Health Effects of Ambient Air Pollution Jennifer L. Peel, PhD, MPH jennifer.peel@colostate.edu Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins, CO 5/18/2010
Health Effects of Ambient Air Pollution Long-term and short-term health effects of ambient air pollution Focus on NO x /NO 2, PM 2.5 mass, ozone PM 2.5 components (nitrate) Traffic Not going to focus on occupational, point source ammonia/ammonium exposures Denver Aerosol Sources and Health (DASH) Study
Health Effects at Current Ambient Levels NO x /NO 2 NO 2 used as indicator PM 2.5 Most evidence for mass, components Ozone Traffic / near roadway NO 2, CO, ultrafine PM, EC/BC used as indicators
Health Effects of NO 2 US EPA Integrated Science Assessment Short term increases in asthma symptoms, increase in respiratory illness, symptoms, health care visits New near road monitor requirement
Respiratory Air Pollution Health Effects Coughing, wheezing, reduced lung function Reduced resistance to infection Exacerbation of asthma, COPD Lung cancer Respiratory mortality Reproductive Low birth weight Preterm births and intrauterine growth retardation (?) Birth defects (?) Central Nervous Cerebrovascular impairment Stroke Neurodegenerative disease? Cognitive development? Cardiovascular Systemic inflammation Autonomic system disorders Atherosclerosis Myocardial infarctions Cardiovascular mortality
Children Are More Susceptible to Air Pollution Children inhale 2-3 times as much air per body weight than adults Source: EPA
Chronic Health Effects: Harvard Six Cities Study Premature mortality 26% higher risk in Steubenville, OH vs. Portage, WI Shortened life expectancy 1-2 years Dockery et al 1994
Chronic Health Effects: Lung development and pollution Children s Health Study Children in California 12 communities Followed for 8 years NO 2 and fine PM related to deficits in FEV 1 growth Gauderman et al 2004 NEJM
Respiratory Health Effects Direct irritation of lungs Inflammation Enhanced allergic effect Decreased immune function leading to respiratory infection
From Pope and Dockery 2006
Adverse Reproductive Outcomes Pregnancy may be a time particularly susceptible to environmental toxins Increased air pollution associated with preterm birth, low birth weight, birth defects, post-neonatal mortality, SIDS Growth and development in utero can have long term impacts Heart disease, diabetes in adults; developmental issues
Neurological Effects PM (ultrafine PM) may enter brain Transported along nerves in the nasal passages Translocated from lungs to bloodstream; reach multiple organ systems Evidence of chronic inflammation (systemic inflammation originating in lungs) Higher levels of black carbon (PM) associated with decreased cognitive function in children (Sugilia et al. 2008) Calderon-Garciduenas et al. 2007
Diesel, Traffic, and Near Roadway Effects Increasing focus on traffic, near roadway exposures CA Children s Health Study: Children living <500m of freeways have deficits in lung growth and development at age 8 compared to those >1500m away (Gauderman et al. 2007) Traffic density related to hospital visits, asthma exacerbations, decreased lung function, and asthma development in children and adults
Fine Particulate Matter Chemical Speciation and Hospital Admissions in Denver: The Denver Aerosol Sources and Health (DASH) Study Colorado State University Jennifer Peel Maggie Clark University of Colorado at Boulder Michael Hannigan Jana Milford Shelly Miller University of Washington Sverre Vedal (PI) Sun-Young Kim Lianne Sheppard US EPA Steve Dutton Funded by the National Institute of Environmental Health Sciences R01ES012197.
DASH Objective: Examine the short-term association of PM 2.5 components and sources with respiratory and cardiovascular hospital admissions in Denver
Daily non-elective hospital admissions for all ages, 2003-2007 Five county Denver metro area DASH: Methods
DASH: Methods Circulatory, Respiratory COPD (ICD-9 490-492, 496) Asthma (493) Pneumonia (480-486) Upper Respiratory Infection (460-466, 477) Ischemic heart disease (410-414) Congestive heart failure (428) Ischemic stroke (434.01, 434.11, 434.91, 436) Injuries (800-899) (control outcome group)
DASH: Methods Monitoring site 5km east of downtown Denver Residential area Teflon and quartz fiber filters Daily 24-hour averagepm 2.5 mass, inorganic ion compounds (sulfate, nitrate), carbon components (EC, OC; NIOSH methods) Daily organic carbon molecular markers
DASH: Source Apportionment Daily source apportionment Positive matrix factorization (PMF) Fine PM mass species and carbon components, carbon monoxide Eventually will incorporate organic carbon molecular marker species Extensive model uncertainty methods
DASH: Health models Poisson generalized additive models (GAMs) Adjust for long term temporal trends (1 df per month), day of week, temperature (3 df), humidity Lag 0 for CVD Distributed lag (0-3) for respiratory outcomes
DASH: Results Relative low PM 2.5 concentrations Mean SD IQR PM 2.5 mass (ug/m 3 ) 8 5 4.5 EC (ug/m 3 ) 0.5 0.3 0.3 OC (ug/m 3 ) 3 1.4 1.7 Nitrate (ug/m 3 ) 1 2 0.9 Sulfate (ug/m 3 ) 1 1 0.8
Summary Ambient air pollution associated with numerous short and long term health effects Most evidence for PM 2.5 mass, ozone Not clear what traffic is a marker for (EC, NO 2, CO, ultrafine particles Few studies have examine components Few studies have examined health effects air pollution sources Increasing interest /need in examining health effects in multipollutant framework