ArticlePublisher preview available

Mortality risk and PM2.5 air pollution in the USA: An analysis of a national prospective cohort

DOI:10.1007/s11869-017-0535-3
Authors:
C. Arden Pope at Brigham Young University - Provo Main Campus
C. Arden Pope
Majid Ezzati
Majid Ezzati
Majid Ezzati
  • This person is not on ResearchGate, or hasn't claimed this research yet.
John B. Cannon
John B. Cannon
John B. Cannon
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Ryan T. Allen
Ryan T. Allen
Ryan T. Allen
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Show all 6 authorsHide
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Epidemiologic evidence indicates that exposure to fine particulate matter air pollution (PM2.5) contributes to global burden of disease, primarily because of increased risk of cardiovascular morbidity and mortality. This study evaluates associations between long-term PM2.5 exposure and mortality risk in national, representative cohorts of the US adult population, constructed from public-use National Health Interview Survey (NHIS) data. Two cohorts consisting of 392,807 and 162,373 individuals (without and with individual smoking data) were compiled from public-use NHIS survey data (1986–2001) with mortality linkage through 2011. Cohorts included persons who lived in a metropolitan statistical area (MSA) were 18–84 years of age and had individual risk factor information. Modeled PM2.5 exposures were assigned as MSA-level mean ambient concentration for 1999 through 2008. Mortality hazard ratios (HRs) were estimated using Cox proportional hazard regression models, controlling for age, race, sex, income, marital status, education, body mass index, and smoking status. Estimated HRs for all-cause and cardiovascular mortality, associated with a 10-μg/m³ exposure increment of PM2.5 were 1.06 (1.01–1.11) and 1.34 (1.21–1.48), respectively, in models that controlled for various individual risk factors, including smoking. This study provides evidence that elevated risks of mortality, especially cardiovascular disease mortality, are associated with long-term exposure to PM2.5 air pollution in US nationwide adult cohorts constructed from public-use NHIS data.
Figures - available from: Air Quality Atmosphere & Health
This content is subject to copyright. Terms and conditions apply.
  • A preview of this full-text is provided by Springer Nature.
  • Learn more
Preview content only
Content available from Air Quality Atmosphere & Health
This content is subject to copyright. Terms and conditions apply.
Mortality risk and PM
2.5
air pollution in the USA: an analysis of a national
prospective cohort
C. Arden Pope III
1
&Majid Ezzati
2
&John B. Cannon
1
&Ryan T. Allen
1
&Michael Jerrett
3
&Richard T. Burnett
4
Received: 14 March 2017 /Accepted: 30 November 2017 /Published online: 8 December 2017
#Springer Science+Business Media B.V., part of Springer Nature 2017
Abstract
Epidemiologic evidence indicates that exposure to fine particulate matter air pollution (PM
2.5
) contributes to global burden of
disease, primarily because of increased risk of cardiovascular morbidity and mortality. This study evaluates associations between
long-term PM
2.5
exposure and mortality risk in national, representative cohorts of the US adult population, constructed from
public-use National Health Interview Survey (NHIS) data. Two cohorts consisting of 392,807 and 162,373 individuals (without
and with individual smoking data) were compiled from public-use NHIS survey data (1986–2001) with mortality linkage through
2011. Cohorts included persons who lived in a metropolitan statistical area (MSA) were 18–84 years of age and had individual
risk factor information. Modeled PM
2.5
exposures were assigned as MSA-level mean ambient concentration for 1999 through
2008. Mortality hazard ratios (HRs) were estimated using Cox proportional hazard regression models, controlling for age, race,
sex, income, marital status, education, body mass index, and smoking status. Estimated HRs for all-cause and cardiovascular
mortality, associated with a 10-μg/m
3
exposure increment of PM
2.5
were 1.06 (1.01–1.11) and 1.34 (1.21–1.48), respectively, in
models that controlled for various individual risk factors, including smoking. This study provides evidence that elevated risks of
mortality, especially cardiovascular disease mortality, are associated with long-term exposure to PM
2.5
air pollution in US
nationwide adult cohorts constructed from public-use NHIS data.
Keywords Air pollution .PM
2.5
.Mortality .Cohort study .Cardiovascular mortality
Introduction
There is growing evidence that long-term exposure to ambient
fine particulate matter air pollution (suspended particles ≤
2.5 μm in aerodynamic diameter, PM
2.5
), even at concentrations
common to US urban areas, contributes to increased risk of
cardiovascular disease (Adar et al. 2013; Brook et al. 2010;
Franklin et al. 2015; Kaufman et al. 2016; Krishnan et al.
2012) and mortality (Hoek et al. 2013; Kioumourtzoglou et al.
2016;Dietal.2017). Recent assessments of health risk factors
that contribute to global burden of disease estimate that expo-
sure to ambient air pollution is the fourth largest contributor to
premature mortality worldwide—largely because of the estimat-
ed contribution of PM
2.5
on cardiovascular disease (GBD 2015
Risk factors collaborators 2016). Given the estimated impact of
PM
2.5
on human health, there is need for additional evidence
from nationally representative cohorts.
Survival analyses of the effects of long-term PM
2.5
air pollu-
tion exposure have provided primary evidence regarding the
impacts of long-term exposure. These studies have been con-
ducted using multiple cohorts from the USA (Dockery et al.
1993; Jerrett et al. 2017; Kioumourtzoglou et al. 2016;
Lepeule et al. 2012; Miller et al. 2007;Popeetal.2002;Puett
et al. 2009,2011;Thurstonetal.2016; Zeger et al. 2008;Di
et al. 2017), Europe (Beelen et al. 2014; Carey et al. 2013;
Cesaroni et al. 2013), and Canada (Crouse et al. 2012,2015).
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11869-017-0535-3) contains supplementary
material, which is available to authorized users.
*C. Arden Pope, III
cap3@byu.edu
1
Department of Economics, Brigham Young University, Provo, UT,
USA
2
MRC-PHE Centre for Environment and Health, School of Public
Health, Imperial College London, London, UK
3
Environmental Health Sciences, UCLA Fielding School of Public
Health, University of California Los Angeles, Los Angeles, CA,
USA
4
Environmental Health Directorate, Health Canada, Ottawa, Canada
Air Quality, Atmosphere & Health (2018) 11:245–252
https://doi.org/10.1007/s11869-017-0535-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The attributable proportion was 9.89%. Ansari and Ehrampoush showed the RR 1.062 due to long-term PM 2.5 exposure between the years 2017-2018 at concentrations above 10 µg/m 3 , which is less than the RR value obtained in our study [36]. ...
Modeling Air Pollution Health Risk for Environmental Management of an Internationally Important Site: The Salt Range (Kallar Kahar), Pakistan
Article
Full-text available
  • Jan 2022
This study aimed to assess the health effects of emissions released by cement industries and allied activities, such as mining and transportation, in the salt range area of district Chakwal, Pakistan. DISPER was used to estimate dispersion and contribution of source emission by cement industries and allied activities to surface accumulation of selected pollutants (PM2.5, PM10, NOx, and O3). To assess the long-term effects of pollutants on human health within the radius of 500 m to 3 km, Air Q+ software was used, which was designed by the World Health Organization (WHO). One-year average monitoring data of selected pollutants, coordinates, health data, and population data were used as input data for the model. Data was collected on lung cancer mortality among different age groups (25+ and 30+), infant post-neonatal mortality, mortality due to respiratory disease, and all-cause mortality due to PM2.5 and NO2. Results showed that PM2.5 with the year-long concentration of 27.3 ug/m3 contributes a 9.9% attributable proportion (AP) to lung cancer mortality in adults aged 25+, and 13.8% AP in adults age 30+. Baseline incidence is 44.25% per 100,000 population. PM10 with the year-long concentration of 57.4 ug/m3 contributes 16.96% AP to infant post-neonatal mortality and baseline incidence is 53.86% per 1000 live births in the country. NO2 with the year-long concentration of 14.33 ug/m3 contributes 1.73% AP to all-cause mortality. Results obtained by a simulated 10% reduction in pollutant concentration showed that proper mitigation measures for reduction of pollutants’ concentration should be applied to decrease the rate of mortalities and morbidities. Furthermore, the study showed that PM2.5 and PM10 are significantly impacting the human health in the nearby villages, even after mitigation measures were taken by the selected cement industries. The study provides a roadmap to policymakers and stakeholders for environmental and health risk management in the area.
... First, a variety of adverse health outcomes is attributed to long-term exposure to air pollution. Evidence showed that acute respiratory symptoms, exacerbated asthma, and nonfatal heart attacks, among others, were associated with long-term exposure to air pollutants, especially PM 2.5 and O 3 (Dedoussi et al. 2020;Lelieveld et al. 2015;Pope et al. 2018). The mechanisms of these diseases are as follows: fine particles carry more radioactive elements producing free radicals; destroy the balance of intracellular calcium; and are related to inflammatory injury (Xing et al. 2016). ...
Impacts of air pollution on COVID-19 case fatality rate: a global analysis
Article
Full-text available
The coronavirus disease 2019 (COVID-19) pandemic is still rapidly spreading globally. To probe high-risk cities and the impacts of air pollution on public health, this study explores the relationship between the long-term average concentration of air pollution and the city-level case fatality rate (CFR) of COVID-19 globally. Then, geographically weighted regression (GWR) is applied to examine the spatial variability of the relationships. Six air pollution factors, including nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), PM2.5 (particles with diameter ≤2.5 μm), PM10 (particles with diameter ≤10 μm), and air quality index (AQI), are positively associated with the city-level COVID-19 CFR. Our results indicate that a 1-unit increase in NO2 (part per billion, PPB), SO2 (PPB), O3 (PPB), PM2.5 (microgram per cubic meter, μg/m3), PM10 (μg/m3), AQI (score), is related to a 1.450%, 1.005%, 0.992%, 0.860%, 0.568%, and 0.776% increase in the city-level COVID-19 CFR, respectively. Additionally, the effects of NO2, O3, PM2.5, AQI, and probability of living with poor AQI on COVID-19 spatially vary in view of the estimation of the GWR. In other words, the adverse impacts of air pollution on health are different among the cities. In summary, long-term exposure to air pollution is negatively related to the COVID-19 health outcome, and the relationship is spatially non-stationary. Our research sheds light on the impacts of slashing air pollution on public health in the COVID-19 pandemic to help governments formulate air pollution policies in light of the local situations.
... Thus, a CBSA or metropolitan division area's average concentration of air pollution may be closer to a person's actual exposure than the concentration at the centroid point of the person's residential postal code. Additionally, unlike Pope et al. [39] in which air pollution exposures were assigned at the metropolitan statistical area level, we assigned PM2.5 exposures to subjects living in the 11 largest metropolitan statistical areas based on their metropolitan division area codes, which can reduce the exposure misclassification error generated by the over-large metropolitan areas. ...
Fine particles matter components and interstitial lung disease in rheumatoid arthritis
Article
  • Dec 2021
Exposure to ambient fine particulate matter (PM 2.5 ) is a risk factor for pulmonary and systemic autoimmune diseases, however evidence on which PM 2.5 chemical components are more harmful is still scant. Our goal is to investigate potential associations between PM 2.5 components and interstitial lung disease (ILD) onset in rheumatoid arthritis (RA). New-onset RA subjects identified from a United States health care insurance database (MarketScan) were followed for new onset of RA associated ILD (RA-ILD) from 2011 to 2018. Annual ambient PM 2.5 concentrations of its chemical components ( i.e. sulfate, nitrate, ammonium, organic matter, black carbon, mineral dust, and sea salt) were estimated by combining satellite retrievals with chemical transport modelling and refined by geographically weighted regression. Exposures from 2006 up to one year before ILD onset or end of study were assigned to subjects based on their metropolitan division or core-based statistical area codes. A novel time-to-event quantile-based g(generalised)-computation approach was used to estimate potential associations between RA-ILD onset and the exposure mixture of all seven PM 2.5 chemical components adjusting for age, sex, and prior chronic obstructive pulmonary disease (as a proxy for smoking). We followed 280 516 new-onset RA patients and detected 2194 RA-ILD cases across 1 394 385 person-years. The adjusted hazard ratio for RA-ILD onset was 1.54 (95% confidence interval 1.47–1.63) per every decile increase in all seven exposures. Ammonium, mineral dust, and black carbon contributed more to ILD risk than the other PM 2.5 components. In conclusion, exposure to elements of PM 2.5 , particularly ammonium, increases ILD risk in RA.
... Several studies have considered the potential mechanism of air pollutant filtration by trees (Dzhambov et al., 2018;James et al., 2016;Orioli et al., 2019). Air pollutants are linked to many adverse health outcomes including preterm birth (Klepac et al., 2018), cardiovascular diseases (Dabass et al., 2018), cardiovascular mortality and allcause mortality (Pope et al., 2018). Nowak et al. (2014) estimated that trees across the conterminous U.S. could remove 17.4 million tonnes of NO 2 , PM 2.5 , and O 3 annually, preventing approximately 850 air pollution-related deaths per year. ...
Types and spatial contexts of neighborhood greenery matter in associations with weight status in women across 28 U.S. communities
Article
Excess body weight is a risk factor for many chronic diseases. Studies have identified neighborhood greenery as supportive of healthy weight. However, few have considered plausible effect pathways for ecosystem services (e.g., heat mitigation, landscape aesthetics, and venues for physical activities) or potential variations by climate. This study examined associations between weight status and neighborhood greenery that capture ecosystem services most relevant to weight status across 28 U.S. communities. Weight status was defined by body mass index (BMI) reported for 6,591 women from the U.S. Sister Study cohort. Measures of greenery within street and circular areas at 500m and 2000m buffer distances from homes were derived for each participant using one-meter land cover data. Street area is defined as 25m-wide zone on both sides of street centerlines multiplied by the buffer distances, and circular area is the area of the circle centered on the home within each of the buffer distances. Measures of street greenery characterized the pedestrian environment to capture physically and visually accessible greenery for shade and aesthetics. Circular greenery was generated for comparison. Greenery types of tree and herbaceous cover were quantified separately, and a combined measure of tree and herbaceous cover (i.e., aggregate greenery) was also included. Mixed models accounting for the clustering at the community level were applied to evaluate the associations between neighborhood greenery and the odds of being overweight or obese (BMI > 25) with adjustment for covariates selected using gradient boosted regression trees. Analyses were stratified by climate zone (arid, continental, and temperate). Tree cover was consistently associated with decreased odds of being overweight or obese. For example, the adjusted odds ratio [AOR] was 0.92, 95% Confidence Interval [CI]: 0.88 – 0.96, given a 10% increase in street tree cover at the 2000m buffer across the 28 U.S. communities. These associations held across climate zones, with the lowest AOR in the arid climate (AOR: 0.74, 95% CI: 0.54 – 1.01). In contrast, associations with herbaceous cover varied by climate zone. For the arid climate, a 10% increase in street herbaceous cover at the 2000m buffer was associated with lower odds of being overweight or obese (AOR: 0.75, 95% CI: 0.55 – 1.03), whereas the association was reversed for the temperate climate, the odds increased (AOR: 1.19, 95% CI: 1.05 – 1.35). Associations between greenery and overweight/obesity varied by type and spatial context of greenery, and climate. Our findings add to a growing body of evidence that greenery design in urban planning can support public health. These findings also justify to further define the mechanism that underlies the observed associations.
... It was reported that global greenhouse gas emissions have increased nearly 2 times over, nitrous oxide emissions have increased 1.5 times over from 1970 to 2012, and the forest area has decreased by nearly 1.3 million km 2 from 1990 to 2016 (World Bank, 2018). Meanwhile, many countries such as China, India and the USA have suffered severe air pollution, especially PM 2.5 air pollution (Balakrishnan et al., 2019;Pope et al., 2017;Zhang et al., 2019c). ...
Eco-efficiency, eco-technology innovation and eco-well-being performance to improve global sustainable development
Article
In today's world, determining how to improve the quality of the economy, technology innovation and human well-being within resource and environmental limits is a global sustainable development goal. Thus, research on eco-efficiency (EE), eco-technology innovation (ETI) and eco-well-being performance (EWP) has great significance for improving the efficiency of converting ecological consumption into economic benefits, technological innovation and human well-being. This paper presents a two-stage Super-slack-based measure (SBM) model to examine the EE, ETI and EWP (3E) of 102 countries. The indicator system for the 3E network process is constructed by using inputs, intermediate products and outputs. The empirical results show that the highest 3E performers are Singapore, the United States and Iceland. The results also indicate that countries with high levels of economic development have much better EE, ETI and EWP levels than low-income countries. After comparing the values of the 3E in different countries with the global average, the results further show that overall global 3E performance is relatively low. These findings provide significant references to help governments generate different strategies for improving national 3E performance.
... In recent years, there has been growing attention to the role of housing factors in the transmission of influenza. In the United States of America, ambient air pollution was linked to influenza and pneumonia [9]. In China, Wang et al. [10] found a dose-response trend in exposure to indoor air pollution and influenza-like illness (ILI) after controlling for potential confounding factors: Cooking frequency, the use of coal as the primary fuel, and ventilation practices were associated with ILI [10]. ...
Housing Quality in a Rural and an Urban Settlement in South Africa
Article
Full-text available
  • Feb 2021
During 2016 to 2018, a prospective household cohort study of influenza and respiratory syncytial virus community burden and transmission dynamics (the PHIRST study) was undertaken to examine the factors associated with influenza and other respiratory pathogen transmissions in South Africa. We collected information on housing conditions in the PHIRST study sites: Rural villages near Agincourt, Bushbuckridge Municipality, Mpumalanga Province, and urban Jouberton Township in North West Province. Survey data were collected from 159 and 167 study households in Agincourt and Jouberton, respectively. Multiple housing-related health hazards were identified in both sites, but particularly in Agincourt. In Agincourt, 75% (119/159) of households reported daily or weekly interruptions in water supply and 98% (154/159) stored drinking water in miscellaneous containers, compared to 1% (1/167) and 69% (115/167) of households in Jouberton. Fuels other than electricity (such as wood) were mainly used for cooking by 44% (70/159) and 7% (11/167) of Agincourt and Jouberton households, respectively; and 67% (106/159) of homes in Agincourt versus 47% (79/167) in Jouberton were located on unpaved roads, which is associated with the generation of dust and particulate matter. This study has highlighted housing conditions in Agincourt and Jouberton that are detrimental to health, and which may impact disease severity or transmission in South African communities.
Air pollution trajectories and life expectancy in Nigeria
Article
Purpose The purpose of the study is to examine the relationship between air pollution and life expectancy considering the roles of institutional quality, agricultural output, foreign direct investment (FDI) and other socio-economic variables in Nigeria from 1981Q1 to 2019Q4. Design/methodology/approach The study employed spliced quarterly data from annual series collected from the World Bank development indicators and Central Bank of Nigeria. The dynamic multivariate models were analysed using the vector error correction mechanism (VECM), variance decomposition and Granger causality techniques. Findings The VECM result indicated a statistically significant adverse effect of air pollution on life expectancy. However, institutional quality, gross domestic product per capita, agricultural output, government social expenditure and school enrolment rate ameliorate the adverse health effects of air pollution, while FDI had mixed effects on life expectancy at different significance levels and at varying lag lengths. The Granger causality result revealed a uni-directional causality from air pollution to life expectancy; bidirectional causal chain between agriculture, FDI, government social expenditure and life expectancy, while a uni-directional causal linkage run from life expectancy to income per head and from school enrolment to life expectancy respectively. However, there is no evidence of causation between institutional quality and life expectancy due to weak institutional quality, but foreign direct invest causes carbon emission in a uni-directional manner in line with pollution haven hypothesis. Research limitations/implications The study's modelling is limited by not considering the resource curse variable in the model due to paucity of data. Nigeria is the biggest crude oil exporter in Africa and ranks 13th globally with daily output of about 2.4 m barrels. Thus, the negation of resource curse in air pollution–life expectancy nexus de-emphasises the effectiveness of rich resources on health and environment. Future studies could address this limitation by incorporating resource curse in environmental-health models for Nigeria. Practical implications It is imperative for the country to adopt stringent anti-air pollution strategies that would establish a balance between FDI attraction and agricultural expansion to the benefits of her citizens' longevity. Also, education should be considered as a strategic action to enhance life expectancy through expansion in the provision, accessibility and affordability to improved school enrolment rate. The choice of quarterly time series over annual data helped to establish the current relationship between air pollution and life expectancy using efficient estimators. Originality/value The study contributes to literature by disaggregating yearly series into quarterly series, which has implications for the efficiency of the estimates, unlike earlier studies which ignored this fundamental process. The result of this study produced reliable policy direction for improvement in life expectancy in an emerging economy since quarterly estimates are more robust and reliable for forecasting than its yearly counterpart. The outcome of the study extended the original tenets of the Grossman's health stock theory using the environmental Kuznets curve (EKC) and pollution haven hypotheses (PHH).
Measurement report: Receptor modeling for source identification of urban fine and coarse particulate matter using hourly elemental composition
Article
  • Sep 2021
The elemental composition of the fine (PM2:5) and coarse (PM2:5-10) fraction of atmospheric particulate matter was measured at an hourly time resolution by the use of a streaker sampler during a winter period at a Central European urban background site in Warsaw, Poland. A combination of multivariate (Positive Matrix Factorization) and wind- (Conditional Probability Function) and trajectory-based (Cluster Analysis) receptor models was applied for source apportionment. It allowed for the identification of five similar sources in both fractions, including sulfates, soil dust, road salt, and traffic- and industry-related sources. Another two sources, i.e., Cl-rich and wood and coal combustion, were solely identified in the fine fraction. In the fine fraction, aged sulfate aerosol related to emissions from domestic solid fuel combustion in the outskirts of the city was the largest contributing source to fine elemental mass (44 %), while trafficrelated sources, including soil dust mixed with road dust, road dust, and traffic emissions, had the biggest contribution to the coarse elemental mass (together accounting for 83 %). Regional transport of aged aerosols and more local impact of the rest of the identified sources played a crucial role in aerosol formation over the city. In addition, two intensive Saharan dust outbreaks were registered on 18 February and 8 March 2016. Both episodes were characterized by the long-range transport of dust at 1500 and 3000m over Warsaw and the concentrations of the soil component being 7 (up to 3.5 μgm-3) and 6 (up to 6.1 μgm-3) times higher than the mean concentrations observed during non-episodes days (0.5 and 1.1 μgm-3) in the fine and coarse fractions, respectively. The set of receptor models applied to the high time resolution data allowed us to follow, in detail, the daily evolution of the aerosol elemental composition and to identify distinct sources contributing to the concentrations of the different PM fractions, and it revealed the multi-faceted nature of some elements with diverse origins in the fine and coarse fractions. The hourly resolution of meteorological conditions and air mass back trajectories allowed us to follow the transport pathways of the aerosol as well.
Measurement report: Receptor modelling for source identification of urban fine and coarse particulate matter using hourly elemental composition
Preprint
Full-text available
  • Apr 2021
Elemental composition of the fine (PM2.5) and coarse (PM2.5-10) fraction of atmospheric particulate matter was measured at hourly time resolution by the use of a “streaker” sampler during a winter period at a Central European urban background site in Warsaw, Poland. A combination of multivariate (Positive Matrix Factorization), wind- (Conditional Probability Function) and trajectory-based (Cluster Analysis) receptor models, was applied for source apportionment. It allowed for identification of 5 similar sources in both fractions, including sulfates, soil dust, road salt, traffic- and industry-related sources. Another 2 sources, i.e., Cl-rich and wood and waste combustion, were identified in the fine fraction solely. In the fine fraction, aged sulfate aerosol related with emissions from solid fuel combustion in the residential sector located outside the city was the largest contributing source to fine elemental mass (44 %), while traffic-related sources, including soil dust mixed with road dust, road dust, as well as exhaust and non-exhaust traffic emissions, had the biggest contribution in the coarse elemental mass (together accounting for 83 %). Regional transport of aged aerosols and more local impact of the rest of identified sources played a crucial role in aerosol formation over the city. In addition, 2 intensive Saharan dust outbreaks were registered on 18th February and 8th March 2016. Both episodes were characterized by long-range transport of dust at 1 500 m and 3 000 m over Warsaw, as well as the concentrations of the soil component being 7 (up to 3.5 µg m−3) and 6 (up to 6.1 µg m−3) times higher than the mean concentrations observed during non-episodes days (0.5 µg m−3 and 1.1 µg m−3) in the fine and coarse fraction, respectively. The set of receptor models applied to the high time resolution data allowed to follow in detail the daily evolution of the aerosol elemental composition and to identify distinct sources contributing to the concentrations of different PM fractions, as well as revealed “multi-faces” of some elements, having diverse origin in the fine and coarse fraction. The hourly resolution of meteorological conditions and air mass back trajectories empower to follow transport pathways of the aerosol as well.
Systematic review of the association between long-term exposure to fine particulate matter and mortality
Article
Full-text available
  • Apr 2021
We used a transparent systematic review framework based on best practices for evaluating study quality and integrating evidence to conduct a review of the available epidemiology studies evaluating associations between long-term exposure to ambient concentrations of PM2.5 and mortality (all-cause and non-accidental) conducted in North America. We found that while there is some consistency across studies for reporting positive associations, these associations are weak and several important methodological issues have led to uncertainties with regard to the evidence from these studies, including potential confounding by measured and unmeasured factors, exposue measurement error, and model misspecification. These uncertainties provide a plausible, alternative explanation to causality for the weakly positive findings across studies. Using a causality framework that incorporates best practices for making causal determinations, we concluded that the evidence for a causal relationship between long-term exposure to ambient PM2.5 concentrations and mortality from these studies is inadequate.
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Article
Full-text available
  • Nov 2018
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Article
Full-text available
  • Nov 2018
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Article
Full-text available
  • Nov 2018
Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk– outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Lancet 2018; 392: 1923–94 *Collaborators listed at the end of the paper Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evalution, Seattle, WA 98121, USA cjlm@uw.edu Global Health Metrics www.thelancet.com Vol 392 November 10, 2018 1923 Global Health Metrics Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.
Air Pollution and Mortality in the Medicare Population
Article
Full-text available
  • Jun 2017
Background Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups. Methods We constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up. Annual averages of fine particulate matter (particles with a mass median aerodynamic diameter of less than 2.5 μm [PM2.5]) and ozone were estimated according to the ZIP Code of residence for each enrollee with the use of previously validated prediction models. We estimated the risk of death associated with exposure to increases of 10 μg per cubic meter for PM2.5 and 10 parts per billion (ppb) for ozone using a two-pollutant Cox proportional-hazards model that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates. Results Increases of 10 μg per cubic meter in PM2.5 and of 10 ppb in ozone were associated with increases in all-cause mortality of 7.3% (95% confidence interval [CI], 7.1 to 7.5) and 1.1% (95% CI, 1.0 to 1.2), respectively. When the analysis was restricted to person-years with exposure to PM2.5 of less than 12 μg per cubic meter and ozone of less than 50 ppb, the same increases in PM2.5 and ozone were associated with increases in the risk of death of 13.6% (95% CI, 13.1 to 14.1) and 1.0% (95% CI, 0.9 to 1.1), respectively. For PM2.5, the risk of death among men, blacks, and people with Medicaid eligibility was higher than that in the rest of the population. Conclusions In the entire Medicare population, there was significant evidence of adverse effects related to exposure to PM2.5 and ozone at concentrations below current national standards. This effect was most pronounced among self-identified racial minorities and people with low income. (Supported by the Health Effects Institute and others.)
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015
Article
Full-text available
  • Oct 2016
Background: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Funding: Bill & Melinda Gates Foundation.
Comparing the Health Effects of Ambient Particulate Matter Estimated Using Ground-Based versus Remote Sensing Exposure Estimates
Article
Full-text available
Background: Remote sensing (RS) is increasingly used for exposure assessment in epidemiological and burden of disease studies, including those investigating whether chronic exposure to ambient fine particulate matter (PM2.5) is associated with mortality. Objectives: To compare relative risk estimates of mortality from diseases of the circulatory system for PM2.5 modeled from RS with that for PM2.5 modeled using ground-level information. Methods: We geocoded the baseline residence of 668,629 American Cancer Society Cancer Prevention Study II (CPS-II) cohort participants followed from 1982 to 2004 and assigned PM2.5 levels to all participants using seven different exposure models. Most of the exposure models were averaged for the years 2002-2004, while one RS estimate was for a longer, contemporaneous period. We used Cox proportional hazards regression to estimate relative risks (RR) for the association of PM2.5 with circulatory mortality and ischemic heart disease. Results: Estimates of mortality risk differed among exposure models. The smallest relative risk was observed for the RS estimates that excluded ground-based monitors for circulatory deaths (RR = 1.02 (95% confidence interval (CI): 1.00-1.04 per 10 µg/m(3) increment in PM2.5). The largest relative risk was observed for the land use regression model that included traffic information (RR = 1.14, 95% CI: 1.11-1.17 per 10 µg/m(3) increment in PM2.5). Conclusions: We found significant associations between PM2.5 and mortality in every model; however, relative risks estimated from exposure models using ground-based information were generally larger than those estimated with RS alone.
Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): A longitudinal cohort study
Article
Full-text available
Background: Long-term exposure to fine particulate matter less than 2.5 μm in diameter (PM2.5) and traffic-related air pollutant concentrations are associated with cardiovascular risk. The disease process underlying these associations remains uncertain. We aim to assess association between long-term exposure to ambient air pollution and progression of coronary artery calcium and common carotid artery intima-media thickness. Methods: In this prospective 10-year cohort study, we repeatedly measured coronary artery calcium by CT in 6795 participants aged 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) in six metropolitan areas in the USA. Repeated scans were done for nearly all participants between 2002 and 2005, for a subset of participants between 2005 and 2007, and for half of all participants between 2010 and 2012. Common carotid artery intima-media thickness was measured by ultrasound in all participants at baseline and in 2010-12 for 3459 participants. Residence-specific spatio-temporal pollution concentration models, incorporating community-specific measurements, agency monitoring data, and geographical predictors, estimated concentrations of PM2.5 and nitrogen oxides (NOX) between 1999 and 2012. The primary aim was to examine the association between both progression of coronary artery calcium and mean carotid artery intima-media thickness and long-term exposure to ambient air pollutant concentrations (PM2.5, NOX, and black carbon) between examinations and within the six metropolitan areas, adjusting for baseline age, sex, ethnicity, socioeconomic characteristics, cardiovascular risk factors, site, and CT scanner technology. Findings: In this population, coronary calcium increased on average by 24 Agatston units per year (SD 58), and intima-media thickness by 12 μm per year (10), before adjusting for risk factors or air pollutant exposures. Participant-specific pollutant concentrations averaged over the years 2000-10 ranged from 9.2-22.6 μg PM2.5/m(3) and 7.2-139.2 parts per billion (ppb) NOX. For each 5 μg PM2.5/m(3) increase, coronary calcium progressed by 4.1 Agatston units per year (95% CI 1.4-6.8) and for each 40 ppb NOX coronary calcium progressed by 4.8 Agatston units per year (0.9-8.7). Pollutant exposures were not associated with intima-media thickness change. The estimate for the effect of a 5 μg/m(3) higher long-term exposure to PM2.5 in intima-media thickness was -0.9 μm per year (95% CI -3.0 to 1.3). For 40 ppb higher NOX, the estimate was 0.2 μm per year (-1.9 to 2.4). Interpretation: Increased concentrations of PM2.5 and traffic-related air pollution within metropolitan areas, in ranges commonly encountered worldwide, are associated with progression in coronary calcification, consistent with acceleration of atherosclerosis. This study supports the case for global efforts of pollution reduction in prevention of cardiovascular diseases. Funding: US Environmental Protection Agency and US National Institutes of Health.
A class of non-linear exposure-response models suitable for health impact assessment applicable to large cohort studies of ambient air pollution
Article
Full-text available
  • Dec 2016
The effectiveness of regulatory actions designed to improve air quality is often assessed by predicting changes in public health resulting from their implementation. Risk of premature mortality from long-term exposure to ambient air pollution is the single most important contributor to such assessments and is estimated from observational studies generally assuming a log-linear, no-threshold association between ambient concentrations and death. There has been only limited assessment of this assumption in part because of a lack of methods to estimate the shape of the exposure-response function in very large study populations. In this paper, we propose a new class of variable coefficient risk functions capable of capturing a variety of potentially non-linear associations which are suitable for health impact assessment. We construct the class by defining transformations of concentration as the product of either a linear or log-linear function of concentration multiplied by a logistic weighting function. These risk functions can be estimated using hazard regression survival models with currently available computer software and can accommodate large population-based cohorts which are increasingly being used for this purpose. We illustrate our modeling approach with two large cohort studies of long-term concentrations of ambient air pollution and mortality: the American Cancer Society Cancer Prevention Study II (CPS II) cohort and the Canadian Census Health and Environment Cohort (CanCHEC). We then estimate the number of deaths attributable to changes in fine particulate matter concentrations over the 2000 to 2010 time period in both Canada and the USA using both linear and non-linear hazard function models. Electronic supplementary material The online version of this article (doi:10.1007/s11869-016-0398-z) contains supplementary material, which is available to authorized users.
Association Between Air Pollution and Coronary Artery Calcification Within Six Metropolitan Areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): A Longitudinal Cohort Study
Article
Ambient particulate matter air pollution exposure and mortality in the NIH-AARP diet and health cohort. Environ
Article