Effect of air pollution control on life expectancy in the United States: an analysis of 545 U.S. counties for the period from 2000 to 2007

Countervailing effects of income, air pollution, smoking, and obesity on aging and life expectancy: population-based study of U.S. Counties

BACKGROUND

Income, air pollution, obesity, and smoking are primary factors associated with human health and longevity in population-based studies. These four factors may have countervailing impacts on longevity. This analysis investigates longevity trade-offs between air pollution and income, and explores how relative effects of income and air pollution on human longevity are potentially influenced by accounting for smoking and obesity.

METHODS

County-level data from 2,996 U.S. counties were analyzed in a cross-sectional analysis to investigate relationships between longevity and the four factors of interest: air pollution (mean 1999-2008 PM2.5), median income, smoking, and obesity. Two longevity measures were used: life expectancy (LE) and an exceptional aging (EA) index. Linear regression, generalized additive regression models, and bivariate thin-plate smoothing splines were used to estimate the benefits of living in counties with higher incomes or lower PM2.5. Models were estimated with and without controls for smoking, obesity, and other factors.

RESULTS

Models which account for smoking and obesity result in substantially smaller estimates of the effects of income and pollution on longevity. Linear regression models without these two variables estimate that a $1,000 increase in median income (1 μg/m(3) decrease in PM2.5) corresponds to a 27.39 (33.68) increase in EA and a 0.14 (0.12) increase in LE, whereas models that control for smoking and obesity estimate only a 12.32 (20.22) increase in EA and a 0.07 (0.05) increase in LE. Nonlinear models and thin-plate smoothing splines also illustrate that, at higher levels of income, the relative benefits of the income-pollution tradeoff changed-the benefit of higher incomes diminished relative to the benefit of lower air pollution exposure.

CONCLUSIONS

Higher incomes and lower levels of air pollution both correspond with increased human longevity. Adjusting for smoking and obesity reduces estimates of the benefits of higher income and lower air pollution exposure. This adjustment also alters the tradeoff between income and pollution: increases in income become less beneficial relative to a fixed reduction in air pollution-especially at higher levels of income.

Proposed pathophysiologic framework to explain some excess cardiovascular death associated with ambient air particle pollution: Insights for public health translation

The paper proposes a pathophysiologic framework to explain the well-established epidemiological association between exposure to ambient air particle pollution and premature cardiovascular mortality, and offers insights into public health solutions that extend beyond regulatory environmental protections to actions that can be taken by individuals, public health officials, healthcare professionals, city and regional planners, local and state governmental officials and all those who possess the capacity to improve cardiovascular health within the population. The foundation of the framework rests on the contribution of traditional cardiovascular risk factors acting alone and in concert with long-term exposures to air pollutants to create a conditional susceptibility for clinical vascular events, such as myocardial ischemia and infarction; stroke and lethal ventricular arrhythmias. The conceptual framework focuses on the fact that short-term exposures to ambient air particulate matter (PM) are associated with vascular thrombosis (acute coronary syndrome, stroke, deep venous thrombosis, and pulmonary embolism) and electrical dysfunction (ventricular arrhythmia); and that individuals having prevalent heart disease are at greatest risk. Moreover, exposure is concomitant with changes in autonomic nervous system balance, systemic inflammation, and prothrombotic/anti-thrombotic and profibrinolytic-antifibrinolytic balance. Thus, a comprehensive solution to the problem of premature mortality triggered by air pollutant exposure will require compliance with regulations to control ambient air particle pollution levels, minimize exposures to air pollutants, as well as a concerted effort to decrease the number of people at-risk for serious clinical cardiovascular events triggered by air pollutant exposure by improving the overall state of cardiovascular health in the population. This article is part of a Special Issue entitled Air Pollution, edited by Wenjun Ding, Andrew J. Ghio and Weidong Wu.

Spatiotemporal Characteristics of Particulate Matter and Dry Deposition Flux in the Cuihu Wetland of Beijing

In recent years, the rapid development of industrialization and urbanization has caused serious environmental pollution, especially particulate pollution. As the "Earth's kidneys," wetland plays a significant role in improving the environmental quality and adjusting the climate. To study how wetlands work in this aspect, from the early autumn of 2014 to 2015, we implemented a study to measure the PM concentration and chemical composition at three heights (1.5, 6, and 10 m) during different periods (dry, normal water, and wet periods) in the Cuihu wetland park in Beijing for analyzing the dry deposition flux and the effect of meteorological factors on the concentration. Results indicated that (1) the diurnal variations of the PM2.5 and PM10 concentrations at the three heights were similar in that the highest concentration occurred at night and the lowest occurred at noon, and the daytime concentration was lower than that at night; (2) the PM2.5 and PM10 concentrations also varied between different periods that wet period > normal water period > wet period, and the concentration at different heights during different periods varied. In general, the lowest concentration occurred at 10 m during the dry and normal water periods, and the highest concentration occurred at 1.5 m during the wet period. (3) SO42-, NO3-, and Cl- are the dominant constituents of PM2.5, accounting for 42.22, 12.6, and 21.56%, respectively; (4) the dry depositions of PM2.5 and PM10 at 10 m were higher than those at 6 m, and the deposition during the dry period was higher than those during the wet and normal water periods. In addition, the deposition during the night-time was higher than that during the daytime. Moreover, meteorological factors affected the deposition, the temperature and wind speed being negatively correlated with the deposition flux and the humidity being positively correlated. (5) The PM10 and PM2.5 concentrations were influenced by meteorological factors. The PM2.5 and PM10 concentrations were negatively correlated with temperature and wind speed but positively correlated with relative humidity.

Health benefits from improved outdoor air quality and intervention in China

China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats.

Exposure to Traffic-Related Air Pollution in Relation to Progression in Physical Disability among Older Adults

BACKGROUND

Physical disability is common though not inevitable in older age and has direct bearing on a person's ability to perform activities essential for self-care and independent living. Air pollution appears to increase the risk of several chronic diseases that contribute to the progression of disability.

OBJECTIVE

We evaluated long-term exposure to traffic-related air pollution (TRAP) in relation to progression in physical disability.

METHODS

We conducted our investigation within the Chicago Health and Aging Project. We measured participants' exposures to TRAP using two surrogates: residential proximity to major roads (1993 onwards) and ambient concentrations of oxides of nitrogen (NOX; 1999 onwards), predicted via a geographic information systems-based spatiotemporal smoothing model (cross-validation R2 = 0.87) that incorporated community-based monitoring and resolved intraurban exposure gradients at a spatial scale of tens of meters. Participants' lower-extremity physical ability was assessed every 3 years (1993-2012) via tandem stand, chair stand, and timed walking speed.

RESULTS

In multivariable-adjusted analyses (n = 5,708), higher long-term NOX exposure was associated with significantly faster progression in disability. Compared with the 5-year decline in physical ability score among participants in the lowest quartile of NOX exposure, decline among those in the highest exposure quartile was 1.14 units greater (95% confidence interval [CI]: -1.86, -0.42), equivalent to 3 additional years of decline among those in the lowest exposure quartile. The association was linear across the continuum of NOX exposure: per 10-ppb increment in exposure, the 5-year decline in physical ability score was 0.87 unit greater (95% CI: -1.35, -0.39). Proximity to a major road was not associated with disability progression (n = 9,994).

CONCLUSIONS

These data join a growing body of evidence suggesting that TRAP exposures may accelerate aging-related declines in health.

CITATION

Weuve J, Kaufman JD, Szpiro AA, Curl C, Puett RC, Beck T, Evans DA, Mendes de Leon CF. 2016. Exposure to traffic-related air pollution in relation to progression in physical disability among older adults. Environ Health Perspect 124:1000-1008; http://dx.doi.org/10.1289/ehp.1510089.

The respiratory microbiome: an underappreciated player in the human response to inhaled pollutants?

PURPOSE

Microbial communities in or on the body (i.e., the microbiome) are highly physiologically active and influence human health. Although environmental scientists are increasingly aware of the gut microbiome, the respiratory microbiome's role in the human response to inhaled pollutants is largely unknown.

METHODS

We reviewed the literature and present mechanisms by which the microbiome might mediate or modify human responses to inhaled pollutants.

RESULTS

The respiratory microbiome has been shown to influence chronic lung disease exacerbations, and increasing evidence indicates a role in disease development. Research also suggests that the respiratory microbiome could plausibly metabolize inhaled pollutants or modulate host inflammatory responses to exposure. Because these responses depend on the microbes present, defining the composition of the resident microbiome and how microbial communities shift with exposure may help to explain variations in susceptibility to inhaled pollutants. Although more research is needed, significant measurement challenges remain for large epidemiologic studies of the respiratory microbiome.

CONCLUSIONS

The respiratory microbiome is likely an underexplored intermediate and potential cause of individual susceptibility to inhaled irritants/toxicants. Characterizing the microbiome's role in the human response to inhaled exposures could improve our understanding of the casual agents of exposure and suggest novel public health interventions.

The impact of PM2.5 on the human respiratory system

Recently, many researchers paid more attentions to the association between air pollution and respiratory system disease. In the past few years, levels of smog have increased throughout China resulting in the deterioration of air quality, raising worldwide concerns. PM2.5 (particles less than 2.5 micrometers in diameter) can penetrate deeply into the lung, irritate and corrode the alveolar wall, and consequently impair lung function. Hence it is important to investigate the impact of PM2.5 on the respiratory system and then to help China combat the current air pollution problems. In this review, we will discuss PM2.5 damage on human respiratory system from epidemiological, experimental and mechanism studies. At last, we recommend to the population to limit exposure to air pollution and call to the authorities to create an index of pollution related to health.

Association between satellite-based estimates of long-term PM2.5 exposure and coronary artery disease

BACKGROUND

Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiovascular events, though most have relied on concentrations from central-site air quality monitors.

METHODS

We utilized a cohort of 5679 patients who had undergone cardiac catheterization at Duke University between 2002-2009 and resided in North Carolina. We used estimates of daily PM2.5 concentrations for North Carolina during the study period based on satellite derived Aerosol Optical Depth (AOD) measurements and PM2.5 concentrations from ground monitors, which were spatially resolved with a 10×10km resolution, matched to each patient's residential address and averaged for the year prior to catheterization. The Coronary Artery Disease (CAD) index was used to measure severity of CAD; scores >23 represent a hemodynamically significant coronary artery lesion in at least one major coronary vessel. Logistic regression modeled odds of having CAD or an MI with each 1μg/m(3) increase in annual average PM2.5, adjusting for sex, race, smoking status and socioeconomic status.

RESULTS

In adjusted models, a 1μg/m(3) increase in annual average PM2.5 was associated with an 11.1% relative increase in the odds of significant CAD (95% CI: 4.0-18.6%) and a 14.2% increase in the odds of having a myocardial infarction (MI) within a year prior (95% CI: 3.7-25.8%).

CONCLUSIONS

Satellite-based estimates of long-term PM2.5 exposure were associated with both coronary artery disease (CAD) and incidence of myocardial infarction (MI) in a cohort of cardiac catheterization patients.

The impact of PM2.5 on the human respiratory system

Recently, many researchers paid more attentions to the association between air pollution and respiratory system disease. In the past few years, levels of smog have increased throughout China resulting in the deterioration of air quality, raising worldwide concerns. PM2.5 (particles less than 2.5 micrometers in diameter) can penetrate deeply into the lung, irritate and corrode the alveolar wall, and consequently impair lung function. Hence it is important to investigate the impact of PM2.5 on the respiratory system and then to help China combat the current air pollution problems. In this review, we will discuss PM2.5 damage on human respiratory system from epidemiological, experimental and mechanism studies. At last, we recommend to the population to limit exposure to air pollution and call to the authorities to create an index of pollution related to health.

Blue Skies Bluer?

The largest U.S. environmental health risk is cardiopulmonary mortality from ambient PM2.5. The concentration-response (C-R) for ambient PM2.5 in the U.S. is generally assumed to be linear: from any initial baseline, a given concentration reduction would yield the same improvement in health risk. Recent evidence points to the perplexing possibility that the PM2.5 C-R for cardiopulmonary mortality and some other major endpoints might be supralinear: a given concentration reduction would yield greater improvements in health risk as the initial baseline becomes cleaner. We explore the implications of supralinearity for air policy, emphasizing U.S.

CONDITIONS

If C-R is supralinear, an economically efficient PM2.5 target may be substantially more stringent than under current standards. Also, if a goal of air policy is to achieve the greatest health improvement per unit of PM2.5 reduction, the optimal policy might call for greater emission reductions in already-clean locales-making "blue skies bluer"-which may be at odds with environmental equity goals. Regardless of whether the C-R is linear or supralinear, the health benefits of attaining U.S. PM2.5 levels well below the current standard would be large. For the supralinear C-R considered here, attaining the current U.S. EPA standard, 12 μg m(-3), would avert only ~17% (if C-R is linear: ∼ 25%) of the total annual cardiopulmonary mortality attributable to PM2.5.

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.

Tradeoffs between income, air pollution and life expectancy: Brief report on the US experience, 1980-2000

During the period of 1980-2000, the US obtained substantial reductions in air pollution and improvements in life expectancy (LE). Multiple factors contributed to improved health. This report explores and illustrates trade-offs between income, air pollution, and LE. Both improved air quality and income growth contributed to LE gains - without evidence of substantial negative tradeoffs between air pollution and income. Cleaner air may be considered an "economic good" with contributions to health, wellbeing, and human capital.

Association between NOx exposure and deaths caused by respiratory diseases in a medium-sized Brazilian city

Exposure to nitrogen oxides (NOx) emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide) were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD) of 1.05±1.03 (range: 0-5). Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR)=1.035 (95% confidence interval [CI]: 1.008-1.063) for lag 2, RR=1.064 (95%CI: 1.017-1.112) lag 3, RR=1.055 (95%CI: 1.025-1.085) lag 4, and RR=1.042 (95%CI: 1.010-1.076) lag 5. A 3 µg/m³ reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases.

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.

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.

Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

IMPORTANCE

In a period of dynamic change in health care technology, delivery, and behaviors, tracking trends in health and health care can provide a perspective on what is being achieved.

OBJECTIVE

To comprehensively describe national trends in mortality, hospitalizations, and expenditures in the Medicare fee-for-service population between 1999 and 2013.

DESIGN, SETTING, AND PARTICIPANTS

Serial cross-sectional analysis of Medicare beneficiaries aged 65 years or older between 1999 and 2013 using Medicare denominator and inpatient files.

MAIN OUTCOMES AND MEASURES

For all Medicare beneficiaries, trends in all-cause mortality; for fee-for-service beneficiaries, trends in all-cause hospitalization and hospitalization-associated outcomes and expenditures. Geographic variation, stratified by key demographic groups, and changes in the intensity of care for fee-for-service beneficiaries in the last 1, 3, and 6 months of life were also assessed.

RESULTS

The sample consisted of 68,374,904 unique Medicare beneficiaries (fee-for-service and Medicare Advantage). All-cause mortality for all Medicare beneficiaries declined from 5.30% in 1999 to 4.45% in 2013 (difference, 0.85 percentage points; 95% CI, 0.83-0.87). Among fee-for-service beneficiaries (n = 60,056,069), the total number of hospitalizations per 100,000 person-years decreased from 35,274 to 26,930 (difference, 8344; 95% CI, 8315-8374). Mean inflation-adjusted inpatient expenditures per Medicare fee-for-service beneficiary declined from $3290 to $2801 (difference, $489; 95% CI, $487-$490). Among fee-for-service beneficiaries in the last 6 months of life, the number of hospitalizations decreased from 131.1 to 102.9 per 100 deaths (difference, 28.2; 95% CI, 27.9-28.4). The percentage of beneficiaries with 1 or more hospitalizations decreased from 70.5 to 56.8 per 100 deaths (difference, 13.7; 95% CI, 13.5-13.8), while the inflation-adjusted inpatient expenditure per death increased from $15,312 in 1999 to $17,423 in 2009 and then decreased to $13,388 in 2013. Findings were consistent across geographic and demographic groups.

CONCLUSIONS AND RELEVANCE

Among Medicare fee-for-service beneficiaries aged 65 years or older, all-cause mortality rates, hospitalization rates, and expenditures per beneficiary decreased from 1999 to 2013. In the last 6 months of life, total hospitalizations and inpatient expenditures decreased in recent years.

Evaluating the Long-Term Health and Economic Impacts of Central Residential Air Filtration for Reducing Premature Mortality Associated with Indoor Fine Particulate Matter (PM2.5) of Outdoor Origin

Much of human exposure to fine particulate matter (PM2.5) of outdoor origin occurs in residences. High-efficiency particle air filtration in central heating, ventilating, and air-conditioning (HVAC) systems is increasingly being used to reduce concentrations of particulate matter inside homes. However, questions remain about the effectiveness of filtration for reducing exposures to PM2.5 of outdoor origin and adverse health outcomes. Here we integrate epidemiology functions and mass balance modeling to estimate the long-term health and economic impacts of HVAC filtration for reducing premature mortality associated with indoor PM2.5 of outdoor origin in residences. We evaluate 11 classifications of filters (MERV 5 through HEPA) using six case studies of single-family home vintages and ventilation system combinations located in 22 U.S. cities. We estimate that widespread use of higher efficiency filters would reduce premature mortality by 0.002-2.5% and increase life expectancy by 0.02-1.6 months, yielding annual monetary benefits ranging from $1 to $1348 per person in the homes and locations modeled herein. Large differences in the magnitude of health and economic impacts are driven largely by differences in rated filter efficiency and building and ventilation system characteristics that govern particle infiltration and persistence, with smaller influences attributable to geographic location.

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.

Chemical Composition of Fine Particulate Matter and Life Expectancy: In 95 US Counties Between 2002 and 2007

BACKGROUND

In a previous study, we provided evidence that a decline in fine particulate matter (PM2.5) air pollution during the period between 2000 and 2007 was associated with increased life expectancy in 545 counties in the United States. In this article, we investigated which chemical constituents of PM2.5 were the main drivers of the observed association.

METHODS

We estimated associations between temporal changes in seven major components of PM2.5 (ammonium, sulfate, nitrate, elemental carbon matter, organic carbon matter, sodium, and silicon) and temporal changes in life expectancy in 95 counties between 2002 and 2007. We included US counties that had adequate chemical components of PM2.5 mass data across all seasons. We fitted single pollutant and multiple pollutant linear models, controlling for available socioeconomic, demographic, and smoking variables and stratifying by urban and nonurban counties.

RESULTS

In multiple pollutant models, we found that: (1) a reduction in sulfate was associated with an increase in life expectancy; and (2) reductions in ammonium and sodium ion were associated with increases in life expectancy in nonurban counties only.

CONCLUSIONS

Our findings suggest that recent reductions in long-term exposure to sulfate, ammonium, and sodium ion between 2002 and 2007 are associated with improved public health.

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.

Influence of Asian dust storms on daily acute myocardial infarction hospital admissions

OBJECTIVE

This study was the first to explore the relationship between Asian dust storm events (ADS) and acute myocardial infarction (AMI) hospital admissions by applying time series models.

DESIGN AND SAMPLE

Nationwide population-based hospitalization claims data in Taiwan were used. There were 143,063 AMI admissions during 2000-2009.

MEASURES

An autoregressive with exogenous variables (ARX) time series model was used to investigate the dynamic connection between AMI hospital admissions and ADS events.

RESULTS

AMI hospitalizations significantly spiked on post-ADS day three. Among the total population, 3.2 more cases of AMI admissions occurred on post-ADS day three. When the data were stratified by age and gender, the same delayed effect was present in the male population, especially those aged 45-64 and over 74.

CONCLUSIONS

Our study shows that although an ADS event does not cause an immediate incidence of AMI, storms may increase AMI incidence through a delayed effect. Hence, AMI prevention is not only important during a dust storm, but particularly so in subsequent days. During the days after an ADS, exposure to dust should be minimized by staying indoors as much as possible and by wearing a mask when exposure to dust is unavoidable. This is especially true for working and older adults. Nurses at local public health centers can increase awareness and promote public safety by providing health information to local communities regarding the link between dust storms and AMI.

Effects of particulate matter and antioxidant dietary intake on blood pressure

OBJECTIVES

We assessed 2 pathways through which dietary antioxidants may counter adverse effects of exposure to particulate matter less than 2.5 micrometers in diameter (PM2.5) on blood pressure (BP): main (compensatory) and modifying (protective) models.

METHODS

We used 2002 to 2003 data from the Detroit Healthy Environments Partnership community survey conducted with a multiethnic sample of adults (n = 347) in low- to moderate-income, predominantly Hispanic and non-Hispanic Black neighborhoods in Detroit, Michigan. We used generalized estimating equations to test the effects of ambient exposure to PM2.5 and dietary antioxidant intake on BP, with adjustment for multiple confounders.

RESULTS

Dietary antioxidant intake was inversely associated with systolic BP (b = -0.5; P < .05) and pulse pressure (b  = -0.6; P < .05) in neighborhoods closest to major sources of air pollutants. Adverse effects of PM2.5 remained significant after accounting for antioxidant intakes. Exploratory analyses suggested potential modifying effects of antioxidant intake on associations between ambient PM2.5 exposure and BP.

CONCLUSIONS

Interventions to improve access to antioxidant-rich foods in polluted urban areas may be protective of cardiovascular health. However, efforts to reduce PM2.5 exposure remain critical for cardiovascular health promotion.

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.

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.

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.

Changes in air quality and tropospheric composition due to depletion of stratospheric ozone and interactions with changing climate: implications for human and environmental health

UV radiation is an essential driver for the formation of photochemical smog, which includes ground-level ozone and particulate matter (PM).

A review on the human health impact of airborne particulate matter

Particulate matter (PM) is a key indicator of air pollution brought into the air by a variety of natural and human activities. As it can be suspended over long time and travel over long distances in the atmosphere, it can cause a wide range of diseases that lead to a significant reduction of human life. The size of particles has been directly linked to their potential for causing health problems. Small particles of concern include "inhalable coarse particles" with a diameter of 2.5 to 10μm and "fine particles" smaller than 2.5μm in diameter. As the source-effect relationship of PM remains unclear, it is not easy to define such effects from individual sources such as long-range transport of pollution. Because of the potent role of PM and its associated pollutants, detailed knowledge of their human health impacts is of primary importance. This paper summarizes the basic evidence on the health effects of particulate matter. An in-depth analysis is provided to address the implications for policy-makers so that more stringent strategies can be implemented to reduce air pollution and its health effects.

Point: clarifying policy evidence with potential-outcomes thinking--beyond exposure-response estimation in air pollution epidemiology

The regulatory environment surrounding policies to control air pollution warrants a new type of epidemiologic evidence. Whereas air pollution epidemiology has typically informed policies with estimates of exposure-response relationships between pollution and health outcomes, these estimates alone cannot support current debates surrounding the actual health effects of air quality regulations. We argue that directly evaluating specific control strategies is distinct from estimating exposure-response relationships and that increased emphasis on estimating effects of well-defined regulatory interventions would enhance the evidence that supports policy decisions. Appealing to similar calls for accountability assessment of whether regulatory actions impact health outcomes, we aim to sharpen the analytic distinctions between studies that directly evaluate policies and those that estimate exposure-response relationships, with particular focus on perspectives for causal inference. Our goal is not to review specific methodologies or studies, nor is it to extoll the advantages of "causal" versus "associational" evidence. Rather, we argue that potential-outcomes perspectives can elevate current policy debates with more direct evidence of the extent to which complex regulatory interventions affect health. Augmenting the existing body of exposure-response estimates with rigorous evidence of the causal effects of well-defined actions will ensure that the highest-level epidemiologic evidence continues to support regulatory policies.

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.

Microsatellite DNA mutations in double-crested cormorants (Phalacrocorax auritus) associated with exposure to PAH-containing industrial air pollution

Hamilton Harbour, Ontario, Canada is one of the most polluted sites on the Great Lakes, and is subject to substantial airborne pollution due to emissions from both heavy industry and intense vehicle traffic. Mutagenic Polycyclic aromatic hydrocarbons (PAHs) are present at very high concentrations in the air and sediment of Hamilton Harbour. We used five variable DNA microsatellites to screen for mutations in 97 families of Double-crested Cormorants (Phalacrocorax auritus) from three wild colonies, two in Hamilton Harbour and one in cleaner northeastern Lake Erie. Mutations were identified in all five microsatellites at low frequencies, with the majority of mutations found in chicks from the Hamilton Harbour site closest to industrial sources of PAH contamination. Microsatellite mutation rates were 6-fold higher at the Hamilton Harbour site closest to the industrial sources of PAH contamination than the other Hamilton Harbour site, and both were higher than the reference colony. A Phase I metabolite of the PAH benzo[a]pyrene identified by LC-MS/MS in bile and liver from Hamilton Harbour cormorant chicks suggests that these cormorants are exposed to and metabolizing PAHs, highlighting their potential to have caused the observed mutations.

Epidemiological evaluation of notifications of environmental events in the State of São Paulo, Brazil

Increasing urbanization across the globe, combined with an increased use of chemicals in various regions, contributes to several environmental events that influence environmental health. Measures that identify environmental factors and events should be introduced to facilitate epidemiological investigations by health services. The Brazilian Ministry of Health published a new list of notifiable diseases on 25 January 2011 and introduced environmental events as a new category of notifiable occurrences. The Center for Epidemiologic Surveillance in State of Sao Paulo, Brazil, created an online notification system that highlights “environmental events”, such as exposure to chemical contaminants, drinking water with contaminants outside of the recommended range, contaminated air, and natural or anthropogenic disasters. This paper analyzed 300 notifications received between May 2011 and May 2012. It reports the number of notifications with event classifications and analyzes the events relating to accidents with chemical substances. This paper describes the characteristics of the accidents that involved chemical substances, methods used, types of substances, exposed population, and measures adopted. The online notification of environmental events increases the analysis of the main events associated with diseases related to environmental chemicals; thus, it facilitates the adoption of public policies to prevent environmental health problems.

Improving risk management: from lame excuses to principled practice

The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame-shifting "lame excuses" for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning-especially from near-misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk-reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management.

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.

Identifying PM2.5 and PM0.1 sources for epidemiological studies in California

The University of California-Davis_Primary (UCD_P) model was applied to simultaneously track ∼ 900 source contributions to primary particulate matter (PM) in California for seven continuous years (January 1st, 2000 to December 31st, 2006). Predicted source contributions to primary PM2.5 mass, PM1.8 elemental carbon (EC), PM1.8 organic carbon (OC), PM0.1 EC, and PM0.1 OC were in general agreement with the results from previous source apportionment studies using receptor-based techniques. All sources were further subjected to a constraint check based on model performance for PM trace elemental composition. A total of 151 PM2.5 sources and 71 PM0.1 sources contained PM elements that were predicted at concentrations in general agreement with measured values at nearby monitoring sites. Significant spatial heterogeneity was predicted among the 151 PM2.5 and 71 PM0.1 source concentrations, and significantly different seasonal profiles were predicted for PM2.5 and PM0.1 in central California vs southern California. Population-weighted concentrations of PM emitted from various sources calculated using the UCD_P model spatial information differed from the central monitor estimates by up to 77% for primary PM2.5 mass and 148% for PM2.5 EC because the central monitor concentration is not representative of exposure for nearby population. The results from the UCD_P model provide enhanced source apportionment information for epidemiological studies to examine the relationship between health effects and concentrations of primary PM from individual sources.

Composition and sources of fine particulate matter across urban and rural sites in the Midwestern United States

The composition and sources of fine particulate matter (PM2.5) were investigated in rural and urban locations in Iowa, located in the agricultural and industrial Midwestern United States, from April 2009 to December 2012. Major chemical contributors to PM2.5 mass were sulfate, nitrate, ammonium, and organic carbon. Non-parametric statistical analyses demonstrated that the two rural sites had significantly enhanced levels of crustal materials (Si, Al) driven by agricultural activities and unpaved roads. Meanwhile, the three urban areas had enhanced levels of secondary aerosols (nitrate, sulfate, and ammonium) and combustion products (elemental carbon). The Davenport site had significantly higher levels of PM2.5 and trace metals (Fe, Pb, Zn), demonstrating the important local impact of industrial point sources on air quality. Sources of PM2.5 were evaluated by using the multi-variant positive matrix factorization (PMF) source apportionment model. For each individual site, seven to nine factors were identified: secondary sulfate (accounting for 29-30% of PM2.5), secondary nitrate (17-24%), biomass burning (9-21%), gasoline combustion (6-16%), diesel combustion (3-9%), dust (6-11%), industry (0.4-5%) and winter salt (2-6%). Source contributions demonstrated a clear urban enhancement in PM2.5 from gasoline engines (by a factor of 1.14) and diesel engines (by a factor of 2.3), which is significant due to the well-documented negative health impacts of vehicular emissions. This study presents the first source apportionment results from the state of Iowa and is broadly applicable to understanding the differences in anthropogenic and natural sources in the urban-rural continuum of particle air pollution.

Caveats for causal interpretations of linear regression coefficients for fine particulate (PM2.5) air pollution health effects

Recent linear regression analyses have concluded that decreasing levels of fine particulate matter (PM2.5) air pollution have increased life expectancy in the United States. These findings have left unresolved questions about the causal relation between reductions in PM2.5 levels and changes in cause-specific (especially, cardiovascular disease, CVD) mortality risks. Their robustness (e.g., sensitivity to deletion of a single data point) has also been questioned. We investigate these issues in the National Mortality and Morbidity Air Pollution Study database. Comparing changes in PM2.5 levels and cause-specific mortality rates for elderly people in 24 cities between two periods separated by a decade (1987-1989 and 1999-2000) shows that reductions in PM2.5 were significantly associated with increases in respiratory mortality rates and with decreases in CVD mortality rates. CVD and all-cause mortality risks fell equally for all months of the year over this period, but average PM2.5 levels increased significantly for winter months. This casts doubts on the causal interpretation that declines in PM2.5 over the decade caused reduced short-term mortality risks. Nonlinear regression suggests that reduced or negative marginal health benefits are associated with reductions of PM2.5 below 1999-2000 levels (about 15 μg/m(3)). Such nonlinear relations imply that risk communication statements that project a constant incremental reduction in mortality risks per unit reduction in PM2.5 do not adequately reflect the realistic possibility of nonlinear exposure-response relations and diminishing returns to further exposure reductions.

The effect of biomass fuel exposure on the prevalence of asthma in adults in India - review of current evidence

INTRODUCTION

The combustion of biomass fuels is a major source of respiratory disease among individuals in the developing world. Over two million people world-wide rely on biomass fuels to supply their household energy needs with an estimated 1.6 million deaths annually being attributable to biomass smoke exposure. As a developing country, India relies heavily on the use of solid fuels as a source of energy. These materials supply 75% of the country's domestic energy need and are attributed as the cause of over 600 000 deaths annually. Diseases such as chronic bronchitis and acute lower respiratory tract infections are strongly correlated to biomass smoke exposure. While not as strongly correlated, accumulating evidence suggests that asthma prevalence may be related to solid fuel smoke.

METHODS

This review examines the current literature linking biomass smoke exposure to the reporting of asthma symptoms. A PubMed search was performed using key terms biomass, asthma, India and respiratory disease. Preference was given to recent articles that surveyed the adult population within India.

RESULTS

The reviewed articles showed an increased odds ratio for reporting a diagnosis of asthma or symptoms consistent with asthma following biomass smoke exposure. While the literature supports a strong association between household air pollution and the development of chronic bronchitis and acute lower respiratory tract infections in India, this review establishes a more firm relationship between reported asthma symptoms and biomass smoke exposure.

CONCLUSION

The exposure to biomass fuel smoke results in respiratory diseases in developing countries. Among these diseases, asthma appears to be a preventable pulmonary pathology that is associated with household air pollution. Measures to reduce exposure may decrease the burden of disease which could help advance social and economic progress in these nations. Further research and out-reach efforts are needed to reduce the total burden of lung diseases, including asthma, across the developing world. This reduction could save millions of dollars annually and lower morbidity and mortality in the affected populations.