A study of the association between daily mortality and ambient air pollutant concentrations in Pittsburgh, Pennsylvania

We have studied the possible association of daily mortality with ambient pollutant concentrations (PM10, CO, O3, SO2, NO2, and fine [PM2.5] and coarse PM) and weather variables (temperature and dew point) in the Pittsburgh, PA, area for two age groups--less than 75, and 75 and over--for the 3-year period of 1989-1991. Correlation functions among pollutant concentrations show important seasonal dependence, and this fact necessitates the use of seasonal models to better identify the link between ambient pollutant concentrations and daily mortality. An analysis of the seasonal model results for the younger-age group reveals significant multicollinearity problems among the highly correlated concentrations of PM10, CO, and NO2 (and O3 in spring and summer), and calls into question the rather consistent results of the single- and multi-pollutant non-seasonal models that show a significant positive association between PM10 and daily mortality. For the older-age group, dew point consistently shows a significant association with daily mortality in all models. Collinearity problems appear in the multi-pollutant seasonal and non-seasonal models such that a significant, positive PM10 coefficient is accompanied by a significant, negative coefficient of another ambient pollutant, and the identity of this other pollutant changes with season. The PM2.5 data set is half that of PM10. Identical-model runs for both data sets reveal instability in the pollutant coefficients, especially for the younger age group. The concern for the instability of the pollutant coefficients due to a small signal-to-noise ratio makes it impossible to ascertain credibly the relative associations of the fine- and coarse-particle modes with daily mortality. In this connection, we call for caution in the interpretation of model results for causal inference when the models use fully or partially estimated PM values to fill large data gaps.     

Assessing the Relationship between Personal Particulate and Gaseous Exposures of Senior Citizens Living in Baltimore,MD

ABSTRACT

We conducted a multi-pollutant exposure study in Baltimore, MD, in which 15 non-smoking older adult subjects (>64 years old) wore a multi-pollutant sampler for 12 days during the summer of 1998 and the winter of 1999. The sampler measured simultaneous 24-hr integrated personal exposures to PM₂₅, PM₁₀, SO₄ ^2-, O₃, NO₂, SO₂, and exhaust-related VOCs.

Results of this study showed that longitudinal associations between ambient PM_2.5 concentrations and corresponding personal exposures tended to be high in the summer (median Spearman's r = 0.74) and low in the winter (median Spearman's r = 0.25). Indoor ventilation was an important determinant of personal PM_2.5 exposures and resulting personal-ambient associations. Associations between personal PM₂₅ exposures and corresponding ambient concentrations were strongest for well-ventilated indoor environments and decreased with ventilation. This decrease was attributed to the increasing influence of indoor PM_{2 5} sources. Evidence for this was provided by SO₄ ^2-measurements, which can be thought of as a tracer for ambient PM₂₅. For SO₄ ^2-, personal-ambient associations were strong even in poorly ventilated indoor environments, suggesting that personal exposures to PM_2.5 of ambient origin are strongly associated with corresponding ambient concentrations. The results also indicated that the contribution of indoor PM_2.5 sources to personal PM_2.5 exposures was lowest when individuals spent the majority of their time in well-ventilated indoor environments.

Results also indicate that the potential for confounding by PM_2.5 co-pollutants is limited, despite significant correlations among ambient pollutant concentrations. In contrast to ambient concentrations, PM_2.5 exposures were not significantly correlated with personal exposures to PM_2.5-10, PM_2.5 of non-ambient origin, O₃, NO₂, and SO₂. Since a confounder must be associated with the exposure of interest, these results provide evidence that the effects observed in the PM_2.5 epidemiologic studies are unlikely to be due to confounding by the PM_2.5 co-pollutants measured in this study.     

Daily Mortality and Air Pollution in the Netherlands

ABSTRACT

We studied the association of daily mortality with short-term variations in the ambient concentrations of major gaseous pollutants and PM in the Netherlands. The magnitude of the association in the four major urban areas was compared with that in the remainder of the country. Daily cause-specific mortality counts, air quality, temperature, relative humidity, and influenza data were obtained from 1986 to 1994. The relationship between daily mortality and air pollution was modeled using Poisson regression analysis. We adjusted for potential confounding due to long-term and seasonal trends, influenza epidemics, ambient temperature and relative humidity, day of the week, and holidays, using generalized additive models.

Influenza episodes were associated with increased mortality up to 3 weeks later. Daily mortality was significantly associated with the concentration of all air pollutants. An increase in the PM₁₀ concentration by 100 u.g/m³ was associated with a relative risk (RR) of 1.02 for total mortality. The largest RRs were found for pneumonia deaths. Ozone had the most consistent, independent association with mortality. Particulate air pollution (e.g., PM₁₀, black smoke [BS]) was not more consistently associated with mortality than were the gaseous pollutants SO₂ and NO₂. Aerosol SO₄ ^-2, NO₃ ^-, and BS were more consistently associated with total mortality than was PM₁₀. The RRs for all pollutants were substantially larger in the summer months than in the winter months. The RR of total mortality for PM₁₀ was 1.10 for the summer and 1.03 for the winter. There was no consistent difference between RRs in the four major urban areas and the more rural areas.     

Association between particulate matter air pollution and cardiovascular disease mortality in Lanzhou,China

Ambient particulate matter (PM) pollution has been linked to elevated mortality, especially from cardiovascular diseases. However, evidence on the effects of particulate matter pollution on cardiovascular mortality is still limited in Lanzhou, China. This research aimed to examine the associations of daily mean concentrations of ambient air pollutants (PM_2.5, PM_C, and PM₁₀) and cardiovascular mortality due to overall and cause-specific diseases in Lanzhou. Data representing daily cardiovascular mortality rates, meteorological factors (daily average temperature, daily average humidity, and atmospheric pressure), and air pollutants (PM_2.5, PM₁₀, SO₂, NO₂) were collected from January 1, 2014, to December 31, 2017, in Lanzhou. A quasi-Poisson regression model combined with a distributed lag non-linear model (DLNM) was used to estimate the associations. Stratified analyses were also performed by different cause-specific diseases, including cerebrovascular disease (CD), ischemic heart disease (IHD), heart rhythm disturbances (HRD), and heart failure (HF). The results showed that elevated concentration of PM_2.5, PM_C, and PM₁₀ had different effects on mortality of different cardiovascular diseases. Only cerebrovascular disease showed a significant positive association with elevated PM_2.5. Positive associations were identified between PM_C and daily mortality rates from total cardiovascular diseases, cerebrovascular diseases, and ischemic heart diseases. Besides, increased concentration of PM₁₀ was correlated with increased death of cerebrovascular diseases and ischemic heart diseases. For cerebrovascular disease, each 10 μg/m³ increase in PM_2.5 at lag4 was associated with increments of 1.22% (95% CI 0.11–2.35%). The largest significant effects for PM_C on cardiovascular diseases and ischemic heart diseases were both observed at lag0, and a 10 μg/m³ increment in concentration of PM_C was associated with 0.47% (95% CI 0.06–0.88%) and 0.85% (95% CI 0.18–1.52%) increases in cardiovascular mortality and ischemic heart diseases. In addition, it exhibited a lag effect on cerebrovascular mortality as well, which was most significant at lag6d, and an increase of 10 μg/m³ in PM_C was associated with a 0.76% (95% CI 0.16–1.37%) increase in cerebrovascular mortality. The estimates of percentage change in daily mortality rates per 10 μg/m³ increase in PM₁₀ were 0.52% (95% CI 0.05–1.02%) for cerebrovascular disease at lag6 and 0.53% (95% CI 0.01–1.05%) for ischemic heart disease at lag0, respectively. Our study suggests that elevated concentration of atmospheric PM (PM_2.5, PM_C, and PM₁₀) in Lanzhou is associated with increased mortality of cardiovascular diseases and that the health effect of elevated concentration of PM_2.5 is more significant than that of PM_C and PM₁₀.

     

Effects of Instrument Precision and Spatial Variability on the Assessment of the Temporal Variation of Ambient Air Pollution in Atlanta,Georgia

Abstract

Data from the U.S. Environmental Protection Agency Air Quality System, the Southeastern Aerosol Research and Characterization database, and the Assessment of Spatial Aerosol Composition in Atlanta database for 1999 through 2002 have been used to characterize error associated with instrument precision and spatial variability on the assessment of the temporal variation of ambient air pollution in Atlanta, GA. These data are being used in time series epidemiologic studies in which associations of acute respiratory and cardiovascular health outcomes and daily ambient air pollutant levels are assessed. Modified semivariograms are used to quantify the effects of instrument precision and spatial variability on the assessment of daily metrics of ambient gaseous pollutants (SO₂, CO, NO_x, and O₃) and fine particulate matter ([PM_2.5] PM_2.5 mass, sulfate, nitrate, ammonium, elemental carbon [EC], and organic carbon [OC]). Variation because of instrument imprecision represented 7–40% of the temporal variation in the daily pollutant measures and was largest for the PM_2.5 EC and OC. Spatial variability was greatest for primary pollutants (SO₂, CO, NO_x, and EC). Population–weighted variation in daily ambient air pollutant levels because of both instrument imprecision and spatial variability ranged from 20% of the temporal variation for O₃ to 70% of the temporal variation for SO₂ and EC. Wind rose plots, corrected for diurnal and seasonal pattern effects, are used to demonstrate the impacts of local sources on monitoring station data. The results presented are being used to quantify the impacts of instrument precision and spatial variability on the assessment of health effects of ambient air pollution in Atlanta and are relevant to the interpretation of results from time series health studies that use data from fixed monitors.     

Impact of Covid-19 partial lockdown on PM2.5, SO2, NO2, O3, and trace elements in PM2.5 in Hanoi,Vietnam

Covid-19 lockdowns have improved the ambient air quality across the world via reduced air pollutant levels. This article aims to investigate the effect of the partial lockdown on the main ambient air pollutants and their elemental concentrations bound to PM_2.5 in Hanoi. In addition to the PM_2.5 samples collected at three urban sites in Hanoi, the daily PM_2.5, NO₂, O₃, and SO₂ levels were collected from the automatic ambient air quality monitoring station at Nguyen Van Cu street to analyze the pollution level before (March 10th–March 31st) and during the partial lockdown (April 1st–April 22nd) with “current” data obtained in 2020 and “historical” data obtained in 2014, 2016, and 2017. The results showed that NO₂, PM_2.5, O₃, and SO₂ concentrations obtained from the automatic ambient air quality monitoring station were reduced by 75.8, 55.9, 21.4, and 60.7%, respectively, compared with historical data. Besides, the concentration of PM_2.5 at sampling sites declined by 41.8% during the partial lockdown. Furthermore, there was a drastic negative relationship between the boundary layer height (BLH) and the daily mean PM_2.5 in Hanoi. The concentrations of Cd, Se, As, Sr, Ba, Cu, Mn, Pb, K, Zn, Ca, Al, and Mg during the partial lockdown were lower than those before the partial lockdown. The results of enrichment factor (EF) values and principal component analysis (PCA) concluded that trace elements in PM_2.5 before the partial lockdown were more affected by industrial activities than those during the partial lockdown.

     

Meta-Analysis of Time-Series Studies of Air Pollution and Mortality: Effects of Gases and Particles and the Influence of Cause of Death,Age, and Season

Abstract

A comprehensive, systematic synthesis was conducted of daily time-series studies of air pollution and mortality from around the world. Estimates of effect sizes were extracted from 109 studies, from single- and multipollutant models, and by cause of death, age, and season. Random effects pooled estimates of excess all-cause mortality (single-pollutant models) associated with a change in pollutant concentration equal to the mean value among a representative group of cities were 2.0% (95% CI 1.5-2.4%) per 31.3 μg/m³ particulate matter (PM) of median diameter <10 μm (PM₁₀); 1.7% (1.2-2.2%) per 1.1 ppm CO; 2.8% (2.1-3.5%) per 24.0 ppb NO₂; 1.6% (1.1-2.0%) per 31.2 ppb O₃; and 0.9% (0.7-1.2%) per 9.4 ppb SO₂ (daily maximum concentration for O₃, daily average for others). Effect sizes were generally reduced in multipollutant models, but remained significantly different from zero for PM₁₀ and SO₂. Larger effect sizes were observed for respiratory mortality for all pollutants except O₃. Heterogeneity among studies was partially accounted for by differences in variability of pollutant concentrations, and results were robust to alternative approaches to selecting estimates from the pool of available candidates. This synthesis leaves little doubt that acute air pollution exposure is a significant contributor to mortality.     

The Impact of Particulate Matter on Daily Mortality in Bangkok,Thailand

ABSTRACT

Several studies conducted in U.S. cities report an association between acute exposures to particulate matter (PM), usually measured as PM_10, and mortality. Evidence of high concentrations of PM₁₀ in Eastern Europe and in large metropolitan areas outside of the United States, such as Mexico City and Bangkok, underscores the need to determine whether these same associations occur outside of the United States. In addition, conducting studies of mortality and air pollution in regions that have distinctly different seasonal patterns than those of the United States provides an effective opportunity to assess the potentially confounding aspects of seasonality. Over the last few years, daily measures of ambient PM₁₀ have been collected in Bangkok, a tropical city of over 6 million people. In this metropolitan area, PM₁₀ consists largely of fine particles generated from diesel- and gasoline-powered automobiles, and from two-stroke motorcycle engines. Our analysis involved the examination of the relationship between PM₁₀ and daily mortality for 1992 through 1995. In addition to counts of daily natural mortality (total mortality net of accidents, homicides, and suicides), the data were compiled to assess both cardiovascular and respiratory mortality, and natural mortality by age group. A multivariate Poisson regression model was used to explain daily mortality while controlling for several covariates including temperature, humidity, day of the week, season, and time. The analysis indicated a statistically significant association between PM10 and all of the alternative measures of mortality. The results suggest a 10-µg/m³ change in daily PM₁₀ is associated with a 1–2% increase in natural mortality, a 1–2% increase in cardiovascular mortality, and a 3–6% increase in respiratory mortality. These relative risks are generally consistent with or greater than those reported in most studies undertaken in the United States.     

Estimation of Ambient PM2.5 Concentrations in Maryland and Verification by Measured Values

Abstract

In 1997, Maryland had no available ambient Federal Reference Method data on particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5), but did have annual ambient data for PM smaller than 10 μm (PM₁₀) at 24 sites. The PM₁₀ data were analyzed in conjunction with local annual and seasonal zip-code-level emission inventories and with speciated PM_2.5 data from four nearby monitors in the IMPROVE network (located in the national parks, wildlife refuges, and wilderness areas) in an effort to estimate annual average and seasonal high PM_2.5 concentrations at the 24 PM₁₀ monitor sites operating from 1992 to 1996. All seasonal high concentrations were estimated to be below the 24-hr PM_2.5 National Ambient Air Quality Standards (NAAQS) at the sites operating in Maryland between 1992 and 1996. The estimates also indicated that 12 monitor sites might exceed the 3-year annual average PM_2.5 NAAQS of 15 ug/m³, but Maryland’s air quality shows signs that it has been improving since 1992. The estimates also were compared with actual measurements after the PM_2.5 monitor network was installed. The estimates were adequate for describing the chemical composition of the PM_2.5, forecasting compliance status with the 24-hr and annual standards, and determining the spatial variations in PM_2.5 across central Maryland.     

Effect modification of ambient particle mortality by radon: A time series analysis in 108 U.S. cities

Numerous studies have reported a positive association between ambient fine particles and daily mortality, but little is known about the particle properties or environmental factors that may contribute to these effects. This study assessed potential modification of radon on PM_2.5 (particulate matter with an aerodynamic diameter <2.5 μm)-associated daily mortality in 108 U.S. cities using a two-stage statistical approach. First, city- and season-specific PM_2.5 mortality risks were estimated using over-dispersed Poisson regression models. These PM_2.5 effect estimates were then regressed against mean city-level residential radon concentrations to estimate overall PM_2.5 effects and potential modification by radon. Radon exposure estimates based on measured short-term basement concentrations and modeled long-term living-area concentrations were both assessed. Exposure to PM_2.5 was associated with total, cardiovascular, and respiratory mortality in both the spring and the fall. In addition, higher mean city-level radon concentrations increased PM_2.5-associated mortality in the spring and fall. For example, a 10 µg/m³ increase in PM_2.5 in the spring at the 10th percentile of city-averaged short-term radon concentrations (21.1 Bq/m³) was associated with a 1.92% increase in total mortality (95% CI: 1.29, 2.55), whereas the same PM_2.5 exposure at the 90th radon percentile (234.2 Bq/m³) was associated with a 3.73% increase in total mortality (95% CI: 2.87, 4.59). Results were robust to adjustment for spatial confounders, including average planetary boundary height, population age, percent poverty and tobacco use. While additional research is necessary, this study suggests that radon enhances PM_2.5 mortality. This is of significant regulatory importance, as effective regulation should consider the increased risk for particle mortality in cities with higher radon levels.

Implications: In this large national study, city-averaged indoor radon concentration was a significant effect modifier of PM_2.5-associated total, cardiovascular, and respiratory mortality risk in the spring and fall. These results suggest that radon may enhance PM_2.5-associated mortality. In addition, local radon concentrations partially explain the significant variability in PM_2.5 effect estimates across U.S. cities, noted in this and previous studies. Although the concept of PM as a vector for radon progeny is feasible, additional research is needed on the noncancer health effects of radon and its potential interaction with PM. Future air quality regulations may need to consider the increased risk for particle mortality in cities with higher radon levels.     

Defining the Photochemical Contribution to Particulate Matter in Urban Areas Using Time-Series Analysis

Abstract

The objective of this project is to demonstrate how the ambient air measurement record can be used to define the relationship between O₃ (as a surrogate for photochemistry) and secondary particulate matter (PM) in urban air. The approach used is to develop a time-series transfer-function model describing the daily PM₁₀ (PM with less than 10 μm aerodynamic diameter) concentration as a function of lagged PM and current and lagged O₃, NO or NO₂, CO, and SO₂. Approximately 3 years of daily average PM₁₀, daily maximum 8-hr average O₃ and CO, daily 24-hr average SO₂ and NO₂, and daily 6:00 a.m.-9:00 a.m. average NO from the Aerometric Information Retrieval System (AIRS) air quality subsystem are used for this analysis. Urban areas modeled are Chicago, IL; Los Angeles, CA; Phoenix, AZ; Philadelphia, PA; Sacramento, CA; and Detroit, MI. Time-series analysis identified significant autocorrelation in the O₃, PM₁₀, NO, NO₂,CO, and SO₂ series. Cross correlations between PM₁₀ (dependent variable) and gaseous pollutants (independent variables) show that all of the gases are significantly correlated with PM₁₀ and that O₃ is also significantly correlated lagged up to two previous days. Once a transfer-function model of current PM₁₀ is defined for an urban location, the effect of an O₃-control strategy on PM concentrations is estimated by calculating daily PM₁₀ concentrations with reduced O₃ concentrations. Forecasted summertime PM₁₀ reductions resulting from a 5 percent decrease in ambient O₃ range from 1.2 μg/m³ (3.03%) in Chicago to 3.9 μg/m³ (7.65%) in Phoenix.     

Seasonal ambient particulate matter and population health outcomes among communities impacted by road dust in British Columbia,Canada

In recent years, many air quality monitoring programs have favored measurement of particles less than 2.5 µm (PM_2.5) over particles less than 10 µm (PM₁₀) in light of evidence that health impacts are mostly from the fine fraction. However, the coarse fraction (PM_10-2.5) may have independent health impacts that support continued measurement of PM₁₀ in some areas, such as those affected by road dust. The objective of this study was to evaluate the associations between different measures of daily PM exposure and two daily indicators of population health in seven communities in British Columbia, Canada, where road dust is an ongoing concern. The measures of exposure were PM₁₀, PM_2.5, PM_10-2.5, PM_2.5 adjusted for PM_10-2.5, and PM_10-2.5 adjusted for PM_2.5. The indicators of population health were dispensations of the respiratory reliever medication salbutamol sulfate and nonaccidental mortality. This study followed a time-series design using Poisson regression over a 2003–2015 study period, with analyses stratified by three seasons: residential woodsmoke in winter; road dust in spring; and wildfire smoke in summer. A random-effects meta-analysis was conducted to establish a pooled estimate. Overall, an interquartile range increase in daily PM_10-2.5 was associated with a 3.6% [1.6, 5.6] increase in nonaccidental mortality during the road dust season, which was reduced to 3.1% [0.8, 5.4] after adjustment for PM_2.5. The adjusted coarse fraction had no effect on salbutamol dispensations in any season. However, an interquartile range increase in PM_2.5 was associated with a 2.7% [2.0, 3.4] increase in dispensations during the wildfire season. These analyses suggest different impacts of different PM fractions by season, with a robust association between the coarse fraction and nonaccidental mortality in communities and periods affected by road dust. We recommend that PM₁₀ monitoring networks be maintained in these communities to provide feedback for future dust mitigation programs.

Implications: There was a significant association between daily concentrations of the coarse fraction and nonaccidental mortality during the road dust season, even after adjustment for the fine fraction. The acute and chronic health effects associated with exposure to the coarse fraction remain unclear, which supports the maintenance of PM₁₀ monitoring networks to allow for further research in communities affected by sources such as road dust.     

Temporal Analysis of Airborne Particulate Matter Reveals a Dose-Rate Effect on Mortality in El Paso: Indications of Differential Toxicity for Different Particle Mixtures

Abstract

One of two topics explored is the limitations of the daily average in summarizing pollutant hourly profiles. The daily average of hourly measurements of air pollutant constituents provides continuity with previous studies using monitoring technology that only provided the daily average. However, other summary statistics are needed that make better use of all available information in 24-hr profiles. The daily average reflects the total daily dose, obscuring hourly resolution of the dose rate. Air pollutant exposures with comparable total daily doses may have very different effects when occurring at high levels over a few hours as opposed to low levels over a longer time. Alternative data-based choices for summary statistics are provided using principal component analysis to capture the exposure dose rate, while preserving ease of interpretation. This is demonstrated using the earliest hourly particle concentration data available for El Paso from archived records of particulate matter (PM)₁₀. In this way, a significant association between evening PM₁₀ exposures and nonaccidental daily mortality is found in El Paso from 1992 to 1995, otherwise missed using the daily average. Secondly, the nature and, hence, effects of particles in the ambient aerosol during El Paso sandstorms is believed different from that of particles present during stillair conditions resulting from atmospheric temperature inversions. To investigate this, wind speed (ws) is used as a surrogate variable to label PM₁₀ exposures as Low-ws (primarily fine particles), High-ws (primarily coarse particles), or Mid-ws (a mixture of fine and coarse particles). A High-ws evening is significantly associated with a 10% lower risk of mortality on the succeeding third day, as compared with comparable exposures at Low- or Mid-ws. Although this analysis cannot be used to form firm conclusions because it uses a very small data set, it demonstrates the limitations of the daily average and suggests differential toxicity for different particle compositions.     

Ambient air pollution and term birth weight in Texas from 1998 to 2004

Previous studies have explored the association between air pollution levels and adverse birth outcomes such as lower birth weight. Existing literature suggests an association, although results across studies are not consistent. Additional research is needed to confirm the effect, investigate the exposure window of importance, and distinguish which pollutants cause harm.

We assessed the association between ambient pollutant concentrations and term birth weight for 1,548,904 births in TX from 1998 to 2004. Assignment of prenatal exposure to air pollutants was based on maternal county of residence at the time of delivery. Pollutants examined included particulate matter with aerodynamic diameter ≤10 and ≤2.5 µm (PM₁₀ and PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃). We applied a linear model with birth weight as a continuous variable. The model was adjusted for known risk factors and region. We assessed pollutant effects by trimester to identify biological exposure window of concern, and explored interaction due to race/ethnicity.

An interquartile increase in ambient pollutant concentrations of SO₂ and O₃ was associated with a 4.99-g (95% confidence interval [CI], 1.87–8.11) and 2.72-g (95% CI, 1.11–4.33) decrease in birth weight, respectively. Lower birth weight was associated with exposure to O₃ in the first and second trimester, whereas results were not significant for other pollutants by trimester. A positive association was exhibited for PM_2.5 in the first trimester. Effects estimates for PM₁₀ and PM_2.5 were inconsistent across race/ethnic groups.

Current ambient air pollution levels may be increasing the risk of lower birth weight for some pollutants. These risks may be increased for certain racial/ethnic groups. Additional research including consideration of improved methodology is needed to investigate these findings. Future studies should examine the influence of residual confounding.

Implications: This is one of the most comprehensive studies examining criteria air pollutants and lower birth weight in Texas. Our findings confirm results found previously for adverse effects of the air pollutant SO₂ on lower birth weight. Results from our study suggest that adverse pregnancy outcomes such as lower birth weight can occur even while maintaining air pollution levels below regulatory standards. Future studies should incorporate the assessment of differential pollutant exposure as well as effect estimates by race/ethnicity with individual and community-level social factors in order to enhance our understanding of how physical, social, and host factors influence birth outcomes.

Supplemental Materials: Supplementary information relating to characteristics of excluded births, distribution of air pollutant monitors by pollutant, and correlation coefficients of the air pollutants is available in the publisher's online edition of the Journal of the Air & Waste Management Association.     

Ambient fine particulate matter in China: Its negative impacts and possible countermeasures

In recent decades, China has experienced rapid economic development accompanied by increasing concentrations of ambient PM_2.5, particulate matter of less than 2.5 μm in diameter. PM_2.5 is now believed to be a carcinogen, causing higher lung cancer risks and generating losses to the economy and society. This meta-analysis evaluates the losses generated by ambient PM_2.5 in Suzhou from 2014 to 2016 and predicts losses at different concentrations. Estimations of total losses in Beijing, Shanghai, Hangzhou, Guangzhou, Dalian, and Xiamen are also presented, with a total national loss in 2015. The authors then demonstrate that lowering ambient PM_2.5 concentrations would be a realistic way for China to reduce the evaluated social losses in the short term. Possible legal measures are listed for lowering ambient PM_2.5 concentrations.

Implications: The present findings quantify the economic effects of ambient PM_2.5 due to the increased incidence rate and mortality rate of lung cancer. Lowering ambient PM_2.5 concentrations would be the most realistic way for China to reduce tghe evaluated social losses in the short term. Possible legal measures for lowering ambient PM_2.5 concentrations to reduce the total losses are identified.     

The Association between Ambient Carbon Monoxide Levels and Daily Mortality in Toronto,Canada

ABSTRACT

The role of ambient levels of carbon monoxide (CO) in the exacerbation of heart problems in individuals with both cardiac and other diseases was examined by comparing daily variations in CO levels and daily fluctuations in nonaccidental mortality in metropolitan Toronto for the 15-year period 1980–1994. After adjusting the mortality time series for day-of-the-week effects, nonparametic smoothed functions of day of study and weather variables, statistically significant positive associations were observed between daily fluctuations in mortality and ambient levels of carbon monoxide, nitrogen dioxide, sulfur dioxide, coefficient of haze, total suspended particulate matter, sulfates, and estimated PM_2.5 and PM₁₀. However, the effects of this complex mixture of air pollutants could be almost completely explained by the levels of CO and total suspended particulates (TSP). Of the 40 daily nonaccidental deaths in metropolitan Toronto, 4.7% (95% confidence interval of 3.4%–6.1%) could be attributable to CO while TSP contributed an additional 1.0% (95% confidence interval of 0.2–1.9%), based on changes in CO and TSP equivalent to their average concentrations. Statistically significant positive associations were observed between CO and mortality in all seasons, age, and disease groupings examined. Carbon monoxide should be considered as a potential public health risk to urban populations at current ambient exposure levels.     

Air Pollution and Hospital Admissions for Diseases of the Circulatory System in Three U.S. Metropolitan Areas

ABSTRACT

Generalized additive models were used to analyze the time series of daily hospital admissions for cardiovascular and cerebrovascular diseases over the period of 19871995 in three major metropolitan areas—Cook County, IL; Los Angeles County, CA; and Maricopa County, AZ— in the United States. In Cook and Maricopa Counties, admissions information was only available for the elderly (ages 65 and over), while in Los Angeles County, admissions information was available for all ages. In Cook County, daily monitoring information was available on PM₁₀, CO, SO₂, NO₂, and O₃. In Los Angeles and Maricopa Counties, monitoring information was available daily on the gases, and information on PM₁₀ was available every sixth day. In Los Angeles County, information on PM₂₅ was also available every sixth day. In Cook and Los Angeles Counties, associations were found between each pollutant, with the exception of O₃, and admissions for cardiovascular disease, with the gases showing the strongest associations. In two-pollutant models with PM and one of the gases, the effect of the gases remained stable, while the effect of PM became unstable and insignificant. In Maricopa County, the gases, with the exception of O₃, were weakly associated with hospital admissions for cardiovascular disease, while PM was not. In two-pollutant models with two of CO, SO₂, and NO₂, the pattern of results is heterogeneous in the three counties. In all three counties, only weak evidence of any association between air pollution and cere-brovascular admissions was found.