Overview of air pollution

A/Prof Bin JalaludinMBBS, MPH, PhD, MRCP (UK), FAFPHM

South Western Sydney Area Health Service, and

University of New South Wales

This talk

• Will give an overview of air pollution

• Will mainly focus on the common outdoor air pollutants

• Will discuss types of air pollutants

• Will discuss sources of air pollutants

• Will discuss health effects of air pollution

Air pollution – the problem

• Global– Ozone layer depletion– Greenhouse effect

• Regional– Acid rain– Haze and photochemical smog

• Local• Indoor (homes, factories, offices)

Air pollution – the problem

U p p er a tm o sph e reo zon e d ep le tion

C lim a te ch an ge d ue tog ree n ho use e ffe ct

G lo b a l

A c id R a in P h o to che m ica l sm ogH a ze

R e g io n a l

C O , S O 2 , P b , P M A ir T o x ics

L o ca l

P M , N O 2 , E TSA ir T o x icsB io lo g ica l

In do or

Effects of human activities on the atmosphere (NSW SOE 2000)

Ozone Layer Depletion

• Stratospheric ozone reduces harmful UV radiation

• Chloroflurocarbons (CFCs), methyl chloroform, carbon tetrachloride, halons, methyl bromide

• Montreal Protocol on Substances that Deplete the Ozone Layer

The vertical distribution of ozone in the atmosphere at mid-latitudes (Commonwealth SOE 2001)

Source: after WMO (1999)

Postulated steps from the release of halocarbons to increase in UV related biological damage

Halocarbons release chlorine and bromine ‘radicals’

Increase in ultraviolet-related biological damage

Stratospheric ozone layer depleted

Chlorine and bromine ‘radicals’ destroy ozone molecules

Increase in ultraviolet irradiance at ground level

1

2

3

4

Source: McMichael 1993

Average stratospheric ozone concentrations for the month of October (NSW SOE 2000)

Source: Bureau of Meteorology data, as at 1999

Concentrations of ozone-depleting substances, Cape Grim, Tasmania (NSW SOE 2000)

Source: CSIRO data, as at 1999

Past and future stratospheric chlorine levels (ppb, cumulative) of the major ozone-depleting substances (Commonwealth SOE 2001)

Source: Madronich and Velders (1999).

Greenhouse Gases

• Naturally occurring gases - CO, methane

• Anthropogenic gases – CO2, nitrous oxide, chlorofluorocarbons (CFCs)

Source: CSIRO Atmospheric Research.

                                                                                                     

Annual Australian mean minimum temperature anomalies. (Commonwealth SOE 2001)

Source: Bureau of Meteorology

Global warming potentials of greenhouse gases Potentials are expressed as a multiple of the global warming potential of carbon

dioxide. (Commonwealth SOE 2001)

Gas Global warming potential over 100 years

Carbon dioxide 1

Methane 24

Nitrous oxide 360

Chlorofluorocarbon-11 4 600

Chlorofluorocarbon-12 10 600

Hydrofluorocarbons 10-14 800

Sulfur hexafluoride 22 200

Other perfluorocarbons 5 700-11 400

Source: Granier and Shine (1999).

Carbon dioxide concentrations, Cape Grim, Tasmania (NSW SOE 2000)

Source: CSIRO data, as at 2000

Methane concentrations, Cape Grim, Tasmania (NSW SOE 2000)

Source: CSIRO data, as at 2000

Nitrous oxide concentrations, Cape Grim, Tasmania (NSW SOE 2000)

Source: CSIRO data, as at 2000

Acid Rain

• Emissions of oxides of sulphur and nitrogen produce Acid Aerosols - H2SO4, HNO3 (also regional pollutant)

• Coal fired (and oil fired) power plants

• Trans-boundary issue (especially in Europe and North America)

                                                                                                                        

            

Annual emissions of sulfur dioxide (as millions of tonnes of sulfur, MtS) and the atmospheric sulfur dioxide cycle. (Commonwealth SOE 2001)

Health Effects of Global Environmental Changes

Possible adverse effects upon human health caused by global environmental changes

Environmental change

Manifestation Type (direct, indirect) and timinga (early, late) of adverse health effect

Direct, early Direct, late Indirect, early Indirect, late

Enhanced greenhouse effect

Global warming and other climate change

Heatwave-related illness and death

Extension of vector-borne infections

Altered viability of (edible) fish in warmed oceans

Natural disasters: cyclones, floods, landslides, fires

Food shortages due to impaired agriculture

Sea-level rise Increased risk of flash floods and surges

Inundation social disorder, impaired sanitation, farmland loss

Consequences of damage to foreshore facilities, roads, etc.

Destruction of wetlands decline in fish stocks

Stratospheric ozone depletion

Increased UV-B flux at Earth’s surface

Sunburn, conjunctivitis Suppression of immune system increased risk of infection

Skin cancerOcular effects: cataracts, pterygium

Impaired growth of food crops and of marine microorganisms (base of aquatic food web)

Acid aerosols (from burning of sulphurous fossil fuels)

Acid rain Effects on respiratory system (?)

Aquatic damage (reduced fish) Impaired growth of crops

Impaired forest growth reduced ecosystem productivity

A The designations ‘early’ and ‘late’ are notional, and indicate relative timing. (Based on McMichael, 1993.3)

Possible adverse effects upon human health caused by global environmental changes (cont.)

Environmental change

Manifestation Type (direct, indirect) and timinga (early, late) of adverse health effect

Direct, early Direct, late Indirect, early Indirect, late

Land degradation: intensive agriculture, overgrazing

Erosion, sterility, nutrient loss, salinity, desertification

Decline in agricultural productivity

Rural sector depression migration to fringes of cities (see bottom row)

Exposure to pesticides and fertilisers (may also cause algal blooms)

Consequences of silting up of dams and rivers

Depletion of underground aquifers

Lack of water for drinking and hygiene

Decline in agricultural productivity

Loss of biodiversity

Destruction of habitat

Deforestation disruption of local culture

Loss of potentially edible species

Deforestation greenhouse enhancement

Loss of genetic diversity; weakening of ecosystems

Loss of medicinals, and other health-supporting materials

Greater vulnerability of crops and livestock. Reduced vitality of ecosystems

Other effects of overpopulation (particularly in poor countries)

Proliferation of crowded urban slums (due to migration and high fertility)

Infections Malnutrition Homelessness Antisocial behaviours

Social disorder Chronic toxic effects of environmental pollutants

Consequences of overload of local ecosystems

A The designations ‘early’ and ‘late’ are notional, and indicate relative timing. (Based on McMichael, 1993.3)

Regional/Local Air Pollutants

• Criteria (Common) Air Pollutants - (ambient air quality standards established)– Regional

• Photochemical smog - Ozone (O3)

• Haze - Particulates (PM) & Nitrogen Dioxide (NO2)

– Local• Sulphur Dioxide (SO2)

• Carbon Monoxide (CO)

• Lead (Pb)

• Air Toxics - (often no standards)

Air toxics or Hazardous Air Pollutants (HAPS) – a definition

“gaseous, aerosol or particulate pollutants (other than the six criteria pollutants)

that are present in the air in low concentrations with characteristics such as toxicity or persistence so as to be a hazard to human, plant or animal life”

Air Toxics / HAPS

• Diverse range of toxic compounds– Volatile Organic Compounds (VOCs)

• formaldehyde: lung, eye, skin irritants

• benzene, 1,3-butadiene: carcinogens

– Persistent organic pollutants (POPs)• DDT, PCB, dioxins: toxic, persistent, bioaccumulate

– Polycyclic Aromatic Hydrocarbons (PAHs)• Benzo[a]pyrene: Incomplete combustion of organic matter –

lung cancer, immune system suppression, respiratory problems

– Toxic Metals (associated with PM or as gases) • Arsenic, cadmium, lead, mercury, nickel, chromium:

persistent, bioaccumulate, toxic - kidney/liver damage, CNS disorders

Air Toxics / HAPs

• Diverse range of point and diffuse sources– point sources: industries and other facilities emitting in

a localised area– diffuse sources: mobile sources (eg: road vehicles,

boats), area based sources (eg: wood burning, dry cleaning, paints, thinners)

• Indoor / in vehicle exposures• Increasing regulatory / public concern• Generally little or no exposure data • US EPA - list of 189 HAPs (1990)

List of priority hazardous air pollutants (Commonwealth SOE 2001)

Air pollutantScore

Health effects

Benzene 9 Carcinogenic, causes anaemia

1,3-Butadiene 8 Carcinogen

Polycyclic aromatic hydrocarbons (PAH)

8 Carcinogen, environmentally persistent

Arsenic and compounds 8 Carcinogen, environmentally persistent

Chromium and compounds 8Carcinogen, affects respiratory system, inhalation can damage nose, throat, lungs, stomach and intestines, environmentally persistent. May lead to asthma, other allergic reactions, stomach upsets, ulcers, convulsions and kidney damage

Nickel and compounds 8 Carcinogen, can affect the respiratory system, environmentally persistent

Cadmium and compoundsA 7Carcinogen linked to prostate and kidney cancer in humans and also to lung and testicular cancer in animals. Smoke from burning cadmium or cadmium oxide can, in severe cases, affect respiratory system, environmentally persistent

Dioxins and furans 7 Carcinogen, skin disease, environmentally persistent and bioaccumulates

Mercury 7 Can cause reproductive problems, environmentally persistent, bioaccumulates

Dichloromethane 5Probable carcinogen, moderately persistent in the environment. High concentrations may cause unconsciousness and death. Exposure may irritate lungs, cause pulmonary oedema and irregular heartbeat. Long-term exposures at high level may damage the liver and brain

Formaldehyde 5 Carcinogen, irritates the skin, eye and respiratory system, and can exacerbate asthma

Styrene 5 Possible carcinogen

1,4-Dichlorobenzene 3 Probable carcinogen, moderately persistent in the environment

Tetrachloroethylene 3 Probable carcinogen

Manganese compounds 3 Can affect brain function, moderately persistent in the environment

A higher score indicates a more serious concern. Source: EPAV (1999c).

NEPMS (standards) to be developed for 5 air toxics in Australia

• benzene

• formaldehyde

• polycyclic aromatic hydrocarbons

• toluene

• xylenes

Criteria for selection for inclusion:

• Excluded air toxics from point sources

• Adequate ambient monitoring data exists

• Significant risk to human health

• Has highest mass emissions to the environment

Review of air toxics and health studies in Australia

• WA Department of Environmental Protection:– Found 10 studies– 9 studies addressed air toxics and health– 1 study measured personal exposure– 1 study in the ambient setting, 9 in

occupational/indoor settings– Formaldehyde was the most researched air

toxic

Source: State of knowledge report: Air toxics and indoor air quality in Australia. (EA, 2001)

Indoor air pollution

• Indoor air can be defined as any non-industrial indoor space where a person spends a period of an hour or more in any day.

• This can include the air space in the office, classroom, motor vehicle, shopping centre, hospital and home.

Indoor air pollution

• The quality of indoor air is influenced by two major factors: – amount and quality of outdoor air getting in

(ventilation rates, deposition and chemical decay)

– indoor sources of emissions of air pollutants

Indoor air pollution

• In winter 80 - 90% of time indoors - mostly in own home

• A number of important indoor air pollutants– Particles – Environmental tobacco smoke (ETS)– Oxides of nitrogen– Formaldehyde– Biological pollutants – house dust mites,

moulds, etc

Pollutant ci/caA B

NO2 0.7 0.72

O3 0.4 0.44

SO2 0.3 0.34

CO 1 1

Particles 1 1

Lead 0.5 0.53A Indoor (c i) and outdoor (c a) concentrations of air pollutants. B Ratio of indoor exposure to outdoor exposure.

Source: Beer and Walsh (1997).

Relationships between indoor and outdoor concentration of air pollutants (Commonwealth SOE 2001)

Particles in homes - no major sources

0

5

10

15

20

25

30

35

40

CentralCoast

CentralSydney

Lithgow Armidale Lismore NorthSydney

South EastSydney

South WestSydney

Tumut WesternSydney

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

indoor PM10

TEOM

Nephelometry

Source: V Sheppeard, NSW Health

Fine particle (PM10) levels by number of smokers in house

0

50

100

150

zero one two three

Source: V Sheppeard, NSW Health

Fine particle (PM10) levels by main heating type

010203040

Source: V Sheppeard, NSW Health

Average levels of total suspended particles in selected Sydney clubs & hotels (NSW SOE 2001)

Source: Cummins et al. 1990

Average weekly nitrogen dioxide levels in homes

0

5

10

15

20

25

30

35

None UnfluedHeating

Cooking Flued Heating Any Both Heatingand Cooking

Mean

nit

rog

en

dio

xid

e (

pp

b)

Living Room Bedroom

Source: V Sheppeard, NSW Health

Peak 1-hour average concentrations of nitrogen dioxide, indoors & outdoors, 1987-97

(NSW SOE 2000)

Source: Ferrari 1997

In car carbon monoxide levels

0204060

meanmax

Source: CARB 1998; V Sheppeard, NSW Health

Other in-car exposures (VIC EPA - mean personal concentrations while commuting to CBD (east route) - pilot trial)

0

2

4

6

8

10

12

14

benzene 1,3 butadiene xylenes

VO

C p

pb

cartrain

Source: V Sheppeard, NSW Health

Air toxics in other microenvironments

02468

10121416

benzenexylenes

Source: WA DEP; V Sheppeard, NSW Health

Burden of disease attributable to indoor smoke from solid fuels

(% DALYs in each subregion)(The World Health Report 2002)

Ambient air pollution

Kuching, Sarawak 1997 Forest Fires

A historical perspective of air pollution

• In 1273, England’s King Edward I passed a law prohibiting the use of at least one type of coal

• In the early 1400's, Henry V formed a commission to oversee the use of coal in the city of London

• In 1661, Charles II ordered the scientist John Evelyn to survey the effects of the increasing air pollution over the city. Evelyn recognised the relationship between the ‘dismal cloud’ over London and a number of fatal diseases but his warnings of the need for control were ignored

A historical perspective of air pollution (cont)

• By the late 1800's industrialisation accompanied by the migration of people into cities increased the quantity and diversity of chemical pollutants entering the air

• In December 1873 weather conditions producing stagnant air and a temperature inversion thick cloud of pollutants covering London for several days about 1,150 deaths, making it one of the earliest air pollution disasters

A historical perspective of air pollution (cont)

• Since 1873 at least 40 episodes of sudden buildups of air pollution have caused widespread casualties in the industrialised world

A historical perspective of air pollution (cont)

• Several air pollution episodes occurred in London, England from December 1952 to 1962, with the most famous air pollution episode in December 1952 being responsible for an estimated 4,000 deaths.

London smog and deaths (1)

London smog and deaths (2)

Early Control Measures

• Government regulation– UK Clean Air Act (1956)

– US Clean Air Act (1963, 1970 amendement)• Standards for 6 air pollutants (called criteria pollutants)

• Reviewed every 5 years

• Cost-benefit analysis

– Victorian Clean Air Act (1958), NSW Clean Air Act (1961)

• Standards to establish “safe” thresholds• Control strategies to reduce/prevent exceedences

Air Quality Standards

• USA – 1970 amendment to the 1963 Clean Air Act

– National Ambient Air Quality Standards (NAAQS)

• UK– Expert Panel on Air Quality Standards established in

1991

• Australia– National standards in 1998

Pollutant Averaging period

Maximum concentration (based on arithmetic

means)

Maximum allowable exceedencesA (days

per year)

Carbon monoxide 8h 9.0 ppm 1

Nitrogen dioxide 1h

1y

0.12 ppm

0.03 ppm

10

Photochemical oxidant (as ozone)

1h

4h

0.10 ppm

0.08 ppm

11

Sulfur dioxide 1h

1d

1y

0.20 ppm

0.08 ppm

0.02 ppm

110

Lead (as TSPs) 1y 0.5 g/m3 0

Particles (as PM10) 1d 50 g/m3 5

A Goal to be achieved by 2008.

Source: NEPC (1998).

Schedule 2 of the NEPM giving National Environment Protection Standards for

ambient air quality (Commonwealth SOE 2001)

Primary / secondary pollutants

• Primary pollutants– Particles– NOx

– SO2

– CO

• Secondary pollutant– Ozone– Particles (gaseous pollutants forming aerosols)

Types of air pollution

• Summer episodes (photochemical episodes)– Secondary pollutants – O3, H2SO4, HNO3

– Ozone is the index pollutant– “White haze”

• Winter episodes– Particles, SO2

– “Brown haze”

Air pollution concentration

• Complex interactions of many influences:– quantities of pollutants emitted, the spatial and

temporal distributions of these emissions– rates of pollutant transport, dispersion and

diffusion in the atmosphere– meteorological conditions such as temperature

and sunlight intensity– atmospheric chemical reactions– topography of the region

DISPERSION

Vertical and horizontal – stability, turbulence, wind

TRANSFORMATION

Chemical reactions

REMOVAL

Settling, scavenging adsorption, impaction

EMISSIONS

Rate, type, source configuration

RECEPTOR RESPONSE

Health effects, vegetation damage, soiling, corrosion

The role of the atmosphere in the air pollution source sink relationship

STATE OF ATMOSPHERESOURCE SINK

Sources of air pollution

• Mobile sources– Motor vehicles, rail, shipping, aviation

• Industry sources– Power stations, petroleum refining, chemical

manufacturing

• Area based sources – small point sources– Service stations, combustion sources, lawn

mowing

Sources of 1995 to 1996 emissions for Port Phillip Region, Vic.

(Commonwealth SOE 2001)

Source: Commonwealth SOE 2001

Sources of emissions and exposure to benzene in the USA. (Commonwealth SOE 2001)

Source: Data from Ott and Roberts (1998).

Anthropogenic emission sources – Sydney and Greater MAQS region

Pollutant emissions & VKT of vehicle fleet, Sydney

Source: Carnovale et al. 1997

Contribution of wood burning to TSP, Sydney (NSW SOE 2000)

Why is air pollution an issue?

• Affects large numbers of people

• Involuntary exposure

• The health costs are enormous

• Also affects the health of flora and fauna

• Other health benefits from air pollution control – road trauma, physical activity

Burden of disease attributable to urban air pollution(% DALYs in each subregion)

(The World Health Report 2002)

Total Annual Economic Costs of Motor Traffic Air Pollution (AUD$m) (Bureau of Transport and Regional Economics 2003)

Capital Cities Mortality Morbidity Base case Lower Upper Base case Lower Upper Sydney 713 441 990 785 782 788 Melbourne 448 276 621 466 465 468 Brisbane 197 122 273 223 222 223 Adelaide 113 70 156 109 109 110 Perth 104 64 144 110 110 111 Hobart 8 5 11 7 7 7 Darwin 5 3 7 10 10 10 Canberra 8 5 12 0 0 0 All capital cities 1596 986 2214 1712 1705 1718

Adverse health effects estimated to be avoided by meeting the US EPA’s 80 ppb 8-h average daily maximum standard in

New York City, NY. (Thurston 1997)

2,000,000Acute Respiratory Symptom Days/yr

(i.e., person-days during which respiratory symptoms such as chest discomfort, coughing, wheezing, doctor diagnosed flu, etc. are experienced)

930,000Restricted Activity Days/yr

(i.e., person-days on which activities are restricted due to illness

180,000Asthma Attacks/yr

(i.e., person-days during which notably increased asthma symptoms, e.g., requiring extra

medication, are experienced)

3,500RespiratoryED Visits/yr

265 240

75Non-asthma Respiratory

Hospital Admissions/yr

Deaths/yr

Asthma Hospital Admissions/yr

(0.01% of all adverse impact cases)

Environmental & human health effects of major air pollutants (NSW SOE 2000)

Pollutant Effects – environmental Effects – human health

Ozone Damage to vegetation, reduced plant growth and crop yields, increased susceptibility to pestsLong-term low-level exposure is of concern; limited studies have been done on effects on Australian native vegetationDamage to fabrics, rubber and construction materials

Irritation of eyes and air passages, decreased function, lung inflammation (potent oxidant), sensitivity of asthma patients to asthma triggers, possible increased susceptibility to infection

NO3 Effects on vegetation, damage to leaf surface, reduced plant growthLimited research has been done on Australian native vegetation

Decreased lung function, lung inflammation, increased sensitivity of asthma patients to asthma triggers, increased susceptibility to respiratory infection

CO - Reduces the capacity of blood to carry oxygen; can lead to decreased exercise capacity and aggravation of cardiovascular disease

Source: NHMRC 1996; EPA 1997a

Environmental & human health effects of major air pollutants (cont.)

Pollutant Effects – environmental Effects – human health

SO2 Plant damage and growth inhibition; little known about effects on Australian native vegetationAcid deposition: acidification of soils and lakes change the availability of minerals to plantsCorrosion of construction materials

Decreased lung function; lung inflammation: may provoke wheezing and exacerbate asthma

Fine particles

Reduced visibility; brown haze Increased rates of respiratory illnesses and symptoms, decreased lung function, excess mortality from heart and lung disease, exacerbation of symptoms in asthma patients

Lead Can accumulate in soil and food chain Altered neurobegavioural function in children, i.e. impaired intellectual development, increase human blood pressure and impair renal function

Air toxics Possible bio-accumulative effects (from accumulation in food chain)

Long-term health effects, even at low concentrationsCompounds may be carcinogenic, mutagenic, teratogenic, neurotoxic, toxic, or can cause reproductive dysfunction

Source: NHMRC 1996; EPA 1997a

Source: EPA 1993 (data from ANSTO)

Size & distribution of particles in the atmosphere (NSW SOE 2000)

PM10 – Health effects

• Acute effects– Decreased lung function

– Increased respiratory symptoms

– Hospitalisation/other health care visit – Mortality

– Increased plasma viscosity,heart rate variability

• Chronic effects– Increased mortality rates, reduced survival times,

chronic cardiopulmonary disease, reduced lung function

Stylized summary of acute exposure studies, percent change in health end-point per 10 g/m3

change in PM10

Estimated percent changes in daily mortality associated with a 10 g/m3 increase in PM10 (with 95% confidence intervals) for a number of cities

Ozone - Acute Health Effects

• Decreases in lung function

• Increase in respiratory symptoms, asthma attacks

• Increase in restricted activity days

• Increase in hospital admissions especially respiratory admissions

• Increase in mortality

The effect of ozone on pulmonary function (after Kleinman et al., 1989)

Effects of ozone on respiratory symptoms (after Kleinman et al., 1989)

Asthma camp associations between O3 levels and both peak flow lung function change and asthma exacerbations (as

indicated by -agonist medication use) (Thurston et al., 1997)

Reported RR of respiratory hospital admission associated with a 100 ppb increase in daily 1-h max.

O3 (Ito et al., 1999)

Reported RR of mortality associated with a 100 ppb increase in 1-h max. O3 (Thurston et al., 1999)

Nitrogen dioxide – Health effects

• Decreases in lung function

• Increase in respiratory symptoms

• Increase in hospital admissions – asthma, COPD

• Increase in mortality – conflicting results

Potential human health effects of NO2

Health effect MechanismIncreased intensity of respiratory infections

Increased severity of respiratory infections

Respiratory symptoms

Reduced lung function

Worsening of the clinical status of persons with asthma, chronic obstructive pulmonary disease or other chronic respiratory conditions

Reduced efficacy of lung defences

Reduced efficacy of lung defences

Airways injury

Airways and alveolar (?) injury

Airways injury

Source: Samet and Utell, 1990

Adjusted prevalence of respiratory infections in children of ten communities in Switzerland according to the mean NO2 level (from Braun-Fahrlander, 1997)

Carbon monoxide – health effects

• Angina and ischaemic heart disease

• Hospital admissions – heart disease, asthma

• Mortality – all cause and heart disease

Relative risks of congestive heart failure admission among Medicare patients as a

function of ambient pollutant levelsPollutant and city Single-pollutant model Multipollutant model

Relative risk

95% Confidence interval

Relative risk

95% Confidence interval

Carbon monoxide

Los Angeles

Chicago

Philadelphia

New York

Detroit

Houston

Milwaukee

1.36

1.29

1.17

1.10

1.24

1.11

1.29

1.25, 1.46

1.16, 1.44

1.05, 1.31

1.03, 1.18

1.11, 1.39

0.97, 1.26

1.07, 1.57

1.39

1.23

1.22

1.05

1.38

1.25

1.26

1.23, 1.56

1.07, 1.43

1.05, 1.41

0.97, 1.14

1.17, 1.63

1.05, 1.49

0.89, 1.77

Note: The multipollutant model included all four pollutants. All models included temperature, month, day of week, and year. Values refer to the relative risk associated with an increase of 10 ppm of carbon monoxide.

From Morris et al. (1995). Reproduced with permission of authors and publisher.

Sulphur dioxide – Health effects

• Decrease lung function – in those with asthma

• Increase in symptoms

• ED presentations

• Hospital admissions - respiratory

• Mortality – all cause, respiratory and CVS

APHEA studies

• For a 50 ug/m3 increase in 24 hour average SO2:

– 3% increase in all cause mortality– 4% increase in cardiovascular mortality– 5% increase in respiratory mortality– 2% increase in respiratory admissions (65+

years)

Types of studies

• Animal studies• Human studies

– Experimental (chamber studies)– Epidemiological (or observational)

• Cross-sectional• Time series• Case-control/ Case-crossover• Cohort• Randomised control trials

Health outcome measures in studies of air pollution

GeneralOverall mortalityMorbidity index

RespiratoryAcute and chronic symptomsAcute infectionsChronic respiratory diseasesDegree of non-specific airways responsivenessReduced level of lung functionIncreased rate of lung function declineDecreased rate of lung function growthExacerbation of a chronic respiratory diseaseHospitalization for a chronic respiratory diseaseLung cancer Death secondary to a chronic respiratory disease

NeuropsychologicalReduced performance on neurobehavioural testingNeuropsychological syndromeNeuropsychological disease

Some other health endpoints of interest

• Cardiovascular disease (AMI, heart failure)– ECG changes – Hospital admissions– Mortality

• Perinatal outcomes– Birth weight and gestational age– Neonatal and infant mortality

• Cancer incidence – lung cancer

Determinants of exposure, dose and biologically effective dose that underlie the development of health effects (Modified from

Jaakkola et al., 1994)

Indirect methods of assessing exposureSource of information Type of information

Source strength Emission rate (mass per time), traffic density

Geographical information Distance of the place of residence from the source

Dispersion models Spatio-temporal concentration distributions from modelling of emission rates, meteorology, air chemistry, geography

Outdoor-indoor penetration Modelling from outdoor concentration, building an ventilation characteristics

Stationary monitoring Concentration over time modelling from concentration of pollutants in microenvironments

Questionnaires and interviews Source strength, distance from the source, time-activity

Personal monitoring Continuous or cumulated concentrations over time

Human samples Concentration of biomarkers of exposure in human tissues and hair

Toxicological models Concentration and dose of pollutants in target organs modelling from concentration, breathing rate, metabolism

Some issues in air pollution

• Multi- pollutant exposure

• Low dose exposure

• Size and composition of particles

• Threshold effects

• Shape of the response function

• Time activity patterns

• Confounding by season and weather

Uses of exposure response relationships

• Standard setting and risk assessment

• Cost benefit analyses

• Air pollution control programs

Bill Physick, CSIRO (personal communication)

Study involving modeled air pollution data

A method for exposure assessment

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Green Scenarios

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9 0

1 0 0

P M10- HOU R 9, 7/3/2001. BASECASE

144.2 144.4 144.6 144.8 145.0 145.2 145.4

EASTIN G

-38 .4

-38.2

-38.0

-37.8

-37.6

NO

RT

HIN

G

C R AN BO U R N E

FR AN KSTO N

D AN D EN O N G

BR IG H TO N

PAISLEY

SYD EN H AM

M T D AN D EN O N G

SU N BU R Y

PAN TO N H ILL

W ER R IBEE

PORT PHILLIPBAY

BASS STR AIT

MELBOURNE

GEELONG

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0

P M10- HOU R 9, 7/3/2001. BASECASE

TEST CASE- 25% reduction in motor vehicle usage- public transport, car pooling, home office

144.2 144.4 144.6 144.8 145.0 145.2 145.4

EASTIN G

-38 .4

-38.2

-38.0

-37.8

-37.6

NO

RT

HIN

G

C R AN BO U R N E

FR AN KSTO N

D AN D EN O N G

BR IG H TO N

PAISLEY

SYD EN H AM

M T D AN D EN O N G

SU N BU R Y

PAN TO N H ILL

W ER R IBEE

PORT PHILLIPBAY

BASS STR AIT

MELBOURNE

GEELONG

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0

P M10- HOU R 9, 7/3/2001. BASECASE

144.2 144.4 144.6 144.8 145.0 145.2 145.4

EASTIN G

-38 .4

-38.2

-38.0

-37.8

-37.6

NO

RT

HIN

G

C R AN BO U R N E

FR AN KSTO N

D AN D EN O N G

BR IG H TO N

PAISLEY

SYD EN H AM

M T D AN D EN O N G

SU N BU R Y

PAN TO N H ILL

W ER R IBEE

PORT PHILLIPBAY

BASS STR AIT

MELBOURNE

GEELONG

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0

P M10- HOU R 9, 7/3/2001. BASECASE

Home- 12 hours

Travel- 3 hours

Work- 9 hours

PM10 CUMULATIVE DOSAGE

0100020003000400050006000700080009000

0 6 12 18 24TIME (hours)

DO

SA

GE

(u

g.m

-3.h

ou

rs) BASE

GREEN+car

Green+train

Selected references:• Department of Environment and Heritage. (2001) State of the Environment

Australia 2001.Canberra, Australia. http://www.erin.gov.au/soe/atmosphere/index.html (accessed October 2003)

• Department of Environment and Heritage. (2001) State of Knowledge Report: Air toxics and indoor air quality in Australia. Canberra, Australia. ISBN 0 642 54739 4.

• Holgate ST, Samet JM, Koren HS, Maynard RL. (eds.) (1999) Air pollution and health. Academic Press. London.

• McMichael AJ. (1993) Planetary overload: Global environmental change and the health of the human species. Cambridge University Press.

• New South Wales Environment Protection Authority. (2000) New South Wales State of the Environment 2000. http://www.epa.nsw.gov.au/soe/soe2000/index.htm (accessed October 2003)

• New South Wales Environment Protection Authority. (1998) Action for air. The NSW Government's 25-year air quality management plan. ISBN 0 7313 0160 9. Chatswood, Australia, Environment Protection Authority.

Thank You