortality in the cold season but not in the warm season. In the whole-year analysis, an increase of 10 microg/m3 of 2-day average (lag01) O3 corresponds to 0.45% [95% confidence interval (CI) , 0.16-0.73%], 0.53% (95% CI, 0.10-0.96%), and 0.35% (95% CI, -0.40 to 1.09%) increase of total nonaccidental, cardiovascular, and respiratory mortality, respectively. In the cold season, the estimates increased to 1.38% (95% CI, 0.68-2.07%), 1.53% (95% CI, 0.54-2.52%), and 0.95% (95% CI, -0.71 to 2.60%), respectively. In the warm season, we did not observe significant associations for both total and cause-specific mortality. The results were generally insensitive to model specifications such as lag structure of O3 concentrations and degree of freedom for time trend. Multipollutant models indicate that the effect of O3 was not confounded by particulate matter<or=10 microm in diameter (PM10) or by sulfur dioxide; however, after adding nitrogen dioxide into the model, the association of O3 with total and cardiovascular mortality became statistically insignificant.

CONCLUSIONS

O3 pollution has stronger health effects in the cold than in the warm season in Shanghai. Our analyses also strengthen the rationale for further limiting levels of O3 pollution in outdoor air in the city.

Characterisation and quantification of the sources of PM10 during air pollution episodes in the UK

Data for concentrations of PM(10) and gaseous pollutants from sites in the UK Automatic Urban and Rural Network have been examined during periods of elevated concentrations of PM(10). The ratios of concentrations of PM(10) to those of the other pollutants were used to determine the most probable source of the additional particles. The hypothesis is that because the concentrations of PM(10) were divided by those of the other pollutants, the ratio should decrease when PM(10) and the other pollutants have a common source. Conversely, the ratio should increase when the sources are different. During episodes where road traffic was the most probable source of the additional particles, the ratios of concentrations of PM(10) to carbon monoxide and oxides of nitrogen did decrease, but the comparable ratios for sulphur dioxide and ozone increased. In contrast, during episodes known to have been caused by construction activity, all these ratios increased. This is taken to show that the basic hypothesis is valid. For prolonged episodes, it was possible to use data averaged over the total duration of the episode for the purposes of source identification. For sporadic construction, or other short-duration episodes, it was necessary to use time series data. The data have also been used to calculate the differences between hourly average concentrations of pollutants measured during episodes and long-term hourly average concentrations. These have been used to model the additional PM(10) during air pollution episodes associated with construction activities and road traffic emissions. This confirms the lack of relationship between PM(10) and other pollutants during construction works. During episodes arising from road traffic emissions, there was good agreement between measured and modelled additional concentrations of PM(10) when an appropriate factor, F, related to the contribution of road traffic emissions to PM(10) at different site types was applied. The values used were 0.2 (Suburban), 0.3 (Urban Background/Urban Centre), and 0.5 (Roadside), representing 20%, 30%, and 50% contributions from road traffic, respectively.

Ozone exposure and mortality: an empiric bayes metaregression analysis

BACKGROUND

Results from time-series epidemiologic studies evaluating the relationship between ambient ozone concentrations and premature mortality vary in their conclusions about the magnitude of this relationship, if any, making it difficult to estimate public health benefits of air pollution control measures. We conducted an empiric Bayes metaregression to estimate the ozone effect on mortality, and to assess whether this effect varies as a function of hypothesized confounders or effect modifiers.

METHODS

We gathered 71 time-series studies relating ozone to all-cause mortality, and we selected 48 estimates from 28 studies for the metaregression. Metaregression covariates included the relationship between ozone concentrations and concentrations of other air pollutants, proxies for personal exposure-ambient concentration relationships, and the statistical methods used in the studies. For our metaregression, we applied a hierarchical linear model with known level-1 variances.

RESULTS

We estimated a grand mean of a 0.21% increase (95% confidence interval = 0.16-0.26%) in mortality per 10-microg/m increase of 1-hour maximum ozone (0.41% increase per 10 ppb) without controlling for other air pollutants. In the metaregression, air-conditioning prevalence and lag time were the strongest predictors of between-study variability. Air pollution covariates yielded inconsistent findings in regression models, although correlation analyses indicated a potential influence of summertime PM2.5.

CONCLUSIONS

These findings, coupled with a greater relative risk of ozone in the summer versus the winter, demonstrate that geographic and seasonal heterogeneity in ozone relative risk should be anticipated, but that the observed relationship between ozone and mortality should be considered for future regulatory impact analyses.

Air pollution and daily hospitalization rates for cardiovascular and respiratory diseases in London, Ontario

In this paper, we examine the role that ambient air pollution plays in exacerbating cardiovascular and respiratory disease hospitalization in London, Ontario from 1 November 1995 to 31 December 2000. The number of daily cardiac and respiratory admissions was linked to concentrations of air pollutants (sulphur dioxide, nitrogen dioxide, ozone, carbon monoxide, coefficient of haze, PM(10)) and weather variables (maximum and minimum of temperature and humidity). Results showed that current day carbon monoxide and coefficient of haze produced significant percentage increase in daily cardiac admissions of 8.0% (95% CI: 1.5-11.5%) and 5.7% (95% CI: 0.9-10.8%) for people < 65 years old. PM(10) was found to be significantly associated with asthma admission in the > 65 group, with percentage increase in cardiac admission of 25% (95% CI: 2.8-52.3%) and 26.0% (95% CI: 5.3-50.9%) for current day and 2-day means, respectively.

Air pollution and respiratory hospital admissions in greater Paris: exploring sex differences

The subject of sex and gender differences is relevant to the study of health effects of environmental exposures. In this study the authors aim at assessing the differences that may exist between males and females regarding short-term air pollution health effects. They studied the short-term relationships between air pollution levels and respiratory hospital admissions in greater Paris area for patients older than 15 years between 2000 and 2003. They also conducted time series analyses by using generalized additive models. For an increase of 10 microg/m3 in the air pollutant levels, the increase in relative risk of hospitalization was higher for males than for females and was significant only for males. These differences may not result solely from differences in biological susceptibility to air pollution because other factors related to gender (differences in individual exposures, in health care management, and so on) may play a role.

Cytokine release from alveolar macrophages exposed to ambient particulate matter: heterogeneity in relation to size, city and season

Background

Several studies have demonstrated an association between exposure to ambient particulate matter (PM) and respiratory and cardiovascular diseases. Inflammation seems to play an important role in the observed health effects. However, the predominant particle component(s) that drives the inflammation is still not fully clarified. In this study representative coarse (2.5–10 μm) and fine (0.1–2.5 μm) particulate samples from a western, an eastern, a northern and a southern European city (Amsterdam, Lodz, Oslo and Rome) were collected during three seasons (spring, summer and winter). All fractions were investigated with respect to cytokine-inducing potential in primary macrophages isolated from rat lung. The results were related to the physical and chemical parameters of the samples in order to disclose possible connections between inflammatory potential and specific characteristics of the particles.

Results

Compared on a gram-by gram basis, both site-specific and seasonal variations in the PM-induced cytokine responses were demonstrated. The samples collected in the eastern (Lodz) and southern (Rome) cities appeared to be the most potent. Seasonal variation was most obvious with the samples from Lodz, with the highest responses induced by the spring and summer samples. The site-specific or seasonal variation in cytokine release could not be attributed to variations in any of the chemical parameters. Coarse fractions from all cities were more potent to induce the inflammatory cytokines interleukin-6 and tumour necrosis factor-α than the corresponding fine fractions. Higher levels of specific elements such as iron and copper, some polycyclic aromatic hydrocarbons (PAHs) and endotoxin/lipopolysaccaride seemed to be prevalent in the coarse fractions. However, variations in the content of these components did not reflect the variation in cytokine release induced by the different coarse fractions. Addition of polymyxin B did not affect the particle-induced cytokine release, indicating that the variations in potency among the coarse fractions are not explained by endootoxin.

Conclusion

The inflammatory potential of ambient PM demonstrated heterogeneity in relation to city and season. The coarse particle fractions were consistently more potent than the respective fine fractions. Though a higher level of some elements, PAH and endotoxin was found in the coarse fractions, the presence of specific components was not sufficient to explain all variations in PM-induced cytokine release.

Multisite study of particle number concentrations in urban air

Particle number concentration data are reported from a total of eight urban site locations in the United Kingdom. Of these, six are central urban background sites, while one is an urban street canyon (Marylebone Road) and another is influenced by both a motorway and a steelworks (Port Talbot). The concentrations are generally of a similar order to those reported in the literature, although higher than those in some of the other studies. Highest concentrations are at the Marylebone Road site and lowest are at the Port Talbot site. The central urban background locations lie somewhere between with concentrations typically around 20 000 cm(-3). A seasonal pattern affects all sites, with highest concentrations in the winter months and lowest concentrations in the summer. Data from all sites show a diurnal variation with a morning rush hour peak typical of an anthropogenic pollutant. When the dilution effects of windspeed are accounted for, the data show little directionality at the central urban background sites indicating the influence of sources from all directions as might be expected if the major source were road traffic. At the London Marylebone Road site there is high directionality driven by the air circulation in the street canyon, and at the Port Talbot site different diurnal patterns are seen for particle number count and PM10 influenced by emissions from road traffic (particle number count) and the steelworks (PM10) and local meteorological factors. Hourly particle number concentrations are generally only weakly correlated to NO(x) and PM10, with the former showing a slightly closer relationship. Correlations between daily average particle number count and PM10 were also weak. Episodes of high PM10 concentration in summer typically show low particle number concentrations consistent with transport of accumulation mode secondary aerosol, while winter episodes are frequently associated with high PM10 and particle number count arising from poor dispersion of local primary emissions.

Seasonal variations in air pollution particle-induced inflammatory mediator release and oxidative stress

Health effects associated with particulate matter (PM) show seasonal variations. We hypothesized that these heterogeneous effects may be attributed partly to the differences in the elemental composition of PM. Normal human bronchial epithelial (NHBE) cells and alveolar macrophages (AMs) were exposed to equal mass of coarse [PM with aerodynamic diameter of 2.5-10 microm (PM(2.5-10)], fine (PM(2.5)), and ultrafine (PM(<0.1)) ambient PM from Chapel Hill, North Carolina, during October 2001 (fall) and January (winter), April (spring), and July (summer) 2002. Production of interleukin (IL)-8, IL-6, and reactive oxygen species (ROS) was measured. Coarse PM was more potent in inducing cytokines, but not ROSs, than was fine or ultrafine PM. In AMs, the October coarse PM was the most potent stimulator for IL-6 release, whereas the July PM consistently stimulated the highest ROS production measured by dichlorofluorescein acetate and dihydrorhodamine 123 (DHR). In NHBE cells, the January and the October PM were consistently the strongest stimulators for IL-8 and ROS, respectively. The July PM increased only ROS measured by DHR. PM had minimal effects on chemiluminescence. Principal-component analysis on elemental constituents of PM of all size fractions identified two factors, Cr/Al/Si/Ti/Fe/Cu and Zn/As/V/Ni/Pb/Se, with only the first factor correlating with IL-6/IL-8 release. Among the elements in the first factor, Fe and Si correlated with IL-6 release, whereas Cr correlated with IL-8 release. These positive correlations were confirmed in additional experiments with PM from all 12 months. These results indicate that elemental constituents of PM may in part account for the seasonal variations in PM-induced adverse health effects related to lung inflammation.

A Meta-Analysis of Time-Series Studies of Ozone and Mortality With Comparison to the National Morbidity, Mortality, and Air Pollution Study

BACKGROUND

Although many time-series studies of ozone and mortality have identified positive associations, others have yielded null or inconclusive results, making the results of these studies difficult to interpret.

METHODS

We performed a meta-analysis of 144 effect estimates from 39 time-series studies, and estimated pooled effects by lags, age groups, cause-specific mortality, and concentration metrics. We compared results with pooled estimates from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS), a time-series study of 95 large U.S. urban centers from 1987 to 2000.

RESULTS

Both meta-analysis and NMMAPS results provided strong evidence of a short-term association between ozone and mortality, with larger effects for cardiovascular and respiratory mortality, the elderly, and current-day ozone exposure. In both analyses, results were insensitive to adjustment for particulate matter and model specifications. In the meta-analysis, a 10-ppb increase in daily ozone at single-day or 2-day average of lags 0, 1, or 2 days was associated with an 0.87% increase in total mortality (95% posterior interval = 0.55% to 1.18%), whereas the lag 0 NMMAPS estimate is 0.25% (0.12% to 0.39%). Several findings indicate possible publication bias: meta-analysis results were consistently larger than those from NMMAPS; meta-analysis pooled estimates at lags 0 or 1 were larger when only a single lag was reported than when estimates for multiple lags were reported; and heterogeneity of city-specific estimates in the meta-analysis were larger than with NMMAPS.

CONCLUSIONS

This study provides evidence of short-term associations between ozone and mortality as well as evidence of publication bias.

Associations Between Ozone and Daily Mortality

BACKGROUND

There is ample evidence that short-term ozone exposure is associated with transient decrements in lung functions and increased respiratory symptoms, but the short-term mortality effect of such exposures has not been established.

METHODS

We conducted a review and meta-analysis of short-term ozone mortality studies, identified unresolved issues, and conducted an additional time-series analysis for 7 U.S. cities (Chicago, Detroit, Houston, Minneapolis-St. Paul, New York City, Philadelphia, and St. Louis).

RESULTS

Our review found a combined estimate of 0.39% (95% confidence interval = 0.26-0.51%) per 10-ppb increase in 1-hour daily maximum ozone for the all-age nonaccidental cause/single pollutant model (43 studies). Adjusting for the funnel plot asymmetry resulted in a slightly reduced estimate (0.35%; 0.23-0.47%). In a subset for which particulate matter (PM) data were available (15 studies), the corresponding estimates were 0.40% (0.27-0.53%) for ozone alone and 0.37% (0.20-0.54%) with PM in model. The estimates for warm seasons were generally larger than those for cold seasons. Our additional time-series analysis found that including PM in the model did not substantially reduce the ozone risk estimates. However, the difference in the weather adjustment model could result in a 2-fold difference in risk estimates (eg, 0.24% to 0.49% in multicity combined estimates across alternative weather models for the ozone-only all-year case).

CONCLUSIONS

Overall, the results suggest short-term associations between ozone and daily mortality in the majority of the cities, although the estimates appear to be heterogeneous across cities.

Relation Between Short-Term Fine-Particulate Matter Exposure and Onset of Myocardial Infarction

BACKGROUND

Epidemiologic studies have reported increases in the incidence of cardiovascular morbidity and myocardial infarction (MI) associated with increases in short-term and daily levels of fine-particulate matter air pollution, suggesting a role for particulate matter in triggering an MI.

METHODS

We studied the association between onset time of MI and preceding hourly measures of fine-particulate matter using a case-crossover study of 5793 confirmed cases of acute MI. We linked data from a community-wide database on acute MI from 1988-1994 in King County, Washington, with central site air pollution monitoring data on fine-particulate matter determined by nephelometry. We compared air pollution exposure levels averaged 1 hour, 2 hours, 4 hours, and 24 hours before MI onset to a set of time-stratified referent exposures from the same day of the week in the month of the case event.

RESULTS

: The estimated relative risk for a 10-microg/m increase in fine-particulate matter the hour before MI onset was 1.01 (95% CI=0.98-1.05). Analyses of pollutant levels at the other time points demonstrated a similar lack of association. No increased risk was found in all cases with preexisting cardiac disease (odds ratio = 1.05; 0.95-1.16). Stratification by known cardiovascular risk factors (hypertension, diabetes, and smoking status) also did not modify the relation between fine-particulate matter and MI onset.

CONCLUSION

Although a very small effect cannot be excluded, there was no consistent association between ambient levels of fine-particulate matter and risk of MI onset.

Ozone and short-term mortality in 95 US urban communities, 1987-2000

CONTEXT

Ozone has been associated with various adverse health effects, including increased rates of hospital admissions and exacerbation of respiratory illnesses. Although numerous time-series studies have estimated associations between day-to-day variation in ozone levels and mortality counts, results have been inconclusive.

OBJECTIVE

To investigate whether short-term (daily and weekly) exposure to ambient ozone is associated with mortality in the United States.

DESIGN AND SETTING

Using analytical methods and databases developed for the National Morbidity, Mortality, and Air Pollution Study, we estimated a national average relative rate of mortality associated with short-term exposure to ambient ozone for 95 large US urban communities from 1987-2000. We used distributed-lag models for estimating community-specific relative rates of mortality adjusted for time-varying confounders (particulate matter, weather, seasonality, and long-term trends) and hierarchical models for combining relative rates across communities to estimate a national average relative rate, taking into account spatial heterogeneity.

MAIN OUTCOME MEASURE

Daily counts of total non-injury-related mortality and cardiovascular and respiratory mortality in 95 large US communities during a 14-year period.

RESULTS

A 10-ppb increase in the previous week's ozone was associated with a 0.52% increase in daily mortality (95% posterior interval [PI], 0.27%-0.77%) and a 0.64% increase in cardiovascular and respiratory mortality (95% PI, 0.31%-0.98%). Effect estimates for aggregate ozone during the previous week were larger than for models considering only a single day's exposure. Results were robust to adjustment for particulate matter, weather, seasonality, and long-term trends.

CONCLUSIONS

These results indicate a statistically significant association between short-term changes in ozone and mortality on average for 95 large US urban communities, which include about 40% of the total US population. The findings indicate that this widespread pollutant adversely affects public health.

Effects of Asian dust storm events on daily mortality in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei City. These occurrences are known as Asian dust storm events. The objective of this study was to assess the possible effects of Asian dust storms on the mortality of residents in Taipei, Taiwan, during the period from 1995 to 2000. We identified 39 dust storm episodes, which were classified as index days. Daily deaths on the index days were compared with deaths on the comparison days. We selected two comparison days for each index day, 7 days before the index day and 7 days after the index day. The strongest estimated effects of dust storms were increases of 7.66% in risk for respiratory disease 1 day after the event, 4.92% for total deaths 2 days following the dust storms and 2.59% for circulatory diseases 2 days following the dust storms. However, none of these effects were statistically significant. This study found greater specificity for associations with respiratory deaths, and this increases the likelihood that the association between dust events and daily mortality represents a causal relationship.

Association Between Particulate Air Pollution and First Hospital Admission for Childhood Respiratory Illness in Vancouver, Canada

In this study, the authors assessed the impact of particulate air pollution on first respiratory hospitalization. Study subjects were children less than 3 years of age living in Vancouver, British Columbia, who had their first hospitalization as a result of any respiratory disease (ICD-9 codes 460-519) during the period from June 1, 1995, to March 31, 1999. The authors used logistic regression to estimate the associations between ambient concentrations of particulate matter (PM) and first hospitalization. The adjusted odds ratios for first respiratory hospitalization associated with mean and maximal PM10-2.5 with a lag of 3 days were 1.12 (95% confidence interval: 0.98, 1.28) and 1.13 (1.00, 1.27). After adjustment for gaseous pollutants, the corresponding odds ratios were 1.22 (1.02, 1.48) and 1.14 (0.99, 1.32). The data indicated the possibility of harmful effects from coarse PM on first hospitalization for respiratory disease in early childhood.

Reactive oxygen species in pulmonary inflammation by ambient particulates

Exposure to ambient air pollution particles (PM) has been associated with increased cardiopulmonary morbidity and mortality, particularly in individuals with pre-existing disease. Exacerbation of pulmonary inflammation in susceptible people (e.g., asthmatics, COPD patients) appears to be a central mechanism by which PM exert their toxicity. Health effects are seen most consistently with PM with aerodynamic diameter < 2.5 micrometers (PM(2.5)), although 10 micrometers < PM < 2.5 micrometers can also be toxic. Through its metal, semi-quinone, lipopolysaccaride, hydrocarbon, and ultrafine constituents, PM may exert oxidative stress on cells in the lung by presenting or by stimulating the cells to produce reactive oxygen (ROS). In vivo, PM increase cytokine and chemokine release, lung injury, and neutrophil influx. In vitro analysis of PM effects on the critical cellular targets, alveolar macrophages, epithelial cells, and neutrophils, demonstrates PM- and oxidant-dependent responses consistent with in vivo data. These effects have been observed with PM samples collected over years as well as concentrated PM(2.5) (CAPs) collected in real time. Oxidative stress mediated by ROS is an important mechanism of PM-induced lung inflammation.

Air pollution and health

The health effects of air pollution have been subject to intense study in recent years. Exposure to pollutants such as airborne particulate matter and ozone has been associated with increases in mortality and hospital admissions due to respiratory and cardiovascular disease. These effects have been found in short-term studies, which relate day-to-day variations in air pollution and health, and long-term studies, which have followed cohorts of exposed individuals over time. Effects have been seen at very low levels of exposure, and it is unclear whether a threshold concentration exists for particulate matter and ozone below which no effects on health are likely. In this review, we discuss the evidence for adverse effects on health of selected air pollutants.