Long-term associations of morbidity with air pollution: A catalog and synthesis

I searched the National Institutes of Health MEDLINE database through January 2017 for long-term studies of morbidity and air pollution and cataloged them with respect to cardiovascular, respiratory, cancer, diabetes, hospitalization, neurological, and pregnancy-birth endpoints. The catalog is presented as an online appendix. Associations with PM_2.5 (particulate matter with an aerodynamic diameter <2.5 μm), PM₁₀ (PM with an aerodynamic diameter <10 μm), and nitrogen dioxide (NO₂) were evaluated most frequently among the 417 ambient air quality studies identified. Associations with total suspended particles (TSP), carbon, ozone, sulfur, vehicular traffic, radon, and indoor air quality were also reported. I evaluated each study in terms of pollutant significance (yes, no), duration of exposure, and publication date. I found statistically significant pollutant relationships (P < 0.05) in 224 studies; 220 studies indicated adverse effects. Among 795 individual pollutant effect estimates, 396 are statistically significant. Pollutant associations with cardiovascular indicators, lung function, respiratory symptoms, and low birth weight are more likely to be significant than with disease incidence, heart attacks, diabetes, or neurological endpoints. Elemental carbon (EC), traffic, and PM_2.5 are most likely to be significant for cardiovascular outcomes; TSP, EC, and ozone (O₃) for respiratory outcomes; NO₂ for neurological outcomes; and PM₁₀ for birth/pregnancy outcomes. Durations of exposure range from 60 days to 35 yr, but I found no consistent relationships with the likelihood of statistical significance. Respiratory studies began ca. 1975; studies of diabetes, cardiovascular, and neurological effects increased after about 2005. I found 72 studies of occupational air pollution exposures; 40 reported statistically significant adverse health effects, especially for respiratory conditions. I conclude that the aggregate of these studies supports the existence of nonlethal physiological effects of various pollutants, more so for non–life-threatening endpoints and for noncriteria pollutants (TSP, EC, PM_2.5 metals). However, most studies were cross-sectional analyses over limited time spans with no consideration of lag or disease latency. Further longitudinal studies are thus needed to investigate the progress of disease incidence in association with air pollution exposure.

Implications: Relationships of air pollution with excess mortality are better known than with long-term antecedent morbidity. I cataloged 489 studies of cardiovascular, respiratory, cancer, and neurological effects, diabetes, and birth outcomes with respect to 12 air pollutants. About half of the studies reported statistically significant relationships, more frequently with noncriteria than with criteria pollutants. Indoor and cumulative exposures, coarse or ultrafine particles, and organic carbon were seldom considered. Significant relationships were more likely with less-severe endpoints such as blood pressure, lung function, or respiratory symptoms than with incidence of cancer, chronic obstructive pulmonary disease (COPD), heart failure, or diabetes. Most long-term studies are based on spatial relationships; longitudinal studies are needed to link the progression of pollution-related morbidity to mortality, especially for the cardiovascular system.     

Air Pollution and Mortality: Issues and Uncertainties

Abstract

Results from 31 epidemiology studies linking air pollution with premature mortality are compared and synthesized. Consistent positive associations between mortality and various measures of air pollution have been shown within each of two fundamentally different types of regression studies and in many variations within these basic types; this is extremely unlikely to have occurred by chance. In this paper, the measure of risk used is the elasticity, which is a dimensionless regression coefficient defined as the percentage change in the dependent variable associated with a 1% change in an independent variable, evaluated at the means. This metric has the advantage of independence from measurement units and averaging times, and is thus suitable for comparisons within and between studies involving different pollutants. Two basic types of studies are considered: time-series studies involving daily perturbations, and cross-sectional studies involving longer-term spatial gradients. The latter include prospective studies of differences in individual survival rates in different locations and studies of the differences in annual mortality rates for various communities.

For a given data set, time-series regression results will vary according to the seasonal adjustment method used, the covariates included, and the lag structure assumed. The results from both types of cross-sectional regressions are highly dependent on the methods used to control for socioeconomic and personal lifestyle factors and on data quality. Amajor issue for all of these studies is that of partitioning the response among collinear pollution and weather variables. Previous studies showed that the variable with the least exposure measurement error may be favored in multiple regressions; assigning precise numerical results to a single pollutant is not possible under these circumstances. We found that the mean overall elasticity as obtained from timeseries studies for mortality with respect to various air pollutants entered jointly was about 0.048, with a range from 0.01 to 0.12. This implies that about 5% of daily mortality is associated with air pollution, on average. The corresponding values from population-based cross-sectional studies were similar in magnitude, but the results from the three recent prospective studies varied from zero to about five times as much. Long-term responses in excess of short-term responses might be interpreted as showing the existence of chronic effects, but the uncertainties inherent in both types of studies make such an interpretation problematic.     

Statistical Considerations in Determining the Health Significance of Constituents of Airborne Particulate Matter

ABSTRACT

Because of the U.S. Environmental Protection Agency’s (EPA) new ambient air quality standard for fine particles, the need is likely to continue for more detailed scientific investigation of various types of particles and their effects on human health. Epidemiology studies have become the method of choice for investigating health responses to such particles and to other air pollutants in community settings. Health effects have been associated with virtually all of the gaseous criteria pollutants and with the major constituents of airborne particulate matter (PM), including all size fractions less than about 20 gm, inorganic ions, carbonaceous particles, metals, crustal material, and biological aerosols. In many of the more recent studies, multiple pollutants or agents (including weather variables) have been significantly associated with health responses, and various methods have been used to suggest which ones might be the most important. In an ideal situation, classical least-squares regression methods are capable of performing this task. However, in the real world, where most of the pollutants are correlated with one another and have varying degrees of measurement precision and accuracy, such regression results can be misleading. This paper presents some guidelines for dealing with such collinearity and model comparison problems in both single- and multiple-pollutant regressions. These techniques rely on mean effect (attributable risk) rather than statistical significance per se as the preferred indicator of importance for the pollution variables.     

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.     

A Comparison of the Size Distribution of Particulates Emitted from Air,Mechanical, and Steam Atomized Oil Fired Burners

Particulate size distributions were obtained in the effluent gases from three steam generating boilers of a power station employing mechanical, steam, and air systems for heavy fuel atomization. Samples were obtained with an eight-stage cascade impactor. The air atomized burner produced the lowest particulate loading, the greatest percentage of particulates by weight in the submicron range, and particulates with the lowest combustible content.     

Some Recent Experience with Fabric Filters for Paniculate Collection

EPA's “Third Symposium on Fabric Filters for Particle Collection,” held in Tucson December 5 and 6, 1977, emphasized the results obtained from both laboratory and field experience. Data from selected new and/or continuing research programs as well as from new pilot and field applications are reviewed.     

Dry Deposition Velocity as an Indicator for SO2 Damage to Materials

Data from the literature on dry deposition of SO₂ to various common materials in outdoor atmospheres are reviewed and presented in the context of a theoretical model. The model postulates two resistances to deposition: the aerodynamic resistance, controlled by atmospheric properties; and the surface resistance, controlled by the chemistry of the surface and its moisture layer. Since the dissolution of SO₂ is sensitive to pH, buffering of the moisture layer by corrosion products is essential for SO₂ deposition to continue. Thus, it is hypothesized that SO₂ deposits preferentially on those surfaces that are sensitive to SO₂ attack. Based on extant data, estimates of aerodynamic and surface resistances are derived from the literature and maximum "dry" deposition rates for SO₂ are estimated. Such information could be used to formulate SO₂ dose-response or "damage" functions for certain materials, based on short-term laboratory tests.     

Analysis and comparison of inertinite-derived adsorbent with conventional adsorbents

To increase U.S. petroleum energy-independence, the University of Texas at Arlington (UT Arlington) has developed a coal liquefaction process that uses a hydrogenated solvent and a proprietary catalyst to convert lignite coal to crude oil. This paper reports on part of the environmental evaluation of the liquefaction process: the evaluation of the solid residual from liquefying the coal, called inertinite, as a potential adsorbent for air and water purification. Inertinite samples derived from Arkansas and Texas lignite coals were used as test samples. In the activated carbon creation process, inertinite samples were heated in a tube furnace (Lindberg, Type 55035, Arlington, UT) at temperatures ranging between 300 and 850 degrees C for time spans of 60, 90, and 120 min, using steam and carbon dioxide as oxidizing gases. Activated inertinite samples were then characterized by ultra-high-purity nitrogen adsorption isotherms at 77 K using a high-speed surface area and pore size analyzer (Quantachrome, Nova 2200e, Kingsville, TX). Surface area and total pore volume were determined using the Brunauer Emmet, and Teller method, for the inertinite samples, as well as for four commercially available activated carbons (gas-phase adsorbents Calgon Fluepac-B and BPL 4 x 6; liquid-phase adsorbents Filtrasorb 200 and Carbsorb 30). In addition, adsorption isotherms were developed for inertinite and the two commercially available gas-phase carbons, using methyl ethyl ketone (MEK) as an example compound. Adsorption capacity was measured gravimetrically with a symmetric vapor sorption analyzer (VTI, Inc., Model SGA-100, Kingsville, TX). Also, liquid-phase adsorption experiments were conducted using methyl orange as an example organic compound. The study showed that using inertinite from coal can be beneficially reused as an adsorbent for air or water pollution control, although its surface area and adsorption capacity are not as high as those for commercially available activated carbons. Implications: The United States currently imports two-thirds of its crude oil, leaving its transportation system especially vulnerable to disruptions in international crude supplies. UT Arlington has developed a liquefaction process that converts coal, abundant in the United States, to crude oil. This work demonstrated that the undissolvable solid coal residual from the liquefaction process, called inertinite, can be converted to an activated carbon adsorbent. Although its surface area and adsorption capacity are not as high as those for commercially available carbons, the inertinite source material would be available at no cost, and its beneficial reuse would avoid the need for disposal.     

Estimation of age at maturation and growth of Atlantic green turtles (Chelonia mydas) using skeletochronology

Despite the vast amount of research on threatened and endangered green turtle populations, some uncertainty regarding stage durations, growth rates, and age at maturation remains. We used skeletochronology to address this gap in knowledge for green turtle populations in the North Atlantic Ocean that use coastal waters along the southeastern U.S. as developmental habitat. Oceanic stage duration was estimated at 1–7 years ( [`(\textX)] \overline{\text{X}}  = 3 years). Several growth models, including von Bertalanffy, logistic, Gompertz, and power functions were evaluated for describing sex-specific length-at-age data. Ages at maturation estimated using mean size at nesting for females from each genetic sub-population contributing juveniles to this neritic foraging area were 44 years (Florida), 42.5 years (Costa Rica), and 42 years (Mexico), which were higher than previously reported ages. This implies that nesting populations comprising primarily individuals utilizing foraging grounds in the southeastern U.S. may take longer to recover than previously estimated.