Infant Mortality and Air Pollution: A Comprehensive Analysis of U.S. Data for 1990

ABSTRACT

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 PM_2.5, 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.     

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.     

Daily mortality and air pollution in The Netherlands

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 micrograms/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.     

Comparison of ambient PM risk with risks estimated from PM components of smoking and occupational exposures

Air pollution studies are based on individual-level health response data and group-level exposure data. Therefore, exposure misclassification occurs, and the results may be biased to an unknown magnitude and direction. Testing the validity of such associations requires a study design using individual-level data for both exposure and response. One can test the plausibility of group-level PM risk estimates by comparing them to individual-level estimates of risk from constituents of ambient air. The twofold purpose of this review is to consider the internal consistency of risks estimated from the three major PM cohort studies and to determine individual-level mortality risks associated with ambient concentrations of tobacco smoke and occupational exposures and compare them with risks associated with ambient PM. The paper demonstrates the risks are not consistent within and between the PM cohort studies. Higher ambient concentration risks (ACRs) from the ambient PM cohort studies are not coherent with ACRs derived from individual-level smoking and occupational risks for total, cardiopulmonary, and lung cancer mortality. Individual-level studies suggest increased risk of mortality cannot be measured with reliability at concentrations found in ambient air.     

Comparison of Ambient PM Risk with Risks Estimated from PM Components of Smoking and Occupational Exposures

ABSTRACT

Air pollution studies are based on individual-level health response data and group-level exposure data. Therefore, exposure misclassification occurs, and the results may be biased to an unknown magnitude and direction. Testing the validity of such associations requires a study design using individual-level data for both exposure and response. One can test the plausibility of group-level PM risk estimates by comparing them to individual-level estimates of risk from constituents of ambient air. The twofold purpose of this review is to consider the internal consistency of risks estimated from the three major PM cohort studies and to determine individual-level mortality risks associated with ambient concentrations of tobacco smoke and occupational exposures and compare them with risks associated with ambient PM.

The paper demonstrates the risks are not consistent within and between the PM cohort studies. Higher ambient concentration risks (ACRs) from the ambient PM cohort studies are not coherent with ACRs derived from individual-level smoking and occupational risks for total, cardiopulmonary, and lung cancer mortality. Individual-level studies suggest increased risk of mortality cannot be measured with reliability at concentrations found in ambient air.     

Effect of the fine fraction of particulate matter versus the coarse mass and other pollutants on daily mortality in Santiago, Chile

Daily counts of non-accidental deaths in Santiago, Chile, from 1988 to 1996 were regressed on six air pollutants--fine particles (PM2.5), coarse particles (PM10-2.5), CO, SO2, NO2, and O3. Controlling for seasonal and meteorological conditions was done using three different models--a generalized linear model, a generalized additive model, and a generalized additive model on previously filtered data. Single- and two-pollutant models were tested for lags of 1-5 days and the average of the previous 2-5 days. The increase in mortality associated with the mean levels of air pollution varied from 4 to 11%, depending on the pollutants and the way season of the year was considered. The results were not sensitive to the modeling approaches, but different effects for warmer and colder months were found. Fine particles were more important than coarse particles in the whole year and in winter, but not in summer. NO2 and CO were also significantly associated with daily mortality, as was O3 in the warmer months. No consistent effect was observed for SO2. Given particle composition in Santiago, these results suggest that combustion-generated pollutants, especially from motor vehicles, may be associated with increased mortality. Temperature was closely associated with mortality. High temperatures led to deaths on the same day, while low temperatures lead to deaths from 1 to 4 days later.     

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

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 microg/m3 particulate matter (PM) of median diameter < or = 10 microm (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.     

Air pollution and hospital admissions for diseases of the circulatory system in three U.S. metropolitan areas

Generalized additive models were used to analyze the time series of daily hospital admissions for cardiovascular and cerebrovascular diseases over the period of 1987-1995 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 PM2.5 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 cerebrovascular admissions was found.     

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 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.     

Defining the photochemical contribution to particulate matter in urban areas using time-series analysis

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 microm 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 microg/m3 (3.03%) in Chicago to 3.9 microg/m3 (7.65%) in Phoenix.     

Is daily mortality associated specifically with fine particles? Data reconstruction and replication of analyses

In 1996, Schwartz, Dockery, and Neas reported that daily mortality was more strongly associated with concentrations of PM2.5 than with concentrations of larger particles (coarse mass [CM]) in six U.S. cities ("original paper"/"original analyses"). Because of the public policy implications of the findings and the uniqueness of the concentration data, we undertook a reanalysis of these results. This paper presents results of the reconstruction of these data and replication of the original analyses using the reconstructed data. The original investigators provided particulate air pollution data for this paper. Daily weather and daily counts of total and cause-specific deaths were reconstructed from original public records. The reconstructed particulate air pollution and weather data were consistent with the summaries presented in the original paper. Daily counts of deaths in the reconstructed data set were lower than in the original paper because of restrictions on residence and place of death. The reconstruction process identified an administrative change in county codes that led to higher numbers of deaths in St. Louis. Despite these differences in daily counts of deaths, the estimated effects of particulate air pollution from the reconstructed dataset, using analytic methods as described in the original paper, produced combined effect estimates essentially equivalent to the originally published results. For example, the estimated association of a 10 micrograms/m3 increase in 2-day mean particulate air pollution on total mortality was 1.3% (95% confidence interval [CI] 0.9-1.7%, t = 6.53) for PM2.5 based on the reconstructed dataset, compared to the originally reported association of 1.5% (95% CI 1.1-1.9%, t = 7.41). For coarse particles, the estimated association from the reconstructed dataset was 0.4% (95% CI -0.2-0.9%, t = 1.43) compared to the originally reported association of 0.4% (95% CI -0.1-1.0%, t = 1.48). These results from the reconstructed data suggest that the original results reported by Schwartz, Dockery, and Neas were essentially replicated.     

Interpretation of air pollution mortality: number of deaths or years of life lost?

This paper examines the relation between the results of epidemiologic studies of air pollution mortality and impact indicators that can be informative for environmental policy decisions. Using models that are simple and transparent, yet contain the essential features, it is shown that (1) number of deaths is not meaningful for air pollution, whereas loss of life expectancy (LLE) is an appropriate impact indicator; (2) the usual short-term (time series) studies yield a change in daily number of deaths attributable to acute effects of pollution, without any information on the associated LLE (although some information on this has recently become available by extending the observation window of time series); and (3) long-term studies yield a change in age-specific mortality, which makes it possible to calculate the total population averaged LLE (acute and chronic effects) but not the total number of premature deaths attributable to air pollution. The latter is unobservable because one cannot distinguish whether few individuals suffer a large or many suffer a small LLE. The paper calculates the LLE from exposure to PM10, as implied by the long-term mortality studies of adults and infants; population LLE for infants turns out to be an order of magnitude smaller than for adults. The LLE implied by short-term studies is a small fraction of the total loss implied by long-term studies, even if one assumes a very high loss per death. Applied to environmental policy, taking a permanent 50-70% reduction of PM10 as a reasonable goal, one finds a corresponding increase of average life expectancy in urban areas of the European Union (EU) and the United States of approximately four months.     

Assessment of human exposure to ambient particulate matter

Recent epidemiological studies have consistently shown that the acute mortality effects of high concentrations of ambient particulate matter (PM), documented in historic air pollution episodes, may also be occurring at the low to moderate concentrations of ambient PM found in modern urban areas. In London in December 1952, the unexpected deaths due to PM exposure could be identified and counted as integers by the coroners. In modern times, the PM-related deaths cannot be as readily identified, and they can only be inferred as fractional average daily increases in mortality rates using sophisticated statistical filtering and analyses of the air quality and mortality data. The causality of the relationship between exposure to ambient PM and acute mortality at these lower modern PM concentrations has been questioned because of a perception that there is little significant correlation in time between the ambient PM concentrations and measured personal exposure to PM from all sources (ambient PM plus indoor-generated PM). This article shows that the critical factor supporting the plausibility of a linear PM mortality relationship is the expected high correlation in time of people's exposure to PM of ambient origin with measured ambient PM concentrations, as used in the epidemiological time series studies. The presence of indoor and personal sources of PM masks this underlying relationship, leading to confusion in the scientific literature about the strong underlying temporal relationship between personal exposure to PM of ambient origin and ambient PM concentration. The authors show that the sources of PM of non-ambient origin operate independently of the ambient PM concentrations, so that the mortality effect of non-ambient PM, if any, must be independent of the effects of the ambient PM exposures.     

Assessment of Human Exposure to Ambient Particulate Matter

ABSTRACT

Recent epidemiological studies have consistently shown that the acute mortality effects of high concentrations of ambient particulate matter (PM), documented in historic air pollution episodes, may also be occurring at the low to moderate concentrations of ambient PM found in modern urban areas. In London in December 1952, the unexpected deaths due to PM exposure could be identified and counted as integers by the coroners. In modern times, the PM-related deaths cannot be as readily identified, and they can only be inferred as fractional average daily increases in mortality rates using sophisticated statistical filtering and analyses of the air quality and mortality data. The causality of the relationship between exposure to ambient PM and acute mortality at these lower modern PM concentrations has been questioned because of a perception that there is little significant correlation in time between the ambient PM concentrations and measured personal exposure to PM from all sources (ambient PM plus indoor-generated PM).

This article shows that the critical factor supporting the plausibility of a linear PM mortality relationship is the expected high correlation in time of people's exposure to PM of ambient origin with measured ambient PM concentrations, as used in the epidemiological time series studies. The presence of indoor and personal sources of PM masks this underlying relationship, leading to confusion in the scientific literature about the strong underlying temporal relationship between personal exposure to PM of ambient origin and ambient PM concentration. The authors show that the sources of PM of non-ambient origin operate independently of the ambient PM concentrations, so that the mortality effect of non-ambient PM, if any, must be independent of the effects of the ambient PM exposures.     

Assessing the relationship between personal particulate and gaseous exposures of senior citizens living in Baltimore, MD

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 PM2.5, PM10, SO4(2-), O3, NO2, SO2, and exhaust-related VOCs. Results of this study showed that longitudinal associations between ambient PM2.5 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 PM2.5 exposures and resulting personal-ambient associations. Associations between personal PM2.5 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 PM2.5 sources. Evidence for this was provided by SO4(2-) measurements, which can be thought of as a tracer for ambient PM2.5. For SO4(2-), personal-ambient associations were strong even in poorly ventilated indoor environments, suggesting that personal exposures to PM2.5 of ambient origin are strongly associated with corresponding ambient concentrations. The results also indicated that the contribution of indoor PM2.5 sources to personal PM2.5 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 PM2.5 co-pollutants is limited, despite significant correlations among ambient pollutant concentrations. In contrast to ambient concentrations, PM2.5 exposures were not significantly correlated with personal exposures to PM2.5-10, PM2.5 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 PM2.5 epidemiologic studies are unlikely to be due to confounding by the PM2.5 co-pollutants measured in this study.     

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.     

Maternal exposure to polybrominated and polychlorinated biphenyls: infant birth weight and gestational age

Understanding the influence of maternal exposures on gestational age and birth weight is essential given that pre-term and/or low birth weight infants are at risk for increased mortality and morbidity. We performed a retrospective analysis of a cohort exposed to polybrominated biphenyls (PBB) through accidental contamination of cattle feed and polychlorinated biphenyls (PCB) through residual contamination in the geographic region. Our study population consisted of 444 mothers and their 899 infants born between 1975 and 1997. Using restricted maximum likelihood estimation, no significant association was found between estimated maternal serum PBB at conception or enrollment PCB levels and gestational age or infant birth weight in unadjusted models or in models that adjusted for maternal age, smoking, parity, infant gender, and decade of birth. For enrollment maternal serum PBB, no association was observed for gestational age. However, a negative association with high levels of enrollment maternal serum PBB and birth weight was suggested. We also examined the birth weight and gestational age among offspring of women with the highest (10%) PBB or PCB exposure, and observed no significant association. Because brominated compounds are currently used in consumer products and therefore, are increasingly prevalent in the environment, additional research is needed to better understand the potential relationship between in utero exposure to brominated compounds and adverse health outcomes.     

Air pollution and health studies in China--policy implications

During the rapid economic development in China, ambient air pollutants in major cities, including PM10 (particulate matter with aerodynamic diameter < or =10 microm) and SO2 have been reduced due to various measures taken to reduce or control sources of emissions, whereas NO2 is stable or slightly increased. However, air pollution levels in China are still at the higher end of the world level. Less information is available regarding changes in national levels of other pollutants such as PM2.5 and ozone. The Chinese Ministry of Environmental Protection (MOEP) set an index for "controlling/reducing total SO2 emissions" to evaluate the efficacy of air pollution control strategy in the country. Total SO2 emissions declined for the first time in 2007. Chinese epidemiologic studies evidenced adverse health effects of ambient air pollution similar to those reported from developed countries, though risk estimates on mortality/morbidity per unit increase of air pollutant are somewhat smaller than those reported in developed countries. Disease burden on health attributable to air pollution is relatively greater in China because of higher pollution levels. Improving ambient air quality has substantial and measurable public health benefits in China. It is recommended that the current Chinese air quality standards be updated/revised and the target for "controlling/reducing total SO2 emissions" be maintained and another target for "reducing total NO2 emissions" be added in view of rapid increase in motor vehicles. Continuous and persistent efforts should be taken to improve ambient air quality.     

Evaluation of air quality by passive and active sampling in an urban city in Turkey: current status and spatial analysis of air pollution exposure

Concentrations of air pollutants, nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), ozone (O(3)), particulate matter (PM(2.5) and PM(10)), trace metals, and polycyclic aromatic hydrocarbons (PAHs) were measured in 2008 and 2009 in the city of Eski?ehir, central Turkey. Spatial distributions of NO(2), SO(2), and ozone were determined by passive sampling campaigns carried out during two different seasons with fairly large spatial coverage. A basic population exposure assessment was carried out employing Geographical Information System techniques by combining population density maps with pollutant distribution maps of NO(2) and SO(2). It was found that 95 % of the population is exposed to NO(2) levels close to the World Health Organization guideline value. Regarding SO(2), a large proportion of the population (83 %) is exposed to levels above the WHO second interim target value. Concentrations of all the pollutants showed a seasonal pattern increasing in winter period, except for ozone having higher concentrations in summer season. Daily PM(10) and PM(2.5) concentrations exceeded European Union limit values almost every sampling day. Toxic fractions of the measured PAHs were calculated and approximately fourfold increase was observed in winter period. Copper, Pb, Sn, As, Cd, Zn, Sb, and Se were found to be moderately to highly enriched in PM(10) fraction, indicating anthropogenic input to those elements measured. Exposure assessment results indicate the need for action to reduce pollutant emissions especially in the city center. Passive sampling turns out to be a practical and economical tool for air quality assessment with large spatial coverage.