AACIMP 2009 Summer School lecture by Yoshio Matsuki. "Environmental Externalities of Energy Options - Basics and Applications" course. 3rd hour.

1. Air Pollution and Health
Impact
Y. Matsuki
August 8, 2009
Presented at NTUU “KPI”

2. What’s new on the public health
issue?
Loss of life expectancy for chronic
mortality from air pollution
[Dockery et al 1993, Pope et al 1995]
have found positive correlations
between exposure to particles and
total mortality

3. Epidemiology of Acute Health
Effects
Table of contents
- Introduction
- Studies of air pollution episodes
- Health effects at low levels of air pollution
- Acute Morbidity
- Daily time-series mortality studies
- Slope of the mortality exposure-response relationship and
lead-lag relationships
- Acute Morbidity
- Hospital usage
- Exacerbation of asthma
- Respiratory symptoms
- Lung function
- Restricted activity

4. Introduction
It’s about human health and
pollution.
Where in the world is this story
about?
When did this story start?
What changed for the last 10-15
years?

5. Air pollution episodes
Where the most dramatic episode occurred
and when?
What happened?
Mortality and morbidity
How?
Respiratory and cardiovascular
Cardiopulmonary disease
What was the level of particle and SO2?
500 g/m3 – 2 mg/m3
If not old days, where do these levels exist?

6. Health effects at low level of air
pollution
What was the primary interest to air
pollution policy among the most
developed nations for the last 20
years?
To determine the lowest level
The length of exposure to cause
health impacts
Threshold was often assumed.

7. Health effects at low level of air
pollution
With improved air monitoring, is
threshold proven?
No threshold, or bellow ambient level
in the US in 1996.
Many of the studies suggest linear
model.
What is necessary to prove it?
Number of time-series studies

8. What are the health effects?
Mortality
Hospitalization for respiratory and
heart disease
Aggravation of asthma
Incidence and duration of respiratory
symptoms
Lung function
Restricted activity

10. Acute Mortality
Daily time-series mortality studies
US EPA reviewed Ostro 1993,
Schwartz 1994c, Dockery & Pope
1994, Pope et al. 1995b.
What these studies observed?
Changes in daily death counts
associated with short-term changes
in particulate air pollution.
a near linear function.

13. What do you see from those table
and figures?
Consistency in estimated effects
Statistically significant effect
Estimated Range?
0.5 percent – 1.6 percent in daily
mortality for each 10 g/m3 increase
in PM10 concentration.
Weighted mean?
About 0.8 percent

14. Percent increase in Mortality
per 10 g/m3 increase in PM10
Mortality Cases/ g/m3 ?
0.5 percent – 1.6 percent in daily
mortality for each 10 g/m3 increase
in PM10 concentration.
5 x 10-4 – 1.5 x 10-3 Cases/ g/m3
Weighted mean about 0.8 percent
8 x 10-4

15. Mortality by respiratory disease and
cardiovascular disease
Large effect on respiratory disease
mortality
Also cardiovascular disease causing
death

16. Shape of the mortality exposure-response
relationship and lead-lag relationships
PM10 concentration in typical US
cities
10 to 120 g/m3
Max 365 g/m3 in the Utah Valley
How is in Ukraine?

17. Shape of the mortality exposure-response
relationship and lead-lag relationships
What does it say?
Typically near linear or log-linear
Three possibilities:
(1) no threshold
(2) threshold is bellow existing
pollution levels
(3) looking more linear than it really
is.

18. Shape of the mortality exposure-response
relationship and lead-lag relationships
Increased mortality occurred
concurrently or within 1-5 days
following an increase in air pollution.

19. Acute Morbidity
Hospital usage
What happened in the Utah Valley during
the winter of 1986-1987?
A labor dispute resulted in the closure of
the local steel mill, the largest single source
of particulate emission.
This winter PM10 ave. 51 g/m3 , max. 113
g/m3
Previous year ave. 90 g/m3 , max 365
g/m3
Children hospital admission for respiratory
disease dropped 50 percent.

20. Acute Morbidity
Hospital usage
What was the argument by Lamm et
al. (1994)?
Not closure of the steel mill, but
Respiratory Syncytial Virus (RSV)
What was the argument by Pope
(1991)?
Not by the virus.

22. Acute Morbidity
Hospital usage
What is the exposure-response of the
hospital admission of all respiratory
diseases?
0.8 – 3.4 % increase per 10 g/m3 by
PM10
8 x 10-4 – 3.4 x 10-3 Cases/ g/m3 by
PM10

23. Acute Morbidity
Hospital usage
Emergency department visit %
increase by 10 g/m3 increase of
PM10
0.5 – 3.4 (ave. 1.0) % increase/ 10
g/m3

24. Exacerbation of asthma
Respiratory symptoms
Asthma, Bronchodilator
Cough

26. Exacerbation of asthma
What is the exposure-response relation of
asthmatic attack?
3 % increase in asthmatic attacks with 10
g/m3 increase of PM10
3 x 10-3 cases/ g/m3
What is the exposure-response relation of
bronchodilator use?
1.1 – 12 % (ave. 3.0) increase with 10
g/m3 increase of PM10
3.0 x 10-3 cases/ g/m3

27. Respiratory symptoms
Lower Respiratory symptoms
Wheezing, dry cough, phlegm, shortness of breath,
chest discomfort/pain
What is the exposure-response relation of lower
respiratory symptoms?
Ave. 3.0 % increase in lower respiratory symptoms
with 10 g/m3 increase of PM10
3.0 x 10-3 cases/ g/m3
Upper Respiratory symptoms
Runny nose, stuffy nose, sinusitis, sore throat, wet
cough, head cold, hay fever, red eyes
Statistically insignificant association observed.

28. Key words
Pneumonia
COPD: chronic obstructive pulmonary
(lung) disease
Coronary Artery Disease
Disrythmias (such as slow heart rate)
Congestive Heart Failure

29. Lung function
FEV: forced expiratory volume (a
measure of lung function)
FVC: forced vital capacity
PEF: Peak expiratory flow

31. Epidemiology of Chronic Health
Effects
Table of contents
- Introduction
- Mortality Studies
- Population-based (ecologic) mortality studies
- Research needs for improved study designs
- Prospective Cohort Mortality Studies
- Harvard six-cities study
- Implication of prospective cohort mortality results
- Chronic Health Effects; Morbidity
- Chronic differences in lung function
- Chronic respiratory symptoms and disease

32. Introduction
What is the difference between the acute
effects and the chronic effects?
Acute: associated with short term (day to
day change)
Chronic = long-term: a long time +
cumulative effects of repeated exposure
If acute effect exists, is there also chronic
effect by the same pollutant?
Not automatically

34. Mortality Studies
Population-based mortality studies
What is the summary of the population-based cross-
sectional study?
Average mortality is higher in cities with higher fine
particulate and sulfate particulates.
How the other risks were controlled?
Smoking rate, education levels, income levels,
poverty rates, housing density, etc were included in
the regression models.
What is the coefficients of air pollution related
mortality?
About 3 % per 10 g/m3
4 x 10-3 per g/m3

36. What are limitations of Population-
based Studies?
Systematic and/or analytical bias
Study designs
Data sets
Analytic techniques
Regression analysis
Hypothesis testing
Controlling some other factors
Size of the estimated association
Comparison with the current pollution level to the
chronic mortality is not appropriate,
Because now the pollution level is lower than years
ago.
Cannot control for individual differences in cigarette
smoking, and other risk factors.

37. What are limitations of Population-
based Studies?
Age, poverty, health care,
occupations, cigarette smoking,
housing quality, cooking fuels vary
among cities and potentially could be
confounding the apparent air
pollution associations.

38. Improved study designs
What are 2 important issues 1970s –
1980s
Threshold
Study design – what evidence
needed?
If threshold, what will become easier?
To establish the acceptable goal for
pollution control

39. Prospective Cohort Mortality
Studies
3 cohort mortality studies
With improved study design

40. Prospective Cohort Mortality
Studies
Not on the data available for the
population as a whole,
But, it analyzes the incidence of
health effects in a sample of
individuals.
Negative aspect:
It relies on community-based air
pollution monitoring.
Costly and time-consuming

41. Harvard six-cities study
14-16 follow up of 8,111 adults living in 6 cities of the
US
TSP, PM10, PM2.5, SO4, H+, SO2, NO2 and O3 levels
were monitored.
What is most strongly associated with mortality risk?
Smoking
But, after controlling for individual differences (age,
sex, smoking, body mass, education, occupational
exposure),
Differences in relative mortality risks across 6 cities
were strongly associated with difference in pollution
levels in those cities.
PM10, PM2.5, SO4 than TSP and SO2, H+, or ozone.

43. Shape of the figure
Mortality risk and fine particulate
Nearly linear
No threshold

44. Implications of prospective cohort
mortality results
The increased risk from air pollution
bigger or smaller than cigarette
smoking?
Small
But, there is a correlation.

46. Summary
Mortality
Acute exposure Total 0.5-1.5
%/10 g/m3
5 x 10-4 – 1.5 x 10-3 (cases/ g/m3)
Chronic exposure 3 – 9 %/10 g/m3
3 x 10-3 – 9 x 10-3 (cases/ g/m3)

47. Exposure-Response Function f(r,C(r,Q))
PM10 and Nitrates
Health impact cases/(year.person. g/m3)
Long-term Mortality 2.60E-4
Chronic Bronchitis 7.65E-5
Restricted Activity Days 5.0E-2
Work Days Lost 1.0E-2
Hospital Admissions
Cardiovascular, Respiratory 6.00E-5, 2.56E-6
Asthmatic adults
Bronchodilator 6.00E-2
Lower respiratory symptoms 1.63E-1
Infant Mortality 2.78E-5
Asthmatic children
Cardiovascular, Respiratory
7.8E-2, 1.0E-1

48. f(r,C(r,Q)) SO2
Health impact cases/(year.person. g/m3)
Short-term Mortality 2.30E-6
Hospital Admissions
Admissions 2.84E-6
Source: Rabl 2001

49. Concentration of the pollution( g/m3)
C(x,Q) Gaussian Plume Model
Q - h2
C = ---------------- exp [--------]
21/2 3/2 ux z z
2

50. z

51. z

52. Atmospheric Stability
Day Night
Surface Wind
Incoming Solar Radiation Thinly Heavy
Speed
Overcast Cloud
(meter/second) Strong Moderate Slight
or clear
sky
<2 A A-B B
2-3 A-B B C E F
3-5 B B-C C D E
5-6 C C-D D D D
>6 C D D D D

53. Weather observation
Day Wind Speed Wind Direction Atmospheric Stability(A,
(meter/second) E, ESE, SSE, S….. B… .F)
Aug 7 1800
1900
2000
2100
2200
2300
2400
Aug 8 0600
0700
0800
0900
2100
0900