An overview of cross-sectional studies of mortality and air pollution and related statistical issues

A heuristic framework is developed for assessing statistical studies of air pollution and mortality which use the General Linear Model as a principal tool for analysis. Arrays that systematically compare the information of each study are introduced. In addition, a number of studies are contrasted against several statistical criteria to assess the reliability of the study results. Reliability is considered in terms of statistical estimation theory and practice. Finally, there is a discussion of several points of statistical contention which can affect the results of these studies. The conclusion is that statistical studies that use the General Linear Model have made limited use of available methods and tests. Several issues are raised which will require additional research.     

Human mortality in Cyprus: the role of temperature and particulate air pollution

Climatic change results in increased occurrence of heat waves, and the thermal stress caused by such phenomena is leading to higher levels of heat-related mortality worldwide. This study is the first to examine the effect of extreme weather on mortality in Cyprus. It investigates the individual effect of meteorological indicators on mortality, as well as the role of particulate air pollution (PM₁₀). A generalized linear model (GLM) with quasi-Poisson regression was implemented. GLM included a temperature function and was adjusted for relative humidity and seasonality. The temperature function was developed under a newly developed framework of distributed lag nonlinear models, which capture nonlinearities and delayed effects of heat simultaneously. GLM was extended to examine the confounding effect of air pollution. All the results on heat effects are presented. High temperatures had a significant effect on mortality with increased mortality rates, independent of humidity and seasonality. Mortality risk increased steeply above a temperature threshold. A direct heat effect was shown, with higher risk on the current and next day of a severe heat event. PM₁₀ was not found to have a confounding effect on the temperature–mortality relationship, since the strength of this relationship remained after the inclusion of PM₁₀ in the model. Differences existed between urban and coastal areas.     

Relationship between air pollution and daily mortality in a subtropical city: Taipei, Taiwan

Air pollution has been associated with daily mortality in numerous studies over the past decade. However most of these studies were conducted in the United States and Europe with relatively few done in Asia. In the current study, the association between ambient air pollution and daily mortality in Taipei, Taiwan's largest city which has a subtropical climate was undertaken, for the period 1994-1998 using a case-crossover analysis. This design is an alternative to Poisson time series regression for studying the short-term adverse health effects of air pollution. The air pollutants examined included particulate matter (PM(10)), sulfur dioxide (SO(2)), ozone (O(3)), nitrogen dioxide (NO(2)), and carbon monoxide (CO). The largest observed effect, which was without statistical significance, was seen for NO(2) and CO levels on deaths due to respiratory diseases (ORs=1.013 and 1.014, respectively). The well established link between air pollution levels and daily mortality may not be as strong in cities in subtropical areas, although other factors such as differences in pollutant mix or the underlying health of the population may explain the lack of a strong association in this study. Further studies of this type in cities with varying climates and cultures are needed.     

A review of traffic-related air pollution exposure assessment studies in the developing world

Exposure assessment studies in the developing world are important. Although recent years have seen an increasing number of traffic-related pollution exposure studies, exposure assessment data on this topic are still limited. Differences among measuring methods and a lack of strict quality control in carrying out exposure assessment make it difficult to generalize and compare findings between studies. In this article, exposure assessment studies carried out in the developing world on several traffic-related air pollutants are reviewed. These pollutants include particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO(2)), volatile organic compounds (VOCs), and polycyclic aromatic hydrocarbons (PAHs). In addition, it discusses advantages and disadvantages of various monitoring methods (ambient fixed-site monitoring, microenvironment monitoring, and personal exposure assessment using portable samplers) for these pollutants in exposure assessment studies. Also included in this paper is a brief introduction of standards for these pollutants in ambient air or in occupational settings established by the United States Environmental Protection Agency (USEPA), the United States Occupational Safety and Health Administration (OSHA) and the World Health Organization (WHO). The review ends with a summary of the limitations and gaps in recent studies and suggestions for future research in the developing world.     

Using air pollution based community clusters to explore air pollution health effects in children

To study respiratory health effects of long-term exposure to ambient air pollutant mixture, we observed 7058 school children 5-16 years of age living in the four Chinese cities of Lanzhou, Chongqing, Wuhan, and Guangzhou. These children were enrolled from elementary schools located in eight districts, one urban district and one suburban district in each of the above cities. Ambient levels of PM(2.5), PM(10-2.5), total suspended particles (TSP), SO(2), and NO(x) were measured in these districts from 1993 to 1996. Based on a cluster analysis of arithmetic mean concentrations of PM(2.5), PM(10-2.5), (TSP-PM(10)), SO(2), and NO(x), we classified these children into four ordinal categories of exposure to ambient air pollutant mixtures. We tested for exposure-response relationships using logistic regression models, controlling for relevant covariates. We observed monotonic, positive relationships of exposure to the pollutant mixture with prevalence rates of cough with phlegm and wheeze. Other outcomes were not associated with the exposure in a monotonic exposure-response pattern. Even so, odds ratios for cough, phlegm, bronchitis, and asthma in the higher exposure district clusters were all higher than in the lowest exposure district cluster. We found evidence that exposure to the pollutant mixtures had adverse effects on children living in the four Chinese cities.     

Particulate air pollution in Lanzhou China

Concentrations of total suspended particles (TSP) and PM(10) in Lanzhou China have been kept high for the past two decades. Data collected during the intensive observational period from October 1999 to April 2001 show high TSP and PM(10) concentrations. Starting from November, the PM(10) pollution intensifies, and reaches mid to high alert level of air pollution, continues until April next year, and is at low alert level in the summer. In the winter and spring, the TSP concentration is 2-10 times higher than the third-level criterion of air quality (severe pollution). Effects of intrinsic factors (sources of pollution) and remote preconditions (propagation of dust storms) for severe PM(10) and TSP pollution in Lanzhou are analyzed.     

Indoor air pollution and public policy

In recent years, scientist have come to realize that contaminated air inside buildings is a major route of human exposure to certain air pollutants. While scientific interest in the problem continues to grow, efforts to measure indoor pollution concentrations, define exposure levels, and estimate health risks remain in their infancy. Within this arena, policymakers must deal with the question of how best to protect public health and safety in the face of incomplete and often contradictory information. In the past, official response to environmental pollution has traditionally taken the form of “control by regulation.” However, creation of a regulatory framework for indoor air quality poses special policy issues that suggest the need to explore alternative modes of intervention. Ambient outdoor air is a public good, in the sense that enjoyment by one individual in no way detracts from use or enjoyment by others. Indoor air, on the other hand, is not a public good, especially in private residences. Costs and benefits of maintaining adequate indoor air quality are internalized within households, suggesting the possibility of a private demand for clean indoor air. Promulgation of indoor air quality standards and other regulations must confront the fact that individuals are already making decisions about their own air quality. Regulations might or might not improve these decisions. Development of effective and reasonable policy requires an appreciation of the scope for private action and consideration of the likelihood that public intervention will foster improved private choices. Among the logical and relatively inexpensive modes of intervention are public information programs, development of simple warning devices, and product testing and labeling.     

Personal monitoring of air pollution exposures

In industrial hygiene and health physics the goal has been to protect the health of the individual. Therefore monitoring the exposure people actually receive has been the principal concern. In regulating public exposures to air pollution, the focus has been much different. Recently, use of personal monitors and alternative means of estimating actual exposures has expanded rapidly. The role of personal monitors in epidemiology, exposure studies, and in supplementing the existing fixed station monitoring network for establishing trends and for regulatory purposes is discussed. The implications for air quality standards in recent findings of personal and indoor exposures is considered. New developments that are needed, and those that are not needed, are outlined.     

Evaluation of some air pollution indicators in Turkey

This article intends to shed a light on air quality in Turkey and compare air pollutant emissions on a national scale with that of the European countries. In order to estimate the quantities of Turkish emissions in the past and their future predictions, a national emission inventory was prepared with respect to five major pollutants consisting of particulate matter(PM), SOx, NOx, non-methane volatile organic compounds, and CO with 5-year intervals between 1985 and 2005. The results suggest that Turkey is a rather large emission source at the European scale, although emission indicators on unit area and per capita were shown to be somewhat smaller in magnitude. Levels of air pollution in some of the big cities in Turkey were also evaluated from available national monitoring data. These evaluations for the urban air qualities covered SO2 and PM parameters between 1986 and 1996, and results were compared with the present Turkish air quality limits, their probable revisions, WHO (Europe) guidelines and related EC directives. Results showed that the air quality limits were not met, especially during the winter periods in Turkish cities. Urban air pollutants characterizing the air in Turkish cities other than SO2 and PM, however, could not have been evaluated as these pollutants were not systematically monitored in these cities.     

Ambient air pollution and children's lung function in China

ObjectiveTo describe the correlations between ambient air pollutants (TSP, SO₂, NO_x) and the level of children's lung function (FVC, FEV₁, MMEF) in China.MethodsWe collected the research articles on ambient air pollution and children's lung function published from 1985 to 2006 and selected 11 articles finally according to the following criteria: (1) Children between the age of 7 and 15 as objects; (2) Local air quality monitoring results were reported; (3) Strict quality control was taken when testing children's lung function; (4) The results were expressed by the average of measured value. Then we analyzed the correlation relationship between the level of ambient air pollutants and children's lung function and compared the effects of ambient air pollutants on children's lung function of boy and girl.ResultsThe selected articles included the results of 7 cities in China. Among them, the results of 6 cities' studies revealed that the levels of children's lung function were significantly lower in the areas with heavy ambient air pollution than those in the areas with light ambient air pollution. According to the articles, the average levels of TSP were at the range of 0.084 mg/m³–0.835 mg/m³, SO₂ were 0.013 mg/m³–0.929 mg/m³, NO_x were 0.044 mg/m³–0.229 mg/m³. Correlation analysis showed significant negative correlation between the levels of TSP and SO₂ and children's FVC and FEV₁, as well as the levels of NO_x and children's MMEF. The correlation coefficient was ? 0.797 (t = ? 4.384, P = 0.001) between TSP and FVC, ? 0.693 (t = ? 4.190, P < 0.001) between Ln (SO₂) and FVC, ? 0.886 (t = ? 5.392, P = 0.001) and ? 0.685 (t = ? 4.101, P = 0.001) between FEV₁ and TSP and Ln (SO₂), and ? 0.973 (t = ? 5.993, P = 0.027) between NO_xNO_x and MMEF, respectively. The results also suggested that the decreases of lung function for girl with the increasing of ambient air pollution were significantly greater for boy.ConclusionThe levels of ambient air TSP and SO₂ correlated with the damage of the big airway function of children, while NO_xNO_x affected the small airway function chiefly. Furthermore, lung function of girl was more susceptible to ambient air pollutants than boy.     

Exploring uncertainty of the change from ICD-9 to ICD-10 on acute mortality effects of air pollution

The change in ICD coding from ICD-9 to ICD-10 may produce inconsistencies and discontinuities in cause-specific mortality, thus impacting on effects estimates of air pollution on mortality. The current study was conducted in Wuhan, China. We examined the concordant rates and Kappa statistics using the mortality data from the year 2002 coded with both ICD-9 and ICD-10 codes and compared the estimated effects of air pollution using the Generalized Additive Model in R. We found high concordant rates (>99.3%) and Kappa statistics close to 1.0 (>0.98). Little difference was identified in the estimated effects of air pollution on daily cardiovascular, stroke, cardiac, cardiopulmonary, and respiratory mortality. This study provides evidence that, based on the wide definitions of cause-specific morality typically used in the studies of time-series air pollution mortality, the change in the ICD coding does not significantly affect the estimated effects of air pollution.     

Concepts of human exposure to air pollution

In recent years, considerable attention has focused on the concept of “human exposure” to environmental pollutants, but different investigators seem to have developed different definitions of this concept and used different approaches for estimating it. This paper reviews a number of “exposure” studies in a single environmental medium—air pollution—to see how others have defined this concept in the literature. Many previous investigators unfortunately calculate “exposures” by relying on data from fixed air monitoring stations, and they assume that people are located in the same place, usually their residential address, throughout a 24-h period. However, a second body of literature shows that fixed air monitoring stations do not necessarily reflect human exposures, because concentrations observed indoors—in homes, offices, factories, and motor vehicles—differ from those observed at fixed stations, and people usually spend considerable time in these locations. In an effort to standardize the nomenclature dealing with exposures, a definition is proposed in which the pollutant must come into contact with the physical boundary of the person. Then, exposure of person i to pollutant concentration c is viewed as two events occurring jointly: person i is present at a particular location, and concentration c is present at the same location. Mathematical definitions for “integrated exposure,” “average exposure,” and “standardized exposure” with various averaging periods also are introduced. Finally, two different yet compatible research approaches are suggested for determining human exposures to air pollution.     

Fertility and air pollution: Some empirical findings

This paper attempts to explain regional differences in fertility rates in the standard metropolitan statistical areas of the United States through socioeconomic factors and air pollution. An important feature of this study is that it uses the most recent data pertaining to a homogeneous sample of observations within a country rather than using data for different countries. Statistical results suggest that given other factors, fertility and the level of air pollution have an inverse relationship. This quantitative effect is statistically significant but the absolute impact is rather low. Our results also suggest that an increase in the level of income, relative education of females, temperature, and the availability of physicians would in the long run reduce fertility rates in the urban areas of the United States.     

Control of industrial air pollution through sustainable development

The environmental issue has become a major subject in the last few decades affecting science and technology throughout the world due to the serious environmental impacts caused by industrial air pollution. Consequently, pulse jet filtration has become the preferred choice all around the world. Researchers are continuously striving for new concepts of more energy-efficient and compact particulate collector which can meet future emission limits and operating requirements. The system can also satisfy stringent emission norms and if required, it can be embedded with new technique for simultaneous control of particulate and gaseous pollutants. In the recent past, stress is also being given to having control over the source to reduce or eliminate waste, and finally, on waste management. Prevention is frequently more cost-effective than control. The paper discusses all these methodology toward sustainability in the perspective of effective control of industrial air pollution.     

Long-term air pollution exposure and diabetes in a population-based Swiss cohort

Air pollution is an important risk factor for global burden of disease. There has been recent interest in its possible role in the etiology of diabetes mellitus. Experimental evidence is suggestive, but epidemiological evidence is limited and mixed. We therefore explored the association between air pollution and prevalent diabetes, in a population-based Swiss cohort.We did cross-sectional analyses of 6392 participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults [SAPALDIA], aged between 29 and 73 years. We used estimates of average individual home outdoor PM₁₀ [particulate matter <10 μm in diameter] and NO₂ [nitrogen dioxide] exposure over the 10 years preceding the survey. Their association with diabetes was modeled using mixed logistic regression models, including participants' study area as random effect, with incremental adjustment for confounders.There were 315 cases of diabetes (prevalence: 5.5% [95% confidence interval (CI): 2.8, 7.2%]). Both PM₁₀ and NO₂ were associated with prevalent diabetes with respective odds ratios of 1.40 [95% CI: 1.17, 1.67] and 1.19 [95% CI: 1.03, 1.38] per 10 μg/m³ increase in the average home outdoor level. Associations with PM₁₀ were generally stronger than with NO₂, even in the two-pollutant model. There was some indication that beta blockers mitigated the effect of PM₁₀. The associations remained stable across different sensitivity analyses.Our study adds to the evidence that long term air pollution exposure is associated with diabetes mellitus. PM₁₀ appears to be a useful marker of aspects of air pollution relevant for diabetes. This association can be observed at concentrations below air quality guidelines.     

Institutional aspects of indoor air pollution in energy efficient residences

This paper examines the institutional constraints regarding indoor air pollution that exist or may be imposed on the housing industry. These constraints may be manifested in building codes and health laws, tax incentives and spending subsidies, and/or regulations restricting the activities of the industry itself. It also assesses the potential liabilities of designers, manufacturers, builders, and owners of energy-efficient residences should they fail to take appropriate actions to address indoor air quality problems. These liabilities may result from product liability (defective design or manufacture), breach of warranty, or negligence, causing harm to people from indoor air pollution.     

Carbon-14, tree rings,and urban air pollution

Differences in natural ¹⁴C content of rings from trees from urban and rural locations have been compared on a year by year basis. The differences as a fraction of the urban tree's radioactivity reflect the local excess ¹⁴C-free carbon dioxide from fossil fuel combustion in the urban environment. New York City, Boston, and Washington, D.C., show different degrees of excess carbon dioxide. New York City averages about 6% excess carbon dioxide between 1950 and 1970. From this is infered an average carbon monoxide concentration during this period of 5 ppm.     

Traffic and outdoor air pollution levels near highways in Baghdad,Iraq

In Iraq, the number of passenger cars, trucks and buses, local generators, and heavy construction equipment rose to a considerable extent since 2003, causing high environmental problems. Many types of pollutants were monitored and recorded for 24 h during March 2016. The study attempts to explore and establish a relationship between the volume of activity and the movement of motor vehicles of various compounds and contaminants resulting from their exhaust pipes, such as sulfur dioxide, particulate matters, oxides of nitrogen, VOCs, and unburned hydrocarbons. The study focused in and around Mohammad Al-Qasim highway adjacent to the University of Technology, Baghdad. The results showed the need for urgent treatments addressed by the environmental authorities in the city. The study results demonstrated that these contaminants are increased during periods of the beginning and end of working hours for government departments. Some types of sulfur compounds (H₂S and SO₂) concentrations were at serious health-threatening levels, which is a result of the high sulfur content in the Iraqi fuel. The concentrations of NOx and VOC were high, also, which could make the studied area vulnerable to the risk of smog formation. The Iraqi government should make greater efforts to protect the environment and human in this country from the transportation pollution risks.     

Health risk assessment of indoor air pollution in Finnish ice arenas

Poor indoor air quality and epidemic carbon monoxide (CO) and nitrogen dioxide (NO(2)) poisonings due to exhaust emissions from ice resurfacers have been continuously reported from enclosed ice arenas for over 30 years. The health risks in users of Finnish ice arenas were analysed in three ways: (1) evaluation of four cases of epidemic CO poisonings, (2) modelling the association between NO(2) exposure and respiratory symptoms among junior ice hockey players, and (3) estimation of the number of arena users at risk of breathing poor quality air due to non-compliance of ice arenas with recommended abatement measures. The common causes for the CO poisonings involving over 300 subjects were large emissions from propane-fuelled ice resurfacer, small arena volume, negligible ventilation, and very recent opening of the arena. Rhinitis (prevalence 18.3%) and cough (13.7%) during or after training or game were significantly associated with the estimated personal NO(2) exposure of young hockey players (n=793) to average concentrations ranging from 21 to 1176 microg/m(3) in their home arena. During a 6-year follow-up of an intensive information campaign the portion of electric resurfacers increased from 9% to 27%, and that of emission control technology on propane-fuelled resurfacers increased from 13% to 84%. The portion of inadequately ventilated arenas decreased from 34% to 25%. However, 48% of the investigated Finnish ice arenas (n=125) did not fully comply with the non-regulatory recommendations. Consequently, 20000 daily users of ice arenas were estimated to remain in 2001 at risk of breathing poor quality air. Modern small and inadequately ventilated ice arenas pose their users (mostly children and young adults) at risk of breathing poor quality air and suffering from acute adverse health effects. Governmental regulations are needed worldwide to ensure safe sports in enclosed ice arenas.