Seasonal and regional short-term effects of fine particles on hospital admissions in 202 US counties, 1999-2005

Ambient ozone concentrations and cardiac mortality in Southern California 1983-2000: application of a new marginal structural model approach

The authors evaluated the association between ambient ozone levels and cardiac mortality in California's South Coast Air Basin during the period 1983-2000 and compared inferences from several types of marginal structural model (MSM) estimators. The authors undertook an ecologic study during the high-ozone seasons among persons over age 55 years. In contrast to conditional regression analysis and MSMs based on G-computation and simple inverse probability-of-treatment weighting (IPTW), an MSM that protected against violation of the experimental treatment assignment (ETA) assumption and considered only those areas that could have experienced both high and low ozone concentrations during 1983-2000 found no consistent evidence that reductions in quarterly 1-hour maximum ozone concentrations from levels above any of the regulatory standards to levels below those standards led to decreases in cardiac mortality; however, it did find evidence of decreases related to a decrease in 8-hour maximum concentrations. The G-computation estimator and simple IPTW estimators were biased because of serious violation of the ETA assumption. These analyses highlight the importance of nonviolation of the ETA assumption for valid inference and the failure of conditional regression to provide marginal estimates in the presence of interactions. Noncausal models also consistently inferred larger associations, which may have been due to bias violation of the ETA assumption on which these models rely.

Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association

In 2004, the first American Heart Association scientific statement on "Air Pollution and Cardiovascular Disease" concluded that exposure to particulate matter (PM) air pollution contributes to cardiovascular morbidity and mortality. In the interim, numerous studies have expanded our understanding of this association and further elucidated the physiological and molecular mechanisms involved. The main objective of this updated American Heart Association scientific statement is to provide a comprehensive review of the new evidence linking PM exposure with cardiovascular disease, with a specific focus on highlighting the clinical implications for researchers and healthcare providers. The writing group also sought to provide expert consensus opinions on many aspects of the current state of science and updated suggestions for areas of future research. On the basis of the findings of this review, several new conclusions were reached, including the following: Exposure to PM <2.5 microm in diameter (PM(2.5)) over a few hours to weeks can trigger cardiovascular disease-related mortality and nonfatal events; longer-term exposure (eg, a few years) increases the risk for cardiovascular mortality to an even greater extent than exposures over a few days and reduces life expectancy within more highly exposed segments of the population by several months to a few years; reductions in PM levels are associated with decreases in cardiovascular mortality within a time frame as short as a few years; and many credible pathological mechanisms have been elucidated that lend biological plausibility to these findings. It is the opinion of the writing group that the overall evidence is consistent with a causal relationship between PM(2.5) exposure and cardiovascular morbidity and mortality. This body of evidence has grown and been strengthened substantially since the first American Heart Association scientific statement was published. Finally, PM(2.5) exposure is deemed a modifiable factor that contributes to cardiovascular morbidity and mortality.

Air pollution and daily emergency department visits for depression

OBJECTIVES

To investigate the potential correlation between ambient air pollution exposure and emergency department (ED) visits for depression.

MATERIALS AND METHODS

A hierarchical clusters design was used to study 27 047 ED visits for depression in six cities in Canada. The data used in the analysis contain the dates of visits, daily numbers of diagnosed visits, and daily mean concentrations of air pollutants as well as the meteorological factors. The generalized linear mixed models technique was applied to data analysis. Poisson models were fitted to the clustered counts of ED visits with a single air pollutant, temperature and relative humidity.

RESULTS

Statistically significant positive correlations were observed between the number of ED visits for depression and the air concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and particulate matter (PM10). The percentage increase in daily ED visits was 15.5% (95% CI: 8.0-23.5) for CO per 0.8 ppm and 20.0% (95% CI: 13.3-27.2) for NO2 per 20.1 ppb, for same day exposure in the warm weather period (April-September). For PM10, the largest increase, 7.2% (95% CI: 3.0-11.6) per 19.4 ug/m3, was observed for the cold weather period (October-March).

CONCLUSIONS

The results support the hypothesis that ED visits for depressive disorder correlate with ambient air pollution, and that a large majority of this pollution results from combustion of fossil fuels (e.g. in motor vehicles).

Adverse health effects of particulate air pollution: modification by air conditioning

BACKGROUND

The short-term effects of particulate matter (PM) on mortality and morbidity differ by geographic location and season. Several hypotheses have been proposed for this variation, including different exposures with air conditioning (AC) versus open windows.

METHODS

Bayesian hierarchical modeling was used to explore whether AC prevalence modified day-to-day associations between PM10 and mortality, and between PM2.5 and cardiovascular or respiratory hospitalizations, for those 65 years and older. We considered yearly, summer-only, and winter-only effect estimates and 2 types of AC (central and window units).

RESULTS

Communities with higher AC prevalence had lower PM effects. Associations were observed for cardiovascular hospitalizations and central AC. Each additional 20% of households with central AC was associated with a 43% decrease in PM2.5 effects on cardiovascular hospitalization. Central AC prevalence explained 17% of between-community variability in PM2.5 effect estimates for cardiovascular hospitalizations.

CONCLUSIONS

Higher AC prevalence was associated with lower health effect estimates for PM.

Fine particulate air pollution and its components in association with cause-specific emergency admissions

BACKGROUND

Although the association between exposure to particulate matter and health is well established, there remains uncertainty as to whether certain chemical components are more harmful than others. We explored whether the association between cause-specific hospital admissions and PM(2.5) was modified by PM(2.5) chemical composition.

METHODS

We estimated the association between daily PM(2.5) and emergency hospital admissions for cardiac causes (CVD), myocardial infarction (MI), congestive heart failure (CHF), respiratory disease, and diabetes in 26 US communities, for the years 2000-2003. Using meta-regression, we examined how this association was modified by season- and community-specific PM(2.5) composition, controlling for seasonal temperature as a surrogate for ventilation.

RESULTS

For a 10 microg/m3 increase in 2-day averaged PM(2.5) concentration we found an increase of 1.89% (95% CI: 1.34- 2.45) in CVD, 2.25% (95% CI: 1.10- 3.42) in MI, 1.85% (95% CI: 1.19- 2.51) in CHF, 2.74% (95% CI: 1.30- 4.2) in diabetes, and 2.07% (95% CI: 1.20- 2.95) in respiratory admissions. The association between PM2.5 and CVD admissions was significantly modified when the mass was high in Br, Cr, Ni, and Na(+), while mass high in As, Cr, Mn, OC, Ni, and Na(+) modified MI, and mass high in As, OC, and SO(4)(2-) modified diabetes admissions. For these species, an interquartile range increase in their relative proportion was associated with a 1-2% additional increase in daily admissions per 10 microg/m(3) increase in mass.

CONCLUSIONS

We found that PM(2.5) mass higher in Ni, As, and Cr, as well as Br and OC significantly increased its effect on hospital admissions. This result suggests that particles from industrial combustion sources and traffic may, on average, have greater toxicity.

Association of ambient air pollution with hospital outpatient and emergency room visits in Shanghai, China

Few studies exist in China examining the association of ambient air pollution with morbidity outcomes. We conducted a time-series analysis to examine the association of outdoor air pollutants (PM(10), SO(2), and NO(2)) with hospital outpatient and emergency room visits in Shanghai, China, using 3 years of daily data (2005-2007). Hospital and air pollution data were collected from the Shanghai Health Insurance Bureau and Shanghai Environmental Monitoring Center. Using a natural spline model, we examined effect of air pollutants with different lag structures including both single-day lag and multi-day lag. We examined effects of air pollution for the warm season (from April to September) and cool season (from October to March) separately. We found outdoor air pollution (SO(2) and NO(2)) was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. The effect estimates varied for different lag structures of pollutants' concentrations. For lag 3, a 10 microg/m(3) increase in concentration of PM(10), SO(2) and NO(2) corresponded to 0.11% (95%CI: -0.03%, 0.26%), 0.34% (95%CI: 0.06%, 0.61%) and 0.55% (95%CI: 0.14%, 0.97%) increase of outpatient visit; and 0.01% (95%CI: -0.09%, 0.10%), 0.17% (95%CI: 0.00%, 0.35%) and 0.08% (95%CI: -0.18%, 0.33%) increase of emergency room visit. The associations appeared to be more evident in the cool season than in the warm season. In conclusion, short-term exposure to outdoor air pollution was associated with increased risk of hospital outpatient and emergency room visits in Shanghai. Our analyses provide evidence that the current air pollution level has an adverse health effect and strengthen the rationale for further limiting air pollution levels in the city.

Hospital admissions and chemical composition of fine particle air pollution

RATIONALE

There are unexplained geographical and seasonal differences in the short-term effects of fine particulate matter (PM(2.5)) on human health. The hypothesis has been advanced to include the possibility that such differences might be due to variations in the PM(2.5) chemical composition, but evidence supporting this hypothesis is lacking.

OBJECTIVES

To examine whether variation in the relative risks (RR) of hospitalization associated with ambient exposure to PM(2.5) total mass reflects differences in PM(2.5) chemical composition.

METHODS

We linked two national datasets by county and by season: (1) long-term average concentrations of PM(2.5) chemical components for 2000-2005 and (2) RRs of cardiovascular and respiratory hospitalizations for persons 65 years or older associated with a 10-microg/m(3) increase in PM(2.5) total mass on the same day for 106 U.S. counties for 1999 through 2005.

MEASUREMENTS AND MAIN RESULTS

We found a positive and statistically significant association between county-specific estimates of the short-term effects of PM(2.5) on cardiovascular and respiratory hospitalizations and county-specific levels of vanadium, elemental carbon, or nickel PM(2.5) content.

CONCLUSIONS

Communities with higher PM(2.5) content of nickel, vanadium, and elemental carbon and/or their related sources were found to have higher risk of hospitalizations associated with short-term exposure to PM(2.5).

Mortality in the Medicare population and chronic exposure to fine particulate air pollution in urban centers (2000-2005)

BACKGROUND

Prospective cohort studies constitute the major source of evidence about the mortality effects of chronic exposure to particulate air pollution. Additional studies are needed to provide evidence on the health effects of chronic exposure to particulate matter < or = 2.5 microm in aerodynamic diameter (PM(2.5)) because few studies have been carried out and the cohorts have not been representative.

OBJECTIVES

This study was designed to estimate the relative risk of death associated with long-term exposure to PM(2.5) by region and age groups in a U.S. population of elderly, for the period 2000-2005.

METHODS

By linking PM(2.5) monitoring data to the Medicare billing claims by ZIP code of residence of the enrollees, we have developed a new retrospective cohort study, the Medicare Cohort Air Pollution Study. The study population comprises 13.2 million participants living in 4,568 ZIP codes having centroids within 6 miles of a PM(2.5) monitor. We estimated relative risks adjusted by socioeconomic status and smoking by fitting log-linear regression models.

RESULTS

In the eastern and central regions, a 10-microg/m(3) increase in 6-year average of PM(2.5) is associated with 6.8% [95% confidence interval (CI), 4.9-8.7%] and 13.2% (95% CI, 9.5-16.9) increases in mortality, respectively. We found no evidence of an association in the western region or for persons > or = 85 years of age.

CONCLUSIONS

We established a cohort of Medicare participants for investigating air pollution and mortality on longer-term time frames. Chronic exposure to PM(2.5) was associated with mortality in the eastern and central regions, but not in the western United States.