Time series analysis of ambient air pollution effects on daily mortality

Although the growths of ambient pollutants have been attracting public concern, the characteristic of the associations between air pollutants and mortality remains elusive. Time series analysis with a generalized additive model was performed to estimate the associations between ambient air pollutants and mortality outcomes in Shenzhen City for the period of 2012–2014. The results showed that nitrogen dioxide (NO₂)-induced excess risks (ER) of total non-accidental mortality and cardiovascular mortality were significantly increased (6.05% (95% CI 3.38%, 8.78%); 6.88% (95% CI 2.98%, 10.93%), respectively) in interquartile range (IQR) increase analysis. Also, these associations were strengthened after adjusting for other pollutants. Moreover, similar associations were estimated for sulfur dioxide (SO₂), particulate matter with an aerodynamic diameter of <10 μm (PM₁₀), and total non-accidental mortality. There were significant higher ERs of associations between PM₁₀ and mortality for men than women; while there were significant higher ERs of associations between PM₁₀/NO₂ and mortality for elders (65 or elder) than youngers (64 or younger). Season analyses showed that associations between NO₂ and total non-accidental mortality were more pronounced in hot seasons than in warm seasons. Taken together, NO₂ was positively associated with total non-accidental mortality and cardiovascular mortality in Shenzhen even when the concentrations were below the ambient air quality standard. Policy measures should aim at reducing residents’ exposure to anthropogenic NO₂ emissions.     

Polychlorinated biphenyls (PCBs) in indoor air and in serum among older residents of upper Hudson River communities

A study was conducted to evaluate the association between PCBs in residential indoor air and in the serum of older, long time residents of three upper Hudson River communities. Samples of indoor air and of serum were collected from 170 persons 55 to 74 years of age, and analyzed for PCBs using glass capillary gas chromatography. After adjusting for age, BMI, cigarette smoking, and Hudson River fish consumption with multiple linear regression analysis, the results indicated statistically significant associations between concentrations in indoor air and serum for PCB-28, a lightly chlorinated congener common in air that accumulates in serum, and PCB-105. Duration of exposure was an important factor, since among persons who had lived in their home for 39 years or more, 11 of the 12 most commonly detected congeners were significantly correlated, as was their sum (∑ PCB). Significant associations between indoor air and serum PCB concentrations also were more likely when collected in cooler months and if the two samples were collected within 20 d of each other. The study is among the first to indicate that PCB concentrations characteristic of residential indoor air are associated with a detectable increase in body burden.     

Daily mortality in the Philadelphia metropolitan area and size-classified particulate matter

Time-series of daily mortality data from May 1992 to September 1995 for various portions of the seven-county Philadelphia, PA, metropolitan area were analyzed in relation to weather and a variety of ambient air quality parameters. The air quality data included measurements of size-classified PM, SO4(2-), and H+ that had been collected by the Harvard School of Public Health, as well as routine air pollution monitoring data. Because the various pollutants of interest were measured at different locations within the metropolitan area, it was necessary to test for spatial sensitivity by comparing results for different combinations of locations. Estimates are presented for single pollutants and for multiple-pollutant models, including gaseous pollutants and mutually exclusive components of PM (PM2.5 and coarse particles, SO4(2-) and non-SO4(2-) portions of total suspended particulate [TSP] and PM10), measured on the day of death and the previous day. We concluded that associations between air quality and mortality were not limited to data collected in the same part of the metropolitan area; that is, mortality for one part may be associated with air quality data from another, not necessarily neighboring, part. Significant associations were found for a wide variety of gaseous and particulate pollutants, especially for peak O3. Using joint regressions on peak O3 with various other pollutants, we found that the combined responses were insensitive to the specific other pollutant selected. We saw no systematic differences according to particle size or chemistry. In general, the associations between daily mortality and air pollution depended on the pollutant or the PM metric, the type of collection filter used, and the location of sampling. Although peak O3 seemed to exhibit the most consistent mortality responses, this finding should be confirmed by analyzing separate seasons and other time periods.     

Associations and lags between air pollution and acute respiratory visits in an ambulatory care setting: 25-month results from the aerosol research and inhalation epidemiological study

Particulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies that utilized data from emergency room visits, hospital admissions, and mortality records. This study is unique in its investigation of associations of air pollution measures, including components of PM, with health outcomes in an ambulatory-care setting. Visit data were collected from Kaiser Permanente, a not-for-profit health maintenance organization in the metropolitan Atlanta, GA, area. Kaiser Permanente collaborated on the Aerosol Research Inhalation Epidemiological Study (ARIES), which provided detailed information on the characteristics of air pollutants. The Kaiser Permanente study was a time-series investigation of the possible associations between daily levels of suspended PM, inorganic gases, and polar volatile organic compounds and ambulatory care acute visit rates during the 25-month period from August 1, 1998, to August 31, 2000. For this interim analysis, the a priori 0-2 days lagged moving average, as well as the 3-5 days and 6-8 days lagged moving averages, of air quality measures were investigated. Single-pollutant Poisson general linear modeling was used to model daily visit counts for asthma and upper and lower respiratory infections (URI and LRI) by selected air quality metrics, controlling for temporal trends and meteorological variables. Most of the statistically significant positive associations were for the 3-5 days lagged air quality metrics with child asthma and LRI.     

A study of air pollutants and acute asthma exacerbations in urban areas: status report

A study to try to better understand the interactions between various air contaminants and acute asthma exacerbations is described. The study evaluates temporal associations between a panel of air contaminants and acute asthmatic exacerbations as measured by emergency room visits for asthma in communities in the Bronx and Manhattan in New York City (NYC). In addition, ambient levels of various air pollutants in two NYC communities are being compared. Almost 2 years of daily data have been collected for most of the air contaminants to be investigated. The air contaminants measured include gaseous compounds (ozone, sulfur dioxide, nitrogen oxides, aldehydes, nitrous acid, nitric acid, hydrochloric acid and ammonia), particulate matter components (metals, elemental and organic carbon, sulfate, hydrogen ion, pollen, mold spores and particle mass and number).     

Daily Mortality in the Philadelphia Metropolitan Area and Size-Classified Particulate Matter

ABSTRACT

Time-series of daily mortality data from May 1992 to September 1995 for various portions of the seven-county Philadelphia, PA, metropolitan area were analyzed in relation to weather and a variety of ambient air quality parameters. The air quality data included measurements of size-classified PM, SO₄ ^2-, and H+ that had been collected by the Harvard School of Public Health, as well as routine air pollution monitoring data. Because the various pollutants of interest were measured at different locations within the metropolitan area, it was necessary to test for spatial sensitivity by comparing results for different combinations of locations. Estimates are presented for single pollutants and for multiple-pollutant models, including gaseous pollutants and mutually exclusive components of PM (PM_2.5 and coarse particles, SO₄ ^2- and non-SO₄ ^2- portions of total suspended particulate [TSP] and PM₁₀), measured on the day of death and the previous day.

We concluded that associations between air quality and mortality were not limited to data collected in the same part of the metropolitan area; that is, mortality for one part may be associated with air quality data from another, not necessarily neighboring, part. Significant associations were found for a wide variety of gaseous and particulate pollutants, especially for peak O₃. Using joint regressions on peak O₃ with various other pollutants, we found that the combined responses were insensitive to the specific other pollutant selected. We saw no systematic differences according to particle size or chemistry. In general, the associations between daily mortality and air pollution depended on the pollutant or the PM metric, the type of collection filter used, and the location of sampling. Although peak O₃ seemed to exhibit the most consistent mortality responses, this finding should be confirmed by analyzing separate seasons and other time periods.     

Childhood asthma acute primary care visits,traffic, and traffic-related pollutants

Previous studies have found associations between traffic-related air pollution and asthma exacerbation in children, where exacerbations were measured according to emergency department visits and hospital admissions. Fewer studies have been undertaken that look at asthma exacerbations in a less severe primary care setting. Therefore, the authors sought to examine the associations between childhood asthma exacerbations, measured as acute visits to a primary care setting, and vehicular-traffic measures in a population of children aged 18 and under in the metropolitan Atlanta area. Statistical tests for differences of mean monthly visits for members with traffic measures above the median compared with below the median and for the upper quartile compared with the lower quartile were conducted. We also compared the odds of having one or more visits in a month for those who lived closer to a major roadway were compared with those who lived farther (greater than 300 m) from a major roadway. Poisson general linear modeling was used to determine associations between daily levels of acute visits for childhood asthma and traffic-related pollutants (zinc, EC [elemental carbon], and PM₁₀ and PM_2.5 [particulate matter with an aerodynamic diameter of ≤10 and ≤2.5 μm, respectively]) for different levels of traffic and distance measures. This analysis found that both larger traffic volumes and smaller distances to the nearest major roadway were positively and significantly associated with larger numbers of childhood asthma visits, when compared with less traffic and larger distances. Our findings point to motor vehicle traffic as an important contributor to childhood asthma exacerbations.

Implications: Previous studies have found associations between traffic-related air pollution and asthma exacerbation in children. However, these studies were mainly conducted in emergency department or hospital admission settings; little is known regarding less acute health effects. This analysis of the association between vehicular traffic measures and childhood asthma in a primary care setting suggests that motor vehicle traffic is a contributor to less acute asthma episodes in children. The present analysis of traffic-related air pollutants and childhood asthma were less conclusive, likely due to methods limitations outlined in the paper. The implication is that further evidence of adverse respiratory health effects in children due to motor vehicle traffic can be found in a primary care setting and similar studies should be considered.     

Practical dissolved-air flotation experience

In this report the performance of the Bayer Flotation Technology BayFlotech? is demonstrated by comparing process data with figures published by the German Deutsche Vereinigung fur Wasserwirtschaft, Abwasser und Abfall e.V. (ATV) and Verband Deutscher Maschinen u. Anlagenbau e.V. (VDMA) associations. In addition experience gained under plant operation is described. Inter alia the relation between the air/solid dosage rate and the specific solids loading is discovered. It was found that the specific air dosage can be decreased with increasing solids loading rates: whereas the specific air dosage is up to 35 l/kg TSS at solids loading 95%) for every compared situation. Finally we report on the newly developed 'phasemixer', which allows high water saturation rates (>95%) and preventing lather.     

Significant Relationships Concerning Exponential Transmission or Penetration

This paper reviews the statistical evidence linking human mortality with air pollution due to sulfur oxides and particulates. Three types of analyses are discussed: episodic increases in mortality coincident with high pollution, perturbations in mortality in a given city as a time-series in relation to perturbations in air quality, and comparisons of geographic differentials in both pollution and mortality rates. The paper concludes that there are no reliable statistical associations between SO _x and mortality, but that particulates are in some cases associated with excess mortality. Establishing whether the association is in fact causal would require elimination of potential confounding effects such as occupational exposures.     

The Transport of Suspended Particulates as a Function of Wind Direction and Atmospheric Conditions

Linear regression of high volume air sampler data and various meteorological parameters was used to determine a suspended particulate air pollution climatology for Albany, NY. A new method for exhibiting associations between wind direction and pollutant levels using correlation coefficients is presented. Correlations between wind direction distribution frequency and other meteorological parameters is employed to help explain differences in correlations for direction with suspended particulate levels. Results show that high particulate concentrations correlate well with southerly wind flow throughout the study area, regardless of relative location of receptor to local sources. This suggests that ambient background concentrations inherent in different air masses more consistently affected suspended particulate levels than did the diffusion from local sources during the study period. Maximum particulate advection occurs under conditions of good mixing of the boundary layer and moderate wind speeds and is enhanced further in the absence of removal processes such as rainout and washout. Trajectory analysis of selected days indicates a definite relationship between path and origin of the wind flow and regional average particulate concentration.     

Dynamic interactive links among sustainable energy investment,air pollution,and sustainable development in regional China

Environmental Science and Pollution Research - This research investigates the dynamic interactive associations among sustainable investment in the energy sector, air pollution, and sustainable...     

Validity of ambient levels of fine particles as surrogate for personal exposure to outdoor air pollution--results of the European EXPOLIS-EAS Study (Swiss Center Basel)

To evaluate the validity of fixed-site fine particle levels as exposure surrogates in air pollution epidemiology, we considered four indicator groups: (1) PM2.5 total mass concentrations, (2) sulfur and potassium for regional air pollution, (3) lead and bromine for traffic-related particles, and (4) calcium for crustal particles. Using data from the European EXPOLIS (Air Pollution Exposure Distribution within Adult Urban Populations in Europe) study, we assessed the associations between 48-hr personal exposures and home outdoor levels of the indicators. Furthermore, within-city variability of fine particle levels was evaluated. Personal exposures to PM2.5 mass were not correlated to corresponding home outdoor levels (n = 44, rSpearman (Sp) = 0.07). In the group reporting neither relevant indoor sources nor relevant activities, personal exposures and home outdoor levels of sulfur were highly correlated (n = 40, rSp = 0.85). In contrast, the associations were weaker for traffic (Pb: n = 44, rSp = 0.53; Br: n = 44, rSp = 0.21) and crustal (Ca: n = 44, rSp = 0.12) indicators. This contrast is consistent with spatially homogeneous regional pollution and higher spatial variability of traffic and crustal indicators observed in Basel, Switzerland. We conclude that for regional air pollution, fixed-site fine particle levels are valid exposure surrogates. For source-specific exposures, however, fixed-site data are probably not the optimal measure. Still, in air pollution epidemiology, ambient PM2.5 levels may be more appropriate exposure estimates than total personal PM2.5 exposure, since the latter reflects a mixture of indoor and outdoor sources.     

Air pollution and mortality: A history

Mortality is the most important health effect of ambient air pollution and has been studied the longest. The earliest evidence relates to fog episodes but with the development of more precise methods of investigation it is still possible to discern short-term temporal associations with daily mortality at the historically low levels of air pollution that now exist in most developed countries. Another early observation was that mortality was higher in more polluted areas. This has been confirmed by modern cohort studies that account for other potential explanations for such associations. There does not appear to be a threshold of effect within the ambient range of concentrations. Advances in the understanding of air pollution and mortality have been driven by the combined development of methods and biomedical concepts. The most influential methodological developments have been in time-series techniques and the establishment of large cohort studies, both of which are underpinned by advances in data processing and statistical analysis. On the biomedical side two important developments can be identified. One has been the application of the concept of multifactorial disease causation to explaining how air pollution may affect mortality at low levels and why thresholds are not obvious at the population level. The other has been an increasing understanding of how air pollution may plausibly have pathophysiological effects that are remote from the lung interface with ambient air. Together, these advances have had a profound influence on policies to protect public health. Throughout the history of air pollution epidemiology, mortality studies have been central and this will continue because of the widespread availability of mortality data on a large population scale and the weight that mortality carries in estimating impacts for policy development.     

Air pollution and hospital visits for acute upper and lower respiratory infections among children in Ningbo,China: A time-series analysis

Acute upper and lower respiratory infections are main causes of mortality and morbidity in children. Air pollution has been recognized as an important contributor to development and exacerbation of respiratory infections. However, few studies are available in China. In this study, we investigated the short-term effect of air pollution on hospital visits for acute upper and lower respiratory infections among children under 15 years in Ningbo, China. Poisson generalized models were used to estimate the associations between air pollution and hospital visits for acute upper and lower respiratory infections adjusted for temporal, seasonal, and meteorological effects. We found that four pollutants (PM_2.5, PM₁₀, NO₂, and SO₂) were significantly associated with hospital visits for acute upper and lower respiratory infections. The effect estimates for acute upper respiratory infections tended to be higher (PM_2.5 ER = 3.46, 95% CI 2.18, 4.76; PM₁₀ ER = 2.81, 95% CI 1.93, 3.69; NO₂ ER = 11.27, 95% CI 8.70, 13.89; SO₂ ER = 15.17, 95% CI 11.29, 19.19). Significant associations for gaseous pollutants (NO₂ and SO₂) were observed after adjustment for particular matter. Stronger associations were observed among older children and in the cold period. Our study suggested that short-term exposure to outdoor air pollution was associated with hospital visits for acute upper and lower respiratory infections in Ningbo.     

Infant mortality and air pollution: a comprehensive analysis of U.S. data for 1990

This paper uses U.S. linked birth and death records to explore associations between infant mortality and environmental factors, based on spatial relationships. The analysis considers a range of infant mortality end points, regression models, and environmental and socioeconomic variables. The basic analysis involves logistic regression modeling of individuals; the cohort comprises all infants born in the United States in 1990 for whom the required data are available from the matched birth and death records. These individual data include sex, race, month of birth, and birth weight of the infant, and personal data on the mother, including age, adequacy of prenatal care, and smoking and education in most instances. Ecological variables from Census and other sources are matched on the county of usual residence and include ambient air quality, elevation above sea level, climate, number of physicians per capita, median income, racial and ethnic distribution, unemployment, and population density. The air quality variables considered were 1990 annual averages of PM10, CO, SO2, SO4(2-), and "non-sulfate PM10" (NSPM10--obtained by subtracting the estimated SO4(2-) mass from PM10). Because all variables were not available for all counties (especially maternal smoking), it was necessary to consider various subsets of the total cohort. We examined all infant deaths and deaths by age (neonatal and postneonatal), by birth weight (normal and low [< 2500 g]), and by specific causes within these categories. Special attention was given to sudden infant death syndrome (SIDS). For comparable modeling assumptions, the results for PM10 agreed with previously published estimates; however, the associations with PM10 were not specific to probable exposures or causes of death and were not robust to changes in the model and/or the locations considered. Significant negative mortality associations were found for SO4(2-). There was no indication of a role for outdoor PM2.5, but possible contributions from indoor air pollution sources cannot be ruled out, given higher SIDS rates in winter, in the north and west, and outside of large cities.     

PCDD/Fs levels in indoor environments and blood of workers of three municipal waste incinerators in Taiwan

This study monitored ambient air concentrations of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) in three municipal waste incineration plants. Blood PCDD/Fs levels of 133 workers randomly selected from these plants were also measured. The associations between workers' blood PCDD/Fs concentrations and occupational exposures to PCDD/Fs were assessed. Means of air PCDD/Fs levels ranged from 0.08 to 3.01 pg/m3 in international toxic equivalents (I-TEQ). The geometric means of blood PCDD/Fs concentrations were 14.6, 15.8, 19.1 pg/g lipid in World Health Organization (WHO) TEQ, respectively, for workers from three plants. Air levels of total I-TEQ and all congeners, except 2,3,7,8-tetrachlorinated dibenzo-p-dioxin (TeCDD) and 1,2,3,4,7,8,9-heptachlorinated dibenzofuran (HpCDF), were significantly higher in plant B. However, blood concentrations of 2,3,7,8-TeCDD, 1,2,3,7,8-PeCDD, 2,3,7,8-TeCDF, 1,2,3,7,8-PeCDF and 1,2,3,4,7,8,9-HpCDF were significantly elevated in plant C workers. Although job contents, duration of employment and time spent in certain location were significantly different among incineration plants, they were not significantly associated with blood concentrations of any congener. Furthermore, results of the multiple regression analysis that assessed important occupational factors simultaneously and adjusted for potential confounders, showed significant associations between four congeners and incineration plant or job contents. However, the results were limited by small R-squares of the regression models. In conclusion, blood concentrations of several PCDD/Fs congeners were significantly different among three incineration plants. The differences were not explained by the discrepancy in job contents, duration of employment, and time activity in these plants.     

Distance-weighted traffic density in proximity to a home is a risk factor for leukemia and other childhood cancers

Occupational exposure to elevated concentrations of benzene is a known cause of leukemia in adults. Concentrations of benzene from motor vehicle exhaust could be elevated along highly trafficked streets. Several studies have reported significant associations between proximity to highly trafficked streets and the occurrence of childhood cancers and childhood leukemia. These associations may be due to chronic exposure to benzene or other carcinogenic components of vehicle exhaust from these nearby streets or to some other factor (e.g., noise, increased light exposure, or some unaccounted--for socioeconomic variable). We used data for homes studied in an earlier childhood cancer study conducted in Denver, CO, in the 1980s. No air pollution measurements were made in the original study. We identified the highest trafficked street near each study home and obtained the traffic density in 1979 and 1990. Traffic density was weighted for the distance from the street to the home using 3 different widths of Gaussian curves to approximate the decay of the emissions into the surrounding neighborhoods. The associations between the 750-ft-wide distance-weighted traffic density metrics and all childhood cancers and childhood leukemia are strongest in the highest traffic density category (> or = 20,000 vehicles per day [VPD]). The odds ratio is 5.90 (95% confidence interval [CI] 1.69-20.56) for all cancers and 8.28 (95% CI 2.09-32.80) for leukemia. The results are suggestive of an association between proximal high traffic streets with traffic counts > or = 20,000 VPD and childhood cancer, including leukemia.     

Determinants of perceived air pollution annoyance and association between annoyance scores and air pollution (PM2.5, NO2) concentrations in the European EXPOLIS study

Apart from its traditionally considered objective impacts on health, air pollution can also have perceived effects, such as annoyance. The psychological effects of air pollution may often be more important to well-being than the biophysical effects. Health effects of perceived annoyance from air pollution are so far unknown. More knowledge of air pollution annoyance levels, determinants and also associations with different air pollution components is needed. In the European air pollution exposure study, EXPOLIS, the air pollution annoyance as perceived at home, workplace and in traffic were surveyed among other study objectives. Overall 1736 randomly drawn 25–55-yr-old subjects participated in six cities (Athens, Basel, Milan, Oxford, Prague and Helsinki). Levels and predictors of individual perceived annoyances from air pollution were assessed. Instead of the usual air pollution concentrations at fixed monitoring sites, this paper compares the measured microenvironment concentrations and personal exposures of PM_2.5 and NO₂ to the perceived annoyance levels. A considerable proportion of the adults surveyed was annoyed by air pollution. Female gender, self-reported respiratory symptoms, downtown living and self-reported sensitivity to air pollution were directly associated with high air pollution annoyance score while in traffic, but smoking status, age or education level were not significantly associated. Population level annoyance averages correlated with the city average exposure levels of PM_2.5 and NO₂. A high correlation was observed between the personal 48-h PM_2.5 exposure and perceived annoyance at home as well as between the mean annoyance at work and both the average work indoor PM_2.5 and the personal work time PM_2.5 exposure. With the other significant determinants (gender, city code, home location) and home outdoor levels the model explained 14% (PM_2.5) and 19% (NO₂) of the variation in perceived air pollution annoyance in traffic. Compared to Helsinki, in Basel and Prague the adult participants were more annoyed by air pollution while in traffic even after taking the current home outdoor PM_2.5 and NO₂ levels into account.     

Associations of residential greenness with obesity and BMI level among Chinese rural population: findings from the Henan Rural Cohort Study

In recent years, increasing evidence supports the notion that obesity risk is affected by residential greenness. However, limited studies have been established in low- and middle-income countries, especially in China. The study aimed to evaluate the associations of residential greenness with obesity and body mass index (BMI) level in Chinese rural-dwelling adults. A total of 39,259 adults from the Henan Rural Cohort Study (HRCS) were included in the analyses. According to the guideline for prevention and control of overweight and obesity in Chinese adults, obesity was defined as BMI?≥?28 kg/m². Residential greenness was measured by satellite-based normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Generalized linear mixed models were used to study the associations between exposure to residential greenness with obesity and BMI level. Higher residential greenness was significantly correlated with lower odds of obesity and BMI level. For example, in the full-adjusted analyses, an interquartile range (IQR) increase in EVI_500-m was linked with reduced odds of obesity (OR?=?0.77, 95%CI 0.72–0.82) and BMI level (β?=????0.41 kg/m², 95%CI???0.48 to???0.33 kg/m²). Mediation analyses showed air pollution and physical activity could be potential mediators in these associations. Besides, we found that the association of NDVI_500-m with BMI was stronger in females and low-income populations. Higher residential greenness was associated with a lower prevalence of obesity and BMI level, particularly among females and the low-income population. These relationships were partially mediated by reducing air pollution and increasing physical activity.

     

Revisiting the Veterans Cohort Mortality Study: New results and synthesis

ABSTRACT

The Veterans Cohort Mortality Study began in 1999 in collaboration with Washington University in St. Louis, comprising ~70,000 male military veterans. We published six research papers on this cohort, considering the dynamics of all-cause mortality as the subjects aged and environmental parameters changed. This paper summarizes those results and presents new results by age group. Pollutants included monitored and modeled criteria pollutants, vehicular traffic density (annual km driven per unit of county land area), and modeled nationwide levels of hazardous species. In addition to spatial relationships, we examined the effects of exposure timing through separate analyses of sequential follow-up and exposure periods from 1976 to 2001. Risks associated with peak ozone decreased with lag between exposure and response, suggesting acute effects. Risks associated with traffic were invariant over time and consistent across five exposure databases. Associations with ozone were also coherent across databases; we found no consistent associations with particulate matter. Epidemiology considers both spatial and temporal relationships; most long-term studies focus on spatial gradients at a given time, thus masking effects of cohort aging and other trends during follow-up. Our new analyses distinguished between these temporal effects by analyzing age deciles for which separate mortality risks had been estimated for nationwide levels of nitrogen oxides (NO_x), benzene, and traffic density during four sequential follow-up subperiods, thus providing 40 sets of mortality risk coefficients. We used ordinary least squares regression to define relationships with subject age and follow-up year for the data set of 40 coefficients. We found strong nonlinear relationships between subject age and mortality coefficients for smoking, climate, poverty status, and air pollution; only smoking and climate coefficients changed over time as well. We concluded that these pollutant-mortality relationships reflected differences among the veterans’ residential locations rather than changes in their pollution exposures during follow-up. We saw no evidence that cleaner air reduced mortality.

Implications: Recent air pollution mortality studies emphasize PM_2.5 (particulate matter with an aerodynamic diameter <2.5 μm); we show associations with many other pollutants and a measure of traffic intensity. Control policies should thus be based on multipollutant analyses. We found no reduced risks with improved air quality after distinguishing cohort aging from purely temporal effects; longitudinal studies of accountability must thus account for changes in demography and exposures. Our studies of exposure timing indicate mainly coincident responses and no evidence for cumulative effects typical of smoking; we had no information on personal exposures. We found the strongest risks were associated with high-traffic locations rather than outdoor air quality per se.