Validation of the Harvard Six Cities Study of particulate air pollution and mortality

Action against inequalities: a synthesis of social justice & equity, diversity, inclusion frameworks

Inequalities in health have long been recognized as interconnected with social, economic, and various other inequalities. The application of social justice and equity, diversity, inclusion (EDI) frameworks may help expand interdisciplinary perspectives in addressing inequalities. This review study conducted an environmental scan for existing syntheses of theories, models, and frameworks (TMFs) relevant to the social justice and EDI. Results from Web of Science, Scopus, PubMed, CINAHL, PsychINFO, and MEDLINE retrieved an existing implementation science framework intently centered upon health inequalities, and draws from a synthesis of postcolonial theory, reflexivity, intersectionality, structural violence, and governance theory. Given this high degree of relevance to the objective of this review, the framework was selected as a basis for expanded synthesis. Subsequent processes sought to identify social justice TMFs which could be integrated into the base framework selected, as well as to refine scope of the study. Based upon considerations of level of evidence and non-tokenistic integration, the following social justice and EDI TMFs were identified: John Rawls' theory of justice; Amartya Sen's Capabilities Approach; Iris Marion Young's theories of justice; Paulo Freire's critical consciousness; and critical race theory (CRT). The focus of the synthesis performed was scoped towards minimizing potential harms arising from actions intending to reduce inequalities. EDI considerations were not collated into a singular construct, but rather extended as a separate component assessing inequitable distribution of risks and benefits given population heterogeneity. Reflexive analysis amended the framework with two key decisions: first, the integration of environmental justice into a single construct, which helps to inform Rawls' and Sen's TMFs; second, a temporal element of sequential-analysis was employed over a unified output. The result of synthesis consists of a three-component framework which: (1) presents sixteen constructs drawn from selected TMFs, to consider various harms or potential reinforcement of existing inequalities; (2) aims to de-invisibilize marginalized groups who are noted to experience inequitable outcomes, and acknowledges the presence of individuals belonging to multiple groups; and (3) synthesizes seven considerations related to equitable dissemination and evaluation as drawn from TMFs, separated for sequential analysis after assessment of harms.

Seasonal extreme temperatures and short-term fine particulate matter increases pediatric respiratory healthcare encounters in a sparsely populated region of the intermountain western United States

BACKGROUND

Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Evaluating while accounting for these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health is becoming more important.

METHODS

We explored short-term exposure to air pollution on children's respiratory health outcomes and how extreme temperature or seasonal period modify the risk of air pollution-associated healthcare events. The main outcome measure included individual-based address located respiratory-related healthcare visits for three categories: asthma, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) across western Montana for ages 0-17 from 2017-2020. We used a time-stratified, case-crossover analysis with distributed lag models to identify sensitive exposure windows of fine particulate matter (PM2.5) lagged from 0 (same-day) to 14 prior-days modified by temperature or season.

RESULTS

For asthma, increases of 1 µg/m3 in PM2.5 exposure 7-13 days prior a healthcare visit date was associated with increased odds that were magnified during median to colder temperatures and winter periods. For LRTIs, 1 µg/m3 increases during 12 days of cumulative PM2.5 with peak exposure periods between 6-12 days before healthcare visit date was associated with elevated LRTI events, also heightened in median to colder temperatures but no seasonal effect was observed. For URTIs, 1 unit increases during 13 days of cumulative PM2.5 with peak exposure periods between 4-10 days prior event date was associated with greater risk for URTIs visits that were intensified during median to hotter temperatures and spring to summer periods.

CONCLUSIONS

Delayed, short-term exposure increases of PM2.5 were associated with elevated odds of all three pediatric respiratory healthcare visit categories in a sparsely population area of the inter-Rocky Mountains, USA. PM2.5 in colder temperatures tended to increase instances of asthma and LRTIs, while PM2.5 during hotter periods increased URTIs.

Alzheimer's Related Neurodegeneration Mediates Air Pollution Effects on Medial Temporal Lobe Atrophy

Exposure to ambient air pollution, especially particulate matter with aerodynamic diameter <2.5 μm (PM2.5) and nitrogen dioxide (NO2), are environmental risk factors for Alzheimer's disease and related dementia. The medial temporal lobe (MTL) is an important brain region subserving episodic memory that atrophies with age, during the Alzheimer's disease continuum, and is vulnerable to the effects of cerebrovascular disease. Despite the importance of air pollution it is unclear whether exposure leads to atrophy of the MTL and by what pathways. Here we conducted a longitudinal study examining associations between ambient air pollution exposure and MTL atrophy and whether putative air pollution exposure effects resembled Alzheimer's disease-related neurodegeneration or cerebrovascular disease-related neurodegeneration. Participants included older women (n = 627; aged 71-87) who underwent two structural brain MRI scans (MRI-1: 2005-6; MRI-2: 2009-10) as part of the Women's Health Initiative Memory Study of Magnetic Resonance Imaging. Regionalized universal kriging was used to estimate annual concentrations of PM2.5 and NO2 at residential locations aggregated to 3-year averages prior to MRI-1. The outcome was 5-year standardized change in MTL volumes. Mediators included voxel-based MRI measures of the spatial pattern of neurodegeneration of Alzheimer's disease (Alzheimer's disease pattern similarity scores [AD-PS]) and whole-brain white matter small-vessel ischemic disease (WM-SVID) volume as a proxy of global cerebrovascular damage. Structural equation models were constructed to examine whether the associations between exposures with MTL atrophy were mediated by the initial level or concurrent change in AD-PS score or WM-SVID while adjusting for sociodemographic, lifestyle, clinical characteristics, and intracranial volume. Living in locations with higher PM2.5 (per interquartile range [IQR]=3.17μg/m3) or NO2 (per IQR=6.63ppb) was associated with greater MTL atrophy (βPM2.5 = -0.29, 95% confidence interval [CI]=[-0.41,-0.18]; βNO2 =-0.12, 95%CI=[-0.23,-0.02]). Greater PM2.5 was associated with larger increases in AD-PS (βPM2.5 = 0.23, 95%CI=[0.12,0.33]) over time, which partially mediated associations with MTL atrophy (indirect effect= -0.10; 95%CI=[-0.15, -0.05]), explaining approximately 32% of the total effect. NO2 was positively associated with AD-PS at MRI-1 (βNO2=0.13, 95%CI=[0.03,0.24]), which partially mediated the association with MTL atrophy (indirect effect= -0.01, 95% CI=[-0.03,-0.001]). Global WM-SVID at MRI-1 or concurrent change were not significant mediators between exposures and MTL atrophy. Findings support the mediating role of Alzheimer's disease-related neurodegeneration contributing to MTL atrophy associated with late-life exposures to air pollutants. Alzheimer's disease-related neurodegeneration only partially explained associations between exposure and MTL atrophy suggesting the role of multiple neuropathological processes underlying air pollution neurotoxicity on brain aging.

Seasonal extreme temperatures and short-term fine particulate matter increases child respiratory hospitalizations in a sparsely populated region of the intermountain western United States

Background

Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Few studies have evaluated these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health.

Methods

We explored short-term exposure to air pollution on childhood respiratory health outcomes and how extreme temperature or seasonal period modify the risk of air pollution-associated hospitalizations. The main outcome measure included all respiratory-related hospital admissions for three categories: asthma, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) across western Montana for all individuals aged 0-17 from 2017-2020. We used a time-stratified, case-crossover analysis and distributed lag models to identify sensitive exposure windows of fine particulate matter (PM2.5) lagged from 0 (same-day) to 15 prior-days modified by temperature or season.

Results

Short-term exposure increases of 1 μg/m3 in PM2.5 were associated with elevated odds of all three respiratory hospital admission categories. PM2.5 was associated with the largest increased odds of hospitalizations for asthma at lag 7-13 days [1.87(1.17-2.97)], for LRTI at lag 6-12 days [2.18(1.20-3.97)], and for URTI at a cumulative lag of 13 days [1.29(1.07-1.57)]. The impact of PM2.5 varied by temperature and season for each respiratory outcome scenario. For asthma, PM2.5 was associated most strongly during colder temperatures [3.11(1.40-6.89)] and the winter season [3.26(1.07-9.95)]. Also in colder temperatures, PM2.5 was associated with increased odds of LRTI hospitalization [2.61(1.15-5.94)], but no seasonal effect was observed. Finally, 13 days of cumulative PM2.5 prior to admissions date was associated with the greatest increased odds of URTI hospitalization during summer days [3.35(1.85-6.04)] and hotter temperatures [1.71(1.31-2.22)].

Conclusions

Children's respiratory-related hospital admissions were associated with short-term exposure to PM2.5. PM2.5 associations with asthma and LRTI hospitalizations were strongest during cold periods, whereas associations with URTI were largest during hot periods.

Classification

environmental public health, fine particulate matter air pollution, respiratory infections.

Toward a Cardio-Environmental Risk Model: Environmental Determinants of Cardiovascular Disease

It is increasingly recognized that strong geographic variations in cardiovascular risk cannot be explained using traditional cardiovascular risk factors alone. Indeed, it is highly unlikely that heredity and classic risk factors such as hypertension, diabetes, dyslipidemia, and tobacco use can explain the tenfold variation observed in cardiovascular mortality among men in Russia and those in Switzerland. Since the advent of industrialization and resultant changes to our climate, it is now clear that environmental stressors also influence cardiovascular health and our thinking around cardiovascular risk prediction is in need of a paradigm shift. Herein, we review the basis for this shift in our understanding of the interplay of environmental factors with cardiovascular health. We illustrate how air pollution, hyperprocessed foods, the amount of green space, and population activity levels are now considered the 4 major environmental determinants of cardiovascular health and provide a framework for how these considerations might be incorporated into clinical risk assessment. We also outline the clinical and socioeconomic effects of the environment on cardiovascular health and review key recommendations from major medical societies.

Changes in healthy effects and economic burden of PM2.5 in Beijing after COVID-19

The COVID-19 lockdown had a positive control effect on urban air quality. However, this effect remains uncertain after the epidemic enters regular management, and furthermore, only limited data are available regarding urban PM2.5 (aerodynamic diameter ≤ 2.5μm) under the impact of the epidemic. We used daily ambient PM2.5 concentration data in Beijing to compare and analyze the changes in urban PM2.5 concentrations before and after the COVID-19 epidemic and to estimate the healthy effects and economic burden associated with PM2.5 before and after the epidemic. The study found that COVID-19 has a significant impact on the urban environmental PM2.5 concentration, which is manifested by the decrease in the PM2.5 concentration in Beijing during the epidemic by 27.8%. Exposure-response models estimated 56.443 (95% CI: 43.084-69.893) thousand people die prematurely in Beijing during the COVID-19 epidemic attributed to long-term PM2.5 exposure, with a 13.3% decrease in the number of premature deaths year-on-year. The total healthy economic losses attributable to PM2.5 in Beijing during the COVID-19 epidemic were 35.76 (95% CI: 28.41-42.44) billion yuan, with a per capita loss of 816.8 yuan. Strict control measures throughout the COVID-19 epidemic had a positive impact on air quality in Beijing, with a decrease in both premature deaths and economic healthy losses attributable to fine particles. This paper helps to enrich and expand the research on the impact of COVID-19 on the urban environment and provides a basis for formulating policies related to air quality improvement in the post-epidemic era.

Evaluation of ·OH Production Potential of Particulate Matter (PM2.5) Collected on TiO2-Supporting Quartz Filters

Oxidative stress induced by fine particulate matter 2.5 (PM2.5) is a potential cause of adverse health effects owing to the production of reactive oxygen species (ROS). Air filtration is a key technology for preventing exposure to particulate contaminations; however, particulate matter trapped by filters has the potential risk of human contact with condensed PM2.5. Thus, this study aims to reduce the hydroxyl radical (·OH) production potential of PM2.5 collected on such TiO2-supporting quartz filters. The ·OH production potential was evaluated for PM2.5, which was collected in Kanagawa, Japan, using a terephthalate assay coupled with flow injection analysis. Although the PM2.5 levels at the sampling site were not severe, the PM2.5 samples exhibited ·OH production potential, which was mostly attributed to organic aerosols. The effect was verified using a TiO2-supporting quartz filter for the collection and subsequent degradation of PM2.5. The ·OH production potential was significantly reduced from 0.58 ± 0.40 pmol/(min m3) to 0.22 ± 0.13 pmol/(min m3) through ultraviolet irradiation for 24 h. This suggests that the photocatalytic reaction of the TiO2 filter is effective in reducing the ·OH production potential of PM2.5.

Photocatalytic Degradation of Polycyclic Aromatic Hydrocarbons in Fine Particulate Matter (PM2.5) Collected on TiO2-Supporting Quartz Fibre Filters

Airborne fine particulate matter (PM2.5) pollution is known to have adverse effects on human health, and owing to their carcinogenic and mutagenic nature, polycyclic aromatic hydrocarbons (PAHs) are of particular concern. This study investigated the effect of ultraviolet (UV)-induced photocatalysis on the degradation of PAHs in PM2.5, employing titanium dioxide (TiO2)-supporting quartz fibre filters. A TiO2 layer was formed on the quartz fibre filters, and airborne PM2.5 was collected using an air sample at a flow rate of 500 L/min for 24 h. The PM2.5 samples were subsequently irradiated with ultraviolet rays at 1.1 mW/cm2. The amounts of nine targeted PAHs (phenanthrene, PHE; anthracene, ANT; pyrene, PYR; benzo[a]anthracene, BaA; chrysene, CHR; benzo[b]fluoranthene, BbF; benzo[k]fluoranthene, BkF; benzo[a]pyrene, BaP; and benzo[g,h,i]perylene, BgP) gradually decreased during the treatment, with half-lives ranging from 18 h (PHE) to 3 h (BaP), and a significantly greater reduction was found in comparison with the PAHs collected in the control (non-TiO2 coated) quartz fibre filters. However, the degradation rates were much faster when the PAHs were in direct contact with the TiO2 layer. As PM2.5 is a mixture of various kinds of solids, co-existing components can be a rate-determining factor in the UV-induced degradation of PAHs. This was demonstrated by a remarkable increase in degradation rates following the removal of co-existing salts from the PM2.5 using water treatment.

Photocatalytic degradation of atmospheric fine particulate matter (PM2.5) collected on TiO2 supporting quartz fibre filter

Carbonaceous constituents in fine particulate matter (PM_2.5) are often associated with adverse health effects in humans. Although air filtration technology is widely used for preventing exposure to PM_2.5, the trapped PM_2.5 still has hazardous property if not treated subsequently. Thus, this study aimed to realise detoxification of PM_2.5 with a photocatalytic decomposition of carbonaceous compounds in PM_2.5 samples collected on a quartz fibre filter coated with titanium dioxide (TiO₂). The mass of PM_2.5 gradually decreased with time during the UV irradiation with a significant release of carbon dioxide (CO₂) as a product. The analysis of organic carbon (OC) and elemental carbon (EC) using a thermal/optical carbon analyser following the IMPROVE protocol showed that carbonaceous constituents such as OC1, OC2, OC3, OC4, and EC1 fractions were successfully decomposed by UV-irradiated TiO₂, whereas EC2 and EC4 fractions were inert to the photocatalysis. However, a majority of the carbon content, approximately 92% of the total carbon, was reduced by the proposed method. This shows that the photon-induced TiO₂ potentially reduces the hazardous effects of PM_2.5.

A century of the Archives of Environmental & Occupational Health

With this issue, the Archives of Environmental & Occupational Health celebrates 100 years of continuous publication since its foundation as the Journal of Industrial Hygiene in 1919. During its first century, the Archives established an extraordinary legacy in the development of no less than three fields of research and practice: (1) occupational medicine, (2) industrial hygiene, and (3) air pollution studies and regulation. Its contribution to American environmental protection standards in air quality was particularly important, as the journal served as a major outlet for crucial air pollution research during the early years of the new United States Environmental Protection Agency. Its pages also chart the development of occupational health as an independent field, as well as the later emergence of modern environmental health as a related co-discipline. As the Archives moves into its second century of continuous publication, the journal will continue shaping the fields of environmental and occupational health; building on the solid foundation of evidence-based research from which humankind continues to benefit.

Inhalational exposure to particulate matter air pollution alters the composition of the gut microbiome

Recent studies suggest an association between particulate matter (PM) air pollution and gastrointestinal (GI) disease. In addition to direct deposition, PM can be indirectly deposited in oropharynx via mucociliary clearance and upon swallowing of saliva and mucus. Within the GI tract, PM may alter the GI epithelium and gut microbiome. Our goal was to determine the effect of PM on gut microbiota in a murine model of PM exposure via inhalation. C57BL/6 mice were exposed via inhalation to either concentrated ambient particles or filtered air for 8-h per day, 5-days a week, for a total of 3-weeks. At exposure's end, GI tract tissues and feces were harvested, and gut microbiota was analyzed. Alpha-diversity was modestly altered with increased richness in PM-exposed mice compared to air-exposed mice in some parts of the GI tract. Most importantly, PM-induced alterations in the microbiota were very apparent in beta-diversity comparisons throughout the GI tract and appeared to increase from the proximal to distal parts. Changes in some genera suggest that distinct bacteria may have the capacity to bloom with PM exposure. Exposure to PM alters the microbiota throughout the GI tract which maybe a potential mechanism that explains PM induced inflammation in the GI tract.

A feasibility study of the association of exposure to biomass smoke with vascular function, inflammation, and cellular aging

BACKGROUND

Biomass smoke at higher concentrations is associated with respiratory symptoms and, after years of exposure, increased risk of respiratory disorders in adults, but its effects on cardiovascular diseases are not well characterized, particularly compared with other pollution sources like tobacco smoke or traffic.

METHODS

We conducted a cross-sectional study and enrolled 25 women living in rural Sichuan, China. We measured integrated 24-h personal exposure to fine particulate matter (PM2.5) and black carbon, and measured PM2.5 and black carbon in their kitchens. We assessed participants' brachial and central blood pressure and arterial stiffness using pulse wave analysis, and analyzed dried blood spot and buccal cell samples for C-reactive protein and relative telomere length. We also evaluated the difference in these physiological and biomarker measures between individuals with high (≥median) versus low (<median) PM2.5 exposure using multivariate regression.

RESULTS

Geometric mean 24-h PM2.5 and black carbon exposures were 61 µg/m(3) (95% CI: 48, 78) and 3.2 µg/m(3) (95% CI: 2.3, 4.5), respectively. Average kitchen PM2.5 and black carbon concentrations were only moderately correlated with personal exposures (PM2.5: r=0.41; black carbon: r=0.63), although they had similar means. Women in the high and low exposure groups were similar in age, obesity, socioeconomic status, salt intake, and physical activity. Women in the high PM2.5 exposure group had higher mean brachial systolic blood pressure (SBP; difference=4.6 mmHg, 95% CI -7.8, 16.9), central SBP (difference=3.1 mmHg, 95% CI: -8.4, 14.5), central pulse pressure (difference=4.1 mmHg; 95% CI: -4.2, 12.4), and augmentation index (difference=2.8%, 95% CI: -1.6, 7.2). High exposed women had 43% shorter telomere length (95% CI: -113, 28) than that of women in the low exposure group. There were no differences in pulse wave velocity or C-reactive protein between the two exposure groups. None of the results was statistically significant.

CONCLUSIONS

Our results suggest that it is feasible to measure markers of vascular function and biomarkers of inflammation and oxidative stress in field studies of biomass smoke. Although many of the associations were in the expected direction, larger studies would be needed to establish the effects.

Associations of World Trade Center exposures with pulmonary and cardiometabolic outcomes among children seeking care for health concerns

OBJECTIVE

Prior research on the physical health of children exposed to the World Trade Center (WTC) attacks has largely relied on parental report via questionnaire. We examined the impact of clinically-reported exposures on the physical health of children who lived and/or attended school in downtown Manhattan on September 11, 2001.

STUDY DESIGN

We performed a cross-sectional study of 148 patients who presented to the WTC Environmental Health Center/Survivors Health Program, and were ≤ 18 years old on September 11, 2001.

RESULTS

38.5% were caught in the dust cloud from the collapsing buildings on September 11; over 80% spent ≥ 1 day in their home between September 11 and 18, 2001; and 25.7% reported home dust exposure. New-onset nasal/sinus congestion was reported in 52.7%, while nearly one-third reported new gastroesophageal reflux (GERD) symptoms. Prehypertension or hypertension was identified in 45.5%. Multivariable regression with exposure variables, body mass index category, and age as covariates identified strongest associations of dust cloud with spirometry (17.1% decrease in maximum midexpiratory flow). Younger children experienced increased peripheral eosinophils (+0.098% per year, p=0.023), while older children experienced more new-onset GERD (OR 1.17, p=0.004), headaches (OR 1.10, p=0.011), and prehypertension (OR 1.09, p=0.024). Home dust exposure was associated with reduced high-density lipoprotein (-10.3mg/dL, p=0.027) and elevated triglycerides (+36.3mg/dL, p=0.033).

CONCLUSIONS

While these findings cannot be assumed to generalize to all children exposed to the WTC attacks, they strongly suggest the need for more extensive study of respiratory, metabolic, and cardiovascular consequences.

Cardiovascular effects of particulate air pollution exposure: time course and underlying mechanisms

Air pollution is now recognized as an important independent risk factor for cardiovascular morbidity and mortality and may be responsible for up to 3 million premature deaths each year worldwide. The mechanisms underlying the observed effects are poorly understood but are likely to be multifactorial. Here, we review the acute and chronic effects of air pollution exposure on the cardiovascular system and discuss how these effects may explain the observed increases in cardiovascular morbidity and mortality.

Particulate matter air pollution causes oxidant-mediated increase in gut permeability in mice

BACKGROUND

Exposure to particulate matter (PM) air pollution may be an important environmental factor leading to exacerbations of inflammatory illnesses in the GI tract. PM can gain access to the gastrointestinal (GI) tract via swallowing of air or secretions from the upper airways or mucociliary clearance of inhaled particles.

METHODS

We measured PM-induced cell death and mitochondrial ROS generation in Caco-2 cells stably expressing oxidant sensitive GFP localized to mitochondria in the absence or presence of an antioxidant. C57BL/6 mice were exposed to a very high dose of urban PM from Washington, DC (200 μg/mouse) or saline via gastric gavage and small bowel and colonic tissue were harvested for histologic evaluation, and RNA isolation up to 48 hours. Permeability to 4 kD dextran was measured at 48 hours.

RESULTS

PM induced mitochondrial ROS generation and cell death in Caco-2 cells. PM also caused oxidant-dependent NF-κB activation, disruption of tight junctions and increased permeability of Caco-2 monolayers. Mice exposed to PM had increased intestinal permeability compared with PBS treated mice. In the small bowel, colocalization of the tight junction protein, ZO-1 was lower in the PM treated animals. In the small bowel and colon, PM exposed mice had higher levels of IL-6 mRNA and reduced levels of ZO-1 mRNA. Increased apoptosis was observed in the colon of PM exposed mice.

CONCLUSIONS

Exposure to high doses of urban PM causes oxidant dependent GI epithelial cell death, disruption of tight junction proteins, inflammation and increased permeability in the gut in vitro and in vivo. These PM-induced changes may contribute to exacerbations of inflammatory disorders of the gut.

[Prolonged exposure to atmospheric air pollution and mortality from respiratory causes]

Different designs can be used to analyze the relationships between respiratory mortality and long term exposure to atmospheric pollution: epidemiological studies (cohort, prevalence study) demonstrate the reality of the relationship and toxicological studies explain it. Cohort studies have the advantage of being able to take into account many confounding factors and thus avoid biases (which is not the case with prevalence studies), but require significant human and financial resources. They were first adopted in the US, but are now more often applied in Europe. The results are relatively consistent, as they all show a statistically significant association between an increase in particulate pollution and cardiopulmonary mortality. Mortality from lung cancer is also associated with long term exposition to particles and sometimes to ozone or nitrogen oxides. Cerebrovascular diseases and sudden death of young children have also been associated with particulate pollution. The relationships are more powerful for long term than short term exposure but are also linear and without threshold. In order to explain these effects (today the causality of the relationship is certain) there are many possible factors, particularly regarding particulate exposures: an increase in cardiovascular risk biomarkers (fibrinogen, white blood cells, and platelets), atherosclerosis, chronic inflammation of lung tissues increased by acute exposure, etc. More and more studies address the interaction between gene and environment and even epigenetic phenomena which could be responsible of these effects. Public Health impact could be quantified. The European E&H surveillance program Apheis, for example, estimated that if PM2.5 levels remained below 15 microg/m(3), a 30 year old person could see his life expectancy increased by 1 month to 2 years, depending on the studied city. Finally, mortality is not the only relevant indicator for health effects of air pollution. ISAAC studies address asthma, allergic rhinitis and eczema among children.

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.

Health effects of particulate air pollution

In the 1980's it was generally felt that particulate air pollution concentrations in the United States were not a hazard to the public health. However, in the early 1990's the application of econometric time-series studies and prospective cohort studies suggested increased mortality associated with acute (daily) and chronic (decades) exposures to particulate air pollution commonly observed in the developed world. The epidemiologic evidence was not supported by evidence of causal associations from other disciplines. Nevertheless, the EPA moved to tighten controls on fine particulate air pollution. The debate over the science was played out in public hearings and the courts. The experience provides lessons on the use of epidemiologic data in setting public policy.

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.

Fine particulate matter and mortality: a comparison of the six cities and American Cancer Society cohorts with a medicare cohort

BACKGROUND

The American Cancer Society study and the Harvard Six Cities study are 2 landmark cohort studies for estimating the chronic effects of fine particulate air pollution (PM2.5) on mortality. Using Medicare data, we assessed the association of PM2.5 with mortality for the same locations included in these studies.

METHODS

We estimated the chronic effects of PM2.5 on mortality for the period 2000-2002 using mortality data for cohorts of Medicare participants and average PM2.5 levels from monitors in the same counties included in the 2 studies. We estimated mortality risk associated with air pollution adjusting for individual-level (age and sex) and area-level covariates (education, income level, poverty, and employment). We controlled for potential confounding by cigarette smoking by including standardized mortality ratios for lung cancer and chronic obstructive pulmonary disease.

RESULTS

Using the Medicare data, we estimated that a 10 microg/m increase in the yearly average PM2.5 concentration is associated with 10.9% (95% confidence interval = 9.0-12.8) and with 20.8% (14.8-27.1) increases in all-cause mortality for the American Cancer Society and Harvard Six Cities study counties, respectively. The estimates are somewhat higher than those reported by the original investigators.

CONCLUSION

Although Medicare data lack information on some potential confounding factors, we estimated risks similar to those in the previously published reports, which incorporated more extensive information on individual-level confounders. We propose that the Medicare files can be used to construct on-going cohorts for tracking the risk of air pollution over time.

Air quality risk assessment and management

This article provides (1) a synthesis of the literature on the linkages between air pollution and human health, (2) an overview of quality management approaches in Canada, the United States, and the European Union (EU), and (3) future directions for air quality research. Numerous studies examining short-term effects of air pollution show significant associations between ambient levels of particulate matter (PM) and other air pollutants and increases in premature mortality and hospitalizations for cardiovascular and respiratory illnesses. Several well-designed epidemiological studies confirmed the adverse long-term effects of PM on both mortality and morbidity. Epidemiological studies also document significant associations between ozone (O3), sulfur (SO2), and nitrogen oxides (NO(x)) and adverse health outcomes; however, the effects of gaseous pollutants are less well documented. Subpopulations that are more susceptible to air pollution include children, the elderly, those with cardiorespiratory disease, and socioeconomically deprived individuals. Canada-wide standards for ambient air concentrations of PM2.5 and O3 were set in 2000, providing air quality targets to be achieved by 2010. In the United States, the Clean Air Act provides the framework for the establishment and review of National Ambient Air Quality Standards for criteria air pollutants and the establishment of emissions standards for hazardous air pollutants. The 1996 European Union's enactment of the Framework Directive for Air Quality established the process for setting Europe-wide limit values for a series of pollutants. The Clean Air for Europe program was established by the European Union to review existing limit values, emission ceilings, and abatement protocols, as set out in the current legislation. These initiatives serve as the legislative framework for air quality management in North America and Europe.

Air pollution and public health: a guidance document for risk managers

This guidance document is a reference for air quality policymakers and managers providing state-of-the-art, evidence-based information on key determinants of air quality management decisions. The document reflects the findings of five annual meetings of the NERAM (Network for Environmental Risk Assessment and Management) International Colloquium Series on Air Quality Management (2001-2006), as well as the results of supporting international research. The topics covered in the guidance document reflect critical science and policy aspects of air quality risk management including i) health effects, ii) air quality emissions, measurement and modeling, iii) air quality management interventions, and iv) clean air policy challenges and opportunities.

Urban and rural variations in morbidity and mortality in Northern Ireland

Background

From a public health perspective and for the appropriate allocation of resources it is important to understand the differences in health between areas. This paper examines the variations in morbidity and mortality between urban and rural areas.

Methods

This is a cohort study looking at morbidity levels of the population of Northern Ireland at the time of the 2001 census, and subsequent mortality over the following four years. Individual characteristics including demographic and socio-economic factors were as recorded on census forms. The urban-rural nature of residence was based on census areas (average population c1900) classified into eight settlement bands, ranging from cities to rural settlements with populations of less than 1000.

Results

The study shows that neither tenure nor car availability are unbiased measures of deprivation in the urban-rural context. There is no indication that social class is biased. There was an increasing gradient of poorer health from rural to urban areas, where mortality rates were about 22% (95% Confidence Intervals 19%–25%) higher than the most rural areas. Differences in death rates between rural and city areas were evident for most of the major causes of death but were greatest for respiratory disease and lung cancer. Conversely, death rates in the most rural areas were higher in children and adults aged less than 20.

Conclusion

Urban areas appear less healthy than the more rural areas and the association with respiratory disease and lung cancer suggests that pollution may be a factor. Rural areas however, have higher death rates amongst younger people, something which requires further research. There is also a need for additional indicators of deprivation that have equal meaning in urban and rural areas.

Sulforaphane-stimulated phase II enzyme induction inhibits cytokine production by airway epithelial cells stimulated with diesel extract

Airborne particulate pollutants, such as diesel exhaust particles, are thought to exacerbate lung and cardiovascular diseases through induction of oxidative stress. Sulforaphane, derived from cruciferous vegetables, is the most potent known inducer of phase II enzymes involved in the detoxification of xenobiotics. We postulated that sulforaphane may be able to ameliorate the adverse effects of pollutants by upregulating expression of endogenous antioxidant enzymes. Stimulation of bronchial epithelial cells with the chemical constituents of diesel particles result in the production of proinflammatory cytokines. We first demonstrated a role for phase II enzymes in regulating diesel effects by transfecting the airway epithelial cell line (BEAS-2B) with the sentinel phase II enzyme NAD(P)H: quinine oxidoreductase 1 (NQO1). IL-8 production in response to diesel extract was significantly reduced in these compared with untransfected cells. We then examined whether sulforaphane would stimulate phase II induction and whether this would thereby ablate the effect of diesel extracts on cytokine production. We verified that sulforaphane significantly augmented expression of the phase II enzyme genes GSTM1 and NQO1 and confirmed that sulforaphane treatment increased glutathione S-transferase activity in epithelial cells without inducing cell death or apoptosis. Sulforaphane pretreatment inhibited IL-8 production by BEAS-2B cells upon stimulation with diesel extract. Similarly, whereas diesel extract stimulated production of IL-8, granulocyte-macrophage colony-stimulating factor, and IL-1β from primary human bronchial epithelial cells, sulforaphane pretreatment inhibited diesel-induced production of all of these cytokines. Our studies show that sulforaphane can mitigate the effect of diesel in respiratory epithelial cells and demonstrate the chemopreventative potential of phase II enzyme enhancement.

Airborne particulate matter: Ionic species role in different Italian sites

Epidemiological studies have provided evidences for an association between exposure to elevated levels of ambient particulate matter (PM) and increased mortality and morbidity. However, the exact physiochemical nature of the responsible component is not clear. Secondary airborne PM formed from gas-phase pollutants contributes significantly to the most severe particulate air quality events. Although chemical formation for ionic species of aerosol have been observed, they have not been well reported for local variation. This work evaluates the amount of secondary particulate ionic species: sulfates (SO(4)(2-)) and nitrates (NO(3)(-)), chlorides (Cl(-)) and the mutagenic activities of PM10 extracts in different Italian sites (one Southern, one Central and three Northern; in one of the latter also PM2.5 has been evaluated). In general, mean secondary species concentration constitutes about 35-45% of PM10 mass in the North sites, 15% in the center site and 20% in the South site and it is positively associated with PM10 levels. There are significant local differences in the mean levels of PM10 ionic constituents: NO(3)(-) are predominant in northern cities, SO(4)(2-) are more equally distributed and coastal southern city is abundant in Cl(-). Samples were also tested for mutagenicity with Salmonella typhimurium strains TA98 and TA100, with and without metabolic activation; mutagenicity did not correlate with PM10 concentrations. The results showed the important roles and the geographical variability of PM secondary species in the total mass PM10 concentrations and the usefulness of this biological approach for monitoring PM to understand hazards from PM.

The mutagenicity of urban particulate matter in an enzyme free system is associated with the generation of reactive oxygen species

Urban particulate matter (UPM) contributes to lung cancer incidence. UPM has been shown to be genotoxic to mammalian cells and to induce mutations in the Ames assay. Here, we have studied the induction of mutations generated by direct acting mutagenic components of UPM, using the supF forward mutation assay. Plasmid pSP189 was exposed to UPM in aqueous solution in the presence of sucrose buffer, to reduce strand breaks. The mutation frequency induced by 1 microg/microl UPM was 4.99 mutants per 10(4) colonies. This was reduced to 0.84 and 1.48 mutants per 10(4) colonies by addition of mannitol (1 mM) or EDTA (1 mM), respectively. A large percentage of mutant plasmids contained frameshift mutations (57%), and 31% of mutant plasmids contained multiple mutations. Of the base substitution mutations, 88% were at GC pairs, with twice as many transversions as transitions. The types of mutations induced, the reduction of mutagenicity by the inclusion of the free radical scavenger, mannitol, or the metal chelator, EDTA, and the sequence context of the induced mutations all support the conclusion that the majority of mutations were induced by reactive oxygen species generated by metal ions present in the UPM. Most mutation studies with UPM have focused on organic carcinogens present on UPM. Our results highlight the potential contribution of metal ions to the mutagenicity of UPM.

Reanalysis of the Harvard Six Cities Study, part I: validation and replication

Because the results of the Harvard Six Cities Study played a critical role in the establishment of the current U.S. ambient air quality objective for fine particles (PM(2.5)), the U.S. Environmental Protection Agency, industry, and nongovernmental organizations called for an independent reanalysis of this study to validate the original findings reported by Dockery and colleagues in the New England Journal of Medicine (vol. 329, pp. 1753-1759) in 1993. Validation of the original findings was accomplished by a detailed statistical audit and replication of original results. With the exception of occupational exposure to dust (14 discrepancies of 249 questionnaires located for evaluation) and fumes (15/249), date of death (2/250), and cause of death (2/250), the audit identified no discrepancies between the original questionnaires and death certificates in the audit sample and the analytic file used by the original investigators. The data quality audit identified a computer programming problem that had resulted in early censorship in 5 of the 6 cities, which resulted in the loss of approximately 1% of the reported person-years of follow-up; the reanalysis team updated the Six Cities cohort to include the missing person-years of observation, resulting in the addition of 928 person-years of observation and 14 deaths. The reanalysis team was able to reproduce virtually all of the original numerical results, including the 26% increase in all-cause mortality in the most polluted city (Stubenville, OH) as compared to the least polluted city (Portage, WI). The audit and validation of the Harvard Six Cities Study conducted by the reanalysis team generally confirmed the quality of the data and the numerical results reported by the original investigators. The discrepancies noted during the audit were not of epidemiologic importance, and did not substantively alter the original risk estimates associated with particulate air pollution, nor the main conclusions reached by the original investigators.

Ambient air pollution and atherosclerosis in Los Angeles

Associations have been found between long-term exposure to ambient air pollution and cardiovascular morbidity and mortality. The contribution of air pollution to atherosclerosis that underlies many cardiovascular diseases has not been investigated. Animal data suggest that ambient particulate matter (PM) may contribute to atherogenesis. We used data on 798 participants from two clinical trials to investigate the association between atherosclerosis and long-term exposure to ambient PM up to 2.5 microm in aerodynamic diameter (PM2.5). Baseline data included assessment of the carotid intima-media thickness (CIMT), a measure of subclinical atherosclerosis. We geocoded subjects' residential areas to assign annual mean concentrations of ambient PM2.5. Exposure values were assigned from a PM2.5 surface derived from a geostatistical model. Individually assigned annual mean PM2.5 concentrations ranged from 5.2 to 26.9 microg/m3 (mean, 20.3). For a cross-sectional exposure contrast of 10 microg/m3 PM2.5, CIMT increased by 5.9% (95% confidence interval, 1-11%). Adjustment for age reduced the coefficients, but further adjustment for covariates indicated robust estimates in the range of 3.9-4.3% (p-values, 0.05-0.1). Among older subjects (greater than or equal to 60 years of age), women, never smokers, and those reporting lipid-lowering treatment at baseline, the associations of PM2.5 and CIMT were larger with the strongest associations in women 60 years of age (15.7%, 5.7-26.6%). These results represent the first epidemiologic evidence of an association between atherosclerosis and ambient air pollution. Given the leading role of cardiovascular disease as a cause of death and the large populations exposed to ambient PM2.5, these findings may be important and need further confirmation.

The genotoxicity of ambient outdoor air, a review: Salmonella mutagenicity

Mutagens in urban air pollution come from anthropogenic sources (especially combustion sources) and are products of airborne chemical reactions. Bacterial mutation tests have been used for large, multi-site, and/or time series studies, for bioassay-directed fractionation studies, for identifying the presence of specific classes of mutagens, and for doing site- or source-comparisons for relative levels of airborne mutagens. Early research recognized that although carcinogenic PAHs were present in air samples they could not account for the majority of the mutagenic activity detected. The mutagenicity of airborne particulate organics is due to at least 500 identified compounds from varying chemical classes. Bioassay-directed fractionation studies for identifying toxicants are difficult to compare because they do not identify all of the mutagens present, and both the analytical and bioassay protocols vary from study to study. However, these studies show that the majority of mutagenicity is usually associated with moderately polar/highly polar classes of compounds that tend to contain nitroaromatic compounds, aromatic amines, and aromatic ketones. Smog chamber studies have shown that mutagenic aliphatic and aromatic nitrogen-containing compounds are produced in the atmosphere when organic compounds (even non-mutagenic compounds) are exposed to nitrogen oxides and sunlight. Reactions that occur in the atmosphere, therefore, can have a profound effect on the genotoxic burden of ambient air. This review illustrates that the mutagenesis protocol and tester strains should be selected based on the design and purpose of the study and that the correlation with animal cancer bioassay results depends upon chemical class. Future emphasis needs to be placed on volatile and semi-volatile genotoxicants, and on multi-national studies that identify, quantify, and apportion mutagenicity. Initial efforts at replacing the Salmonella assay for ambient air studies with some emerging technology should be initiated.