The Health Effects of Combustion

Transcription

1 The Health Effects of Combustion David Christiani, MD, MPH, MS Department of Environmental Health Harvard School of Public Health Energy: The Fuel of Life 1

2 Sources of Energy Renewable Non renewable (US Energy Information Administration, Annual Energy Review 2008) World Energy Consumption ( ) 2006 Energy Information Administration (EIA), International Energy Annual 2006 (June December 2008), Projections: EIA, World Energy Projection Plus (2009) 2

3 World Energy Use by Fuel Type ( ) Fossil fuel 2006 Energy Information Administration (EIA), International Energy Annual 2006 (June December 2008), Projections: EIA, World Energy Projection Plus (2009) Fossil Fuel Combustion Combustion is the sequence of thermo chemical reactions between a fuel and an oxygen producing heat and new chemicals. Most fouls includes organic compounds (especially hydrocarbons) in the gas, liquid or solid phase. h h f In the US, more than 90% of greenhouse gas emissions come from the combustion of fossil fuels (US EPA 2000). 3

4 LA Cheyenne, Wyo Most Polluted: Ozone and Particle Pollution Least Polluted: Particle Pollution State of the Air 2008, American Lung Association, Photo by Texas Hongkong The New York Times, March 22 nd,

5 Soot blackened City: Linfen in China Number of people potentially affected: 3,000,000 Type of pollutant: Coal and particulates Source of pollution: Automobile and industrial emissions Combustion Pollutants Nitrogen oxides (NO x, NO) Sulfur oxides (SOx) Carbon monoxide (CO) Volatile organic compounds (VOCs) Particulate matter (PM) Heavy metals Polycyclic Aromatic Hydrocarbons (PAHs) Coal fired Electric Power Plants: the biggest source of CO 2 emission in the world 5

6 200 of the World's Power Dirtiest Plants: 60% are in the US and East Asia Scherer power plant in Juliette, Georgia Belchatow power plant in Lodz, Poland Taichung power plant in Taiwan PM: Size, Sources, and Composition (Brook et al. Cli Sci 2008) 6

7 Metals and PAHs in PM (Lee et al. CEBP 2009) (Li et al. EHP 2003) (Cho et al. EHP 2009) Deaths and DALYs attributable to 5 Environmental Risks (WHO 2004) 7

8 Deaths from Environmental and Occupational Risks (WHO 2004) Health Effects of Combustion Life Expectancy/Mortality Respiratory system Cardiovascular system Cancer Children s health 8

9 Health Effects of Combustion Air Pollution and Life Expectancy/Mortality Air Pollutants on Acute Stroke Mortality in Korea Stroke mortality increased 3.1% for NO 2, 2.9% for SO 2, 4.1% for CO 2, 1.5% for PM 10, and 2.9% for O 3 for each IQR increase. The elderly and women are more susceptible to the effect of particulate pollutants. (Hong et al. EHP 2002) 9

10 3 Environmental Risks on Mortality Disparities among Mexican Unsafe water and sanitation, household solid fueluse, and urbanpm pollution were responsible for 3.2 deaths per 1,000 children and a 10 month loss of life expectancy. (Stevens et al. PNAS 2008) Distribution of PM (Cormier et al. EHP 2006) 10

11 Carbon in Airway Macrophage from Healthy Children (Kulkarni et al. NEJM 2006) Mitochondrial Damage to a Macrophage caused by Ultrafine Particles (murine) (Nel. Science 2005) Traffic Exposure and Child s Lung Development (Gauderman et al. Lancet 2007) 11

12 Traffic Exposure and Lung Function in Adults with Asthma (Balmes et al. J Allergy Clin Immunol. 2009) Black Carbon Exposure and Lung Function among Urban Women (Suglia et al. EHP 2008) 12

13 Health Effects of Combustion Air Pollution and the Heart PM and Cardiovascular Events (Brook et al. Cli Sci 2008) 13

14 Boilermaker Cohort Study: Particulate Pollution and Heart Rate Variability (Magari et al. Circulation 2001;104: ) Boilermaker Cohort Study: Effects of PM 2.5 on HRV modified by CAD (Chen et al. JOEM 2006) 14

15 Boilermaker Cohort Study: HRV and PAHs Exposure (Submitted to OEM) Boilermaker Cohort Study: PM 2.5 and PM 2.5 Metal content and Oxidative DNA damage 1mg/m 3 increase in PM 2.5 was associated with an increase of 1.67 µg/g in 8 OHdG levels (P = 0.03) PM 2.5 vanadium, manganese, nickel and lead exposure were associated with 8 OHdG levels (P < 0.05). (Kim et al. EHP 2004) 15

16 Health Effects of Combustion Air Pollution and Cancer PAHs Exposure and Lung Cancer Risk Zhang et al. PNAS 2009 The overall population attributable fraction (PAF) for lung cancer caused by inhalation exposure to PAHs was 1.6% (IQR, %), corresponding to an excess annual lung cancer incidence rate of 0.65Χ Armstrong et al. EHP 2004 (meta analysis included 39 cohorts) Considerable independent data are now available that allow us to conclude that occupational exposure to PAHs by inhalation is associated with a risk of lung cancer. 16

17 Wood Smoke Exposure and Lung Cancer Risk The p53 and phospho p53 proteins were significantly increased in LCW (lung cancer associated with wood smoke) samples. The 57 kdmdm2isoform plasma concentration was very high in LCW and LCT (lung cancer associated with tobacco) samples. Wood smoke could produce similar effects on p53, phospho p53, and MDM2 protein expression as tobacco. p53 p p53 MDM2 (Delgado et al. Chest 2005) Carcinogen DNA Adducts and Cancer Risk (Poirier. Nature Review 2004) DNA damage is an important first step in carcinogenic process. Chemical carcinogens can cause the formation of carcinogen DNA adducts. 3 times higher lung cancer risk among current smokers with high DNA adducts in WBCs (Tang et al. Cancer Res 2001). Meta analysis shows that current smokers with high levels of DNA adducts have an increased risk of lung and bladder cancers (Veglia et al. CEBP 2003). 17

18 Health Effects of Combustion Air Pollution and Children Air pollution from Fossil Fuel Combustion has been linked to : Infant mortality (Bobak and Leon. Lancet 1992; Ha et al. Pediatrics 2003) Pediatrics 2003) Respiratory symptoms (Patel et al. AJRCCM 2009) Childhood asthma (Mortimer et al. Epidemiol 2008) Deficits in lung function (Gauderman et al. NEJM 2004) Low birth weight (Srám et al. EHP 2005) Developmental disorders (Grandjean and Landrigan. 2006; Perera et al. EHP 2006b) Childhood Cancer (Whitworth et al. EHP 2008; Knox. JECH 2005a, 2005b) 18

19 Infant Susceptibility of Mortality to Air Pollution Infants are most susceptible to PM 10 in terms of mortality, particularly respiratory mortality. (Ha et al. Pediatrics 2003) Prenatal and Early life Exposures and Lung Function in Asthmatic Children Prenatal and early life exposures to PM 10, NO 2 and CO had a negative effect on pulmonary function in asthmatic children at age 6 to 11 years. (Mortimer et al. Epidemiology 2008) 19

20 Ambient Metals, Elemental Carbon, and Wheeze and Cough (<24 months of age) (Patel et al. AJRCCM 2009) Developmental Effects of PAHs Exposure Prenatal airborne PAHs (>2.26 ng/m 3 ) levels were inversely associated with IQ at age 5 years (Perera et al. Pediatrics 2009). High PAH DNA adduct was associated with reduced weight at 18 months, 24 months, and 30 months of age (p < 0.05) (Tang et al. EHP 2008). Exposure to pollutants from the power plant adversely affected the development of children living in Tongliang, China (Tang et al. EHP 2008). (Scientific American, 2008) 20

21 Thank You Appendix Type of Combustion Complete combustion energy Fuel Incomplete combustion 21

22 Appendix Sandstorms hits Beijing (TIME, March 2010) Appendix Combustion derived Nanoparticle causes CVD (Mills et al. Nat Clin Pract Cardiovasc Med 2009) 22

23 Appendix Air Pollution and Children: Reasons for Concern Prenatal and early life periods represent critical windows for oxidant pollutant induced lung remodeling: 80% percent of alveoli are formed postnatally, and changes in the lung continue through adolescence. Damage during critical windows of susceptibility can permanently diminish lung function. Childrenhave increasedexposure to manyairpollutants Children have increased exposure to many air pollutants compared with adults: higher minute ventilation and higher levels of physical activity. 23