Constrained confidence intervals in time series studies of mortality and air pollution

This paper focuses on constrained confidence intervals in the context of environmental time series studies where one seeks to ascertain the effects of ambient air pollution on human mortality. If the regression parameter representing such effects is non-negative, corresponding to a belief that more pollution cannot be beneficial, a desirable goal is to produce a constrained confidence interval for the parameter which is entirely non-negative. We show how this goal can be achieved using the method of tail functions. The proposed methodology is illustrated by the application to an environmental study of 100 cities in the United States involving regressions of mortality counts on levels of particulate matter air pollution. The large number of constrained CIs that contain zero is an indication that for the majority of the 100 cities there is not enough evidence to conclude a positive association between air pollution and mortality.     

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.     

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.     

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.     

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.     

High resolution exposure modelling of heat and air pollution and the impact on mortality

BackgroundElevated temperature and air pollution have been associated with increased mortality. Exposure to heat and air pollution, as well as the density of vulnerable groups varies within cities. The objective was to investigate the extent of neighbourhood differences in mortality risk due to heat and air pollution in a city with a temperate maritime climate.MethodsA case-crossover design was used to study associations between heat, air pollution and mortality. Different thermal indicators and air pollutants (PM₁₀, NO₂, O₃) were reconstructed at high spatial resolution to improve exposure classification. Daily exposures were linked to individual mortality cases over a 15 year period.ResultsSignificant interaction between maximum air temperature (Ta_max) and PM₁₀ was observed. During “summer smog” days (Ta_max > 25 °C and PM₁₀ > 50 μg/m³), the mortality risk at lag 2 was 7% higher compared to the reference (Ta_max 15 °C and PM₁₀ 15 μg/m³). Persons above age 85 living alone were at highest risk.ConclusionWe found significant synergistic effects of high temperatures and air pollution on mortality. Single living elderly were the most vulnerable group. Due to spatial differences in temperature and air pollution, mortality risks varied substantially between neighbourhoods, with a difference up to 7%.     

Indoor air pollution

As national trends accelerate towards the reduction of ventilation and infiltration rates in buildings, coupled with an increased use of synthetic chemicals in the indoor environment, a new phenomenon has arisen: the “sick building” syndrome. Traditional approaches to environmental health developed for the outdoor air, or for the industrial occupational setting, are inadequate to deal with this problem. It is argued that a comprehensive approach to the problem of indoor air pollution is necessary to protect public health.     

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.     

Cancer risk assessment of selected hazardous air pollutants in Seattle

The risk estimates calculated from the conventional risk assessment method usually are compound specific and provide limited information for source-specific air quality control. We used a risk apportionment approach, which is a combination of receptor modeling and risk assessment, to estimate source-specific lifetime excess cancer risks of selected hazardous air pollutants. We analyzed the speciated PM(2.5) and VOCs data collected at the Beacon Hill in Seattle, WA between 2000 and 2004 with the Multilinear Engine to first quantify source contributions to the mixture of hazardous air pollutants (HAPs) in terms of mass concentrations. The cancer risk from exposure to each source was then calculated as the sum of all available species' cancer risks in the source feature. We also adopted the bootstrapping technique for the uncertainty analysis. The results showed that the overall cancer risk was 6.09 x 10(-5), with the background (1.61 x 10(-5)), diesel (9.82 x 10(-6)) and wood burning (9.45 x 10(-6)) sources being the primary risk sources. The PM(2.5) mass concentration contributed 20% of the total risk. The 5th percentile of the risk estimates of all sources other than marine and soil were higher than 110(-6). It was also found that the diesel and wood burning sources presented similar cancer risks although the diesel exhaust contributed less to the PM(2.5) mass concentration than the wood burning. This highlights the additional value from such a risk apportionment approach that could be utilized for prioritizing control strategies to reduce the highest population health risks from exposure to HAPs.     

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.     

Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study

IntroductionLong-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France.ObjectivesWe analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013.MethodsThe study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM₁₀, PM_10–2.5, PM_2.5, NO₂, O₃, SO₂, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations.ResultsThe cohort recorded 1967 non-accidental deaths. Long-term exposures to baseline PM_2.5, PM_10-25, NO₂ and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 μg/m³, PM_10-25; HR = 1.09;95% CI: 1.04, 1.15 per 2.2 μg/m³, NO₂: HR = 1.14; 95% CI: 0.99, 1.31 per 19.3 μg/m³ and benzene: HR = 1.10; 95% CI: 1.00, 1.22 per 1.7 μg/m³).The strongest association was found for PM₁₀: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 μg/m³. PM₁₀, PM_10-25 and SO₂ were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality.ConclusionLong-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.     

The protection of wildlife from mortality: hypothesis and results for risk assessment

Wildlife deaths associated with cyanide-bearing tailings dams are a significant environmental issue that has affected the gold mining industries for many years and still characterized by little knowledge about how to measure, monitoring, reduce or eliminate those deaths. The purpose of this paper is statistically to determine: the potential for establishing causal relations between exposure to cyanide (in its most common species relevant to tailings) and response (measured by death counts), to develop a protocol of data analysis, the understanding of the significance of data gaps, and the effect of likely risk management interventions to achieve the goals of the International Cyanide Management Code (ICMC); [ICMC The International Cyanide Management Institute. International cyanide management code, the international cyanide management institute 2005, www.cyanidecode.org.]. However, operator's certification under the ICMC is difficult because of the limited data and potentially serious under-estimation of the death counts. This is due to observational skill and monitoring frequency, the small size of the carcasses, large extent of tailings facilities, carcasses loss by; entombment in tailings, sink, or taken by scavenging wildlife. This (1st order or bounding) assessment results focus on bird-deaths, which appear to be most frequent at sites where elevated cyanide concentrations are found. Those results indicate that the empirical causal associations we generate support the hypotheses that: This paper also develops the basis for a complete risk assessment study to be based on additional data gathering activities and detailed statistical analyses. These two activities, combined with a risk management plan also being developed, will provide a tool for compliance with the ICMC.     

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.     

Regional multi-compartment ecological risk assessment: Establishing cadmium pollution risk in the northern Bohai Rim,China

Ecological risk assessment (ERA) has been widely applied in characterizing the risk of chemicals to organisms and ecosystems. The paucity of toxicity data on local biota living in the different compartments of an ecosystem and the absence of a suitable methodology for multi-compartment spatial risk assessment at the regional scale has held back this field. The major objective of this study was to develop a methodology to quantify and distinguish the spatial distribution of risk to ecosystems at a regional scale. A framework for regional multi-compartment probabilistic ecological risk assessment (RMPERA) was constructed and corroborated using a bioassay of a local species. The risks from cadmium (Cd) pollution in river water, river sediment, coastal water, coastal surface sediment and soil in northern Bohai Rim were examined. The results indicated that the local organisms in soil, river, coastal water, and coastal sediment were affected by Cd. The greatest impacts from Cd were identified in the Tianjin and Huludao areas. The overall multi-compartment risk was 31.4% in the region. The methodology provides a new approach for regional multi-compartment ecological risk assessment.     

Estimation of age-related vulnerability to air pollution: assessment of respiratory health at local scale

This paper demonstrates association of short-term variation in pollution and health outcomes within the same geographical area for a typical urban setting in the northern part of the UK from time series analysis. It utilises publicly available datasets for regulated air pollutants (PM??, NO?, SO?, CO and O?), meteorology and respiratory hospital admissions (and mortality) between April 2002 and December 2005 to estimate the respiratory health effect of pollution exposure, mainly in the elderly. Our results show that PM?? and O? are positively associated with respiratory hospital admissions in the elderly, specifically in the age group 70-79. CO effects seem to be concentrated on the most elderly age group (80+) whereas NO? seems to have the opposite age-related effect, with lower effects on the more elderly.     

Associations between short/medium-term variations in black smoke air pollution and mortality in the Glasgow conurbation,UK

ObjectivesTo examine associations between short/medium-term variations in black smoke air pollution and mortality in the population of Glasgow and the adjacent towns of Renfrew and Paisley over a 25-year period at different time lags (0–30 days).MethodsGeneralised linear (Poisson) models were used to investigate the relationship between lagged black smoke concentrations and daily mortality, with allowance for confounding by cold temperature, between 1974 and 1998.ResultsWhen a range of lag periods were investigated significant associations were noted between temperature-adjusted black smoke exposure and all-cause mortality at lag periods of 13–18 and 19–24 days, and respiratory mortality at lag periods of 1–6, 7–12, and 13–18 days. Significant associations between cardiovascular mortality and temperature-adjusted black smoke were not observed. After adjusting for the effects of temperature a 10 μg m^− 3 increase in black smoke concentration on a given day was associated with a 0.9% [95% Confidence Interval (CI): 0.3–1.5%] increase in all cause mortality and a 3.1% [95% CI: 1.4–4.9%] increase in respiratory mortality over the ensuing 30-day period. In contrast for a 10 μg m^− 3 increase in black smoke concentration over 0–3 day lag period, the temperature adjusted exposure mortality associations were substantially lower (0.2% [95% CI: − 0.0–0.4%] and 0.3% [95% CI: − 0.2–0.8%] increases for all-cause and respiratory mortality respectively).ConclusionsThis study has provided evidence of association between black smoke exposure and mortality at longer lag periods than have been investigated in the majority of time series analyses.     

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.     

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.     

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.     

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.