ERF of outdoor air pollution

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Question

What is the the quantitative dose-response relationships between outdoor air PM2.5 concentration and mortality due to cardio-pulmonary, lung cancer, and other non-accidental causes (index Cause of death 2)?

Answer

PM_2.5 are fine particles less than 2.5 μm in diameter. Exposure-response function can be derived from exposure modelling, animal toxicology, small clinical or panel studies, and epidemiological studies. Exposed population can be divided into subpopulations (e.g. adults, children, infants, the elderly), and exposure is assessed per certain time period (e.g. daily or annual exposure).

Health effects related to short-term exposure
- respiratory symptoms
- adverse cardiovascular effects
- increased medication usage
- increased number of hospital admissions
- increased mortality
Health effects related to long-term exposure (more relevance to public health)
- increased incidence of respiratory symptoms
- reduction in lung function
- increased incidence of chronic obstructive pulmonary disease (COPD)
- reduction in life expectancy
  - increased cardiopulmonary mortality
  - increased lung cancer mortality

Sensitive subgroups: children, the elderly, individuals with heart and lung disease, individuals who are active outdoors.

Mortality effects of long-term (chronic) exposure to ambient air

In principle the ERFs for long-term exposure (produced by cohort studies) should also capture the mortality effects of short-term exposure (ERFs produced by time-series studies). In practice it is likely that they do not do so fully. This is due to the so-called "harvesting" phenomenon, i.e. it is possible that acute exposure, at least to some extent, only brings forward deaths that would have happened shortly in any case. However, adding effects of acute exposure to effects of long-term exposure is problematic because the risk of double-counting. ^[1]

Pope et al. (2002) ^[2]

6% increase in the risk of deaths from all causes (excluding violent death) (95% CI 2-11%) per 10 µg/m3 PM2.5 in age group 30+
12% increase in the risk of death from cardiovascular diseases and diabetes (95% CI 8-15%) per 10 µg/m3 PM2.5 in age group 30+
14% increase in the risk of death from lung cancer (95% CI 4-23%) per 10 µg/m3 PM_2.5 in age group 30+

Woodruff et al (1997) ^[3]

4% (95% Cl 2%-7%) increase in all-cause infant mortality per 10 µg/m3 PM₁₀ (age 1 month to 1 year)

Tuomisto et al. 2008:^[4]

A structured expert judgement study of the population mortality effects of PM_2.5 air pollution.
Opinions of six European air pollution experts were elicited.
Percent increase per 1 µg/m³ increase in PM_2.5:
- Equal-weight decision-maker
  - Best estimate 0.97
  - 95% quantile 4.54
  - 5% quantile 0.02
- Performance-based decision-maker
  - Best estimate 0.60
  - 95% quantile 3.80
  - 5% quantile 0.06

'Mortality effects of short-term (acute) exposure to ambient air PM

Anderson et al. 2004 ^[5]

0.6% (95% Cl 0.4%-0.8%) increase in all-cause mortality (excluding accidents) per 10 µg/m3 PM₁₀ in all ages
1.3% (95% Cl 0.5%-2%) increase in respiratory mortality per 10 µg/m3 PM₁₀ in all ages
0.9% (95% Cl 0.5%-1.3%) increase in cardiovascular mortality per 10 µg/m3 PM₁₀ in all ages

Page-specific entries (indices that have exactly one value each for the whole variable; usually mentioned in the title and/or in the scope.):

Pollutant: PM2.5

These coefficients are defined as distributions around estimates of central tendency for each cause of death.

Relative increase of mortality per 1 μgm-3 increase of outdoor PM2.5 concentration. Values were drawn with equal probability from the two distributions reported in ^[6], ^[7]

Crude mortality rate statistics from gas bus model (the dose response sub model). See the model here.

Cause of death	Min	Median	Mean	Max	Std.Dev.
Cardiopulmonary	-0.0036	0.0115	0.0128	0.0375	-0.0060
Lung cancer	-0.0350	0.0140	0.0150	0.0728	0.0109
Other causes	-0.0232	0.0008	0.0008	0.0252	0.0050
All causes	-0.0019	0.0080	0.0091	0.0289	0.0047

Rationale

Causality

List of parents:

None

Data

Concentration-response function

ERF of outdoor air pollution(relative increase of mortality per µg/m3)
Obs	Disease	Response metric	Exposure route	Exposure metric	Exposure unit	ERF parameter	ERF	Description
1	Cardiopulmonary	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0128	Dockery et al. 1993 and Pope et al. 2002:0.0128 (-0.0036-0.0375)
2	Lung cancer	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0150	Dockery et al. 1993 and Pope et al. 2002:0.0150 (-0.0350-0.0728)
3	Other causes	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0008	Dockery et al. 1993 and Pope et al. 2002:0.0008 (-0.0232-0.0252)
4	All causes	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0091	Dockery et al. 1993 and Pope et al. 2002:0.0091 (-0.0019-0.0289)

calculations

+ Show code - Hide code


library(OpasnetUtils) # A package with Opasnet functionalities
library(xtable)       # A package with table formats
library(ggplot2)      # A package with fancy graph formats

objects.latest("Op_en5872", "calculations") # Get the latest ovariables from code calculations on page Op_en5872.

ConcentrationresponsetoPM2.5 <- EvalOutput(ConcentrationresponsetoPM2.5)

print(xtable(ConcentrationresponsetoPM2.5@output),type='html') # Show a result table

ggplot(ConcentrationresponsetoPM2.5@output, #Show a bar chart
	aes(x = disease,y=ConcentrationresponsetoPM2.5)) +
	geom_bar(position="dodge") + 
	theme_grey(base_size = 24)

ERF of outdoor air pollution(relative increase of mortality per µg/m3)
Obs	Disease	Response metric	Exposure route	Exposure metric	Exposure unit	ERF parameter	ERF	Description
1	Cardiopulmonary	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0128	Dockery et al. 1993 and Pope et al. 2002:0.0128 (-0.0036-0.0375)
2	Lung cancer	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0150	Dockery et al. 1993 and Pope et al. 2002:0.0150 (-0.0350-0.0728)
3	Other causes	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0008	Dockery et al. 1993 and Pope et al. 2002:0.0008 (-0.0232-0.0252)
4	All causes	Mortality	Inhalation	Annual average outdoor concentration	µq/m3	Relative increase	0.0091	Dockery et al. 1993 and Pope et al. 2002:0.0091 (-0.0019-0.0289)

Unit

m³/μg D↷

Uncertainties:

Mortality estimate from Hoek et al. (2002)^[8] was not included due to many confounding factors related to mortality, e.g. road noise.
Probability for PM2.5 assumed to be the true cause of the effects in 70 %, 90 %, and 10 % for cardiopulmonary, lung cancer and all other mortality, respectively (author judgement).
Toxicity differences between ambient air particles and the particles generated by different bus types were not taken into account due to lack of comprehensive data. ^[9] ^[10]

No threshold was assumed in the dose-response relationship. ^[11] ^[12]

ERF for chronic PM_2.5 exposure

Cause of death	RR	95% Cl
All-cause	1.06	1.02-1.11
Cardiopulmonary	1.09	1.03-1.16
Lung cancer	1.14	1.04-1.23

References

↑ Service Contract for Carrying out Cost-Benefit Analysis of Air Quality Related Issues, in particular in the Clean Air for Europe (CAFE) Programme. Volume 2: Health Impact Assessment. AEA Technology Environment, 2005.
↑ *Pope CA III, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K & Thurston KD (2002). Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287(9), 1132-1141.
↑ Woodruff TJ, Grillo J & Schoendorf KC (1997). The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environmental Health Perspectives, 105: 608-612.
↑ Tuomisto et al. 2008. Uncertainty in mortality response to airborne fine particulate matter: Combining European air pollution experts. Reliability Engineering and System Safety 93, 732-744.
↑ Anderson HR, Atkinson RW, Peacock JL, Marston L & Konstantinou K (2004). Meta-analysis of time-series studies and panel studies of paticulate matter (PM) and ozone (O3). Report of a WHO task group. World Health Organization.
↑ Dockery, D. W., Pope, C. A., III, Xu, X., Spengler, J. D., Ware, J. H., Fay, M. E., Ferris, B. G., Jr., & Speizer F. E. (1993). An association between air pollution and mortality in six U.S. cities. The New England Journal of Medicine, 329(24), 1753-1759
↑ Pope, C. A. III, Burnett, R. T., Thun, M. J., Calle, E. E., Krewski, D., Ito, K., & Thurston, G. D. (2002). Lung Cancer, Cardiopulmory Mortality, and Long-term Exposure to Fine Particulate Air Pollution. The Journal of the American Medical Association, 287(9), 1132-1141
↑ Hoek, G, Brunekreef, B, Goldbohm, S, Fischer, P, & van den Brandt, P. A. (2002). Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet, 360 (9341), 1203-1209.
↑ Laden, F., Neas, L. M., Dockery, D. W., & Schwartz, J. (2000). Association of fine particulate matter from different sources with daily mortality in six U.S. cities. Environmental Health Perspectives, 108, 941-947.
↑ Mar, T. F., Norris, G. A., Koenig, J. Q., & Larson, T. V. (2000). Associations between air pollution and mortality in Phoenix, 1995-1997. Environmental Health Perspectives, 108(4), 347-353.
↑ WHO Regional Office for Europe (2003). Health Aspects of Air Pollution with Particulate Matter, Ozone and Nitrogen Dioxide, Report on a WHO Working Group. Report on a WHO working group, Bonn, Germany, January 13-15 2003. Copenhagen. 98 pages. Available at http://www.euro.who.int/eprise/main/who/progs/aiq/newsevents/20030115_2
↑ Schwartz, J., Laden, F., & Zanobetti, A. (2002). The concentration-response relation between PM2.5 and daily deaths. Environmental Health Perspectives, 110(10), 1025-1029.

[1] Service Contract for Carrying out Cost-Benefit Analysis of Air Quality Related Issues, in particular in the Clean Air for Europe (CAFE) Programme. Volume 2: Health Impact Assessment. AEA Technology Environment, 2005.

[2] *Pope CA III, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K & Thurston KD (2002). Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287(9), 1132-1141.

[3] Woodruff TJ, Grillo J & Schoendorf KC (1997). The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environmental Health Perspectives, 105: 608-612.

[4] Tuomisto et al. 2008. Uncertainty in mortality response to airborne fine particulate matter: Combining European air pollution experts. Reliability Engineering and System Safety 93, 732-744.

[5] Anderson HR, Atkinson RW, Peacock JL, Marston L & Konstantinou K (2004). Meta-analysis of time-series studies and panel studies of paticulate matter (PM) and ozone (O3). Report of a WHO task group. World Health Organization.

[6] Dockery, D. W., Pope, C. A., III, Xu, X., Spengler, J. D., Ware, J. H., Fay, M. E., Ferris, B. G., Jr., & Speizer F. E. (1993). An association between air pollution and mortality in six U.S. cities. The New England Journal of Medicine, 329(24), 1753-1759

[7] Pope, C. A. III, Burnett, R. T., Thun, M. J., Calle, E. E., Krewski, D., Ito, K., & Thurston, G. D. (2002). Lung Cancer, Cardiopulmory Mortality, and Long-term Exposure to Fine Particulate Air Pollution. The Journal of the American Medical Association, 287(9), 1132-1141

[8] Hoek, G, Brunekreef, B, Goldbohm, S, Fischer, P, & van den Brandt, P. A. (2002). Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet, 360 (9341), 1203-1209.

[9] Laden, F., Neas, L. M., Dockery, D. W., & Schwartz, J. (2000). Association of fine particulate matter from different sources with daily mortality in six U.S. cities. Environmental Health Perspectives, 108, 941-947.

[10] Mar, T. F., Norris, G. A., Koenig, J. Q., & Larson, T. V. (2000). Associations between air pollution and mortality in Phoenix, 1995-1997. Environmental Health Perspectives, 108(4), 347-353.

[11] WHO Regional Office for Europe (2003). Health Aspects of Air Pollution with Particulate Matter, Ozone and Nitrogen Dioxide, Report on a WHO Working Group. Report on a WHO working group, Bonn, Germany, January 13-15 2003. Copenhagen. 98 pages. Available at http://www.euro.who.int/eprise/main/who/progs/aiq/newsevents/20030115_2

[12] Schwartz, J., Laden, F., & Zanobetti, A. (2002). The concentration-response relation between PM2.5 and daily deaths. Environmental Health Perspectives, 110(10), 1025-1029.

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