Air Pollution and Health PDF
Preview Air Pollution and Health
Preface The Industrial Revolution brought to Western Civilization prosperity and social changes that altered the direction of nations. The downside of such industrial proliferation was the extensive use of coal sa an energy source and the severe air pollution that accompanied this. The impact that this pollution had on health was profound and led to the intro- duction of stringent emission control measures in many countries with attendant improvement in these health indices. As we approach the second millennium, air pollution of a different kind si with us again- that derived from the combustion of oil productions and, in particular, vehicle fuels. The proliferation of both personal and commercial vehicles in all countries across the world and the impact that this si having on our towns and cities si taxing all govern- ments, at both national and local levels. The answer will lie in the introduction of new transport policies, the generation of cleaner combustion engines and the introduction of alternative clean energy sources. The nature of the air pollution problem relating to vehicle use varies widely from country to country and from one town or city to another, dictated not just by the volume of traffic but also by the prevailing weather conditions. The range of pollutants produced si also wide although oxides of nitrogen, ozone, carbon monoxide, polyaromatic hydro- carbons and suspended particulates appear to be the most important. The introduction of new methods of detecting and quantifying these pollutants and the establishment of rural and urban air pollution networks to monitor regional and local patterns has provided invaluable information that has been used to build up a profile of air pollutant problems. While many of the vehicle-related pollutants will have adverse effects on many biological systems including trees, grassland, arable crops and farm animals, it si their impact on human health, both alone and in combination, that has caused greatest concern. The 44 chapters contained in this book bring together expertise from across the world vi Preface to review current knowledge about the impact of air pollution on human health. A better understanding of atmospheric chemistry, new methods for pollutant monitoring, detailed epidemiology and the use of controlled exposure studies to examine single and mixtures of pollutants, provide a firm framework against which to devise new legislation to control this intractable problem. This book also contains sections that deal mechanistically with such issues sa cancer, pulmonary and cardiovascular diseases. Special emphasis si placed on new data obtained from many sources on the impact of inhaled small particles on cardiovascular and respiratory morbidity and mortality, sa well sa the interaction of air pollutants with other factors such sa the effects of allergen exposure in asthma and rhinitis. In addition to outdoor air pollution, this volume emphasizes the importance of the indoor environment sa a source of pollutants. Since humans spend much of their life indoors, whether in the home or the workplace, air pollutant exposure in these settings si clearly important when considering total exposure. The principal purpose of this book si to bring together issues concerning air pollution and health in an easily accessible manner and in a single volume. The multidisciplinary nature of the book and the wide range of issues covered should provide the reader with access to up-to-date information on lla issues relating to ambient air pollution and should, therefore, be of use to those interested in the monitoring of air pollution sa well sa those wishing to know more about its impact on indices of human health. In the preparation of this book I have been greatly guided by my co-editors, Jonathan Samet, Hillel Koren and Robert Maynard, and the enormous expertise they brought to the selection of topics covered. However, we are lla especially grateful to the many con- tributors who have expended so much time in preparing their chapters to create a unique book that we hope will be of value to those wishing to find out more about this impor- tant problem. The knowledge gained from a greater focus on the impact of human activities on the environment will lead to a better understanding of the issues involved in assessing the health impact of air pollution and its complexity. Just sa legislation and voluntary steps were introduced to reduce pollution from the industrial and domestic use of coal and its products, os new ways will be found to deal with vehicle-related pollution. These will not only require government intervention, but also the involvement and co-operation of the motor and petroleum manufacturing industries and the public itself. Stephen .T Holgate Contributors Ursula Ackermann-Liebrich, Institute rof laicoS and evitneverP Medicine, University of ,lesaB Steinengraben 49, CH-4051, ,lesaB dnalreztiwS H. Ross Anderson, Department of Public Health ,secneicS tS s'egroeG Hospital Medical ,loohcS Cranmer ,ecarreT London SW17 ,ERO UK David .V Bates, University of British Columbia, 4891 College Highroad, ,revuocnaV BC V6T 1G6, Canada Peter Brimblecombe, School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK Philip A. Bromberg, Center rof Environmental Medicine and Lung ,ygoloiB University of North Carolina, Chapel Hill, NC 27599-7310, ASU Lilian Calder6n-Garciduefias, Curriculum in ,ygolocixoT University of North Carolina, Chapel Hill, NC, ASU Kathleen Cameron, Chemicals and Biotechnology Division, Department of the Environment, Transport and the Regions, Room 3/F8, Ashdown House, 321 Victoria ,teertS London SWIE 6DE, UK Lauraine G. Chestnut, Stratus Consulting, Inc., 1881 Ninth Street, Suite 201, ,redluoB CO 80302, USA Aaron J. Cohen, Health Effects Institute, Suite 700, 955 Massachusetts Avenue, Cambridge, MA 02139, ASU Daniel L. Costa, Pulmonary Toxicology Branch (MD-82), Experimental Toxicology Division, National Health and Environmental Effects Research ,yrotarobaL SU Environmental Protection ,ycnegA hcraeseR elgnairT Park, NC 27711, ASU Stephanie M. Coster, Department of the Environment, Transport and the Regions, Room 4/H16, Ashdown House, 321 Victoria Street, London SW1E 6DE, UK viii Contributors j. Michael Davis, National Center for Environmental Assessment, RTP Division (MD-52), US Environmental Protection Agency, Research Triangle Park, NC 27711, USA Richard G. Derwent, Atmospheric ssecorP ,hcraeseR Room 156, Meteorological ,eciffO London Road, Bracknell GR12 2FZ, UK .W Fred Dimmick, Office of Air Quality Planning and Standards (MD-13), SU Environmental Protection ,ycnegA Research Triangle Park, NC 27711, ASU Douglas .W Dockery, Associate Professor of Environmental Health, Harvard School of Public Health, and etaicossA rosseforP of Medicine (Epidemiology), Harvard lacideM School, 566 Huntington Avenue, Boston MA 02115, USA Kenneth Donaldson, Department of lacigoloiB ,secneicS Napier ,ytisrevinU 01 Colinton Road, Edinburgh, UK .W Michael Foster, Department of Environmental Health ,secneicS School of Hygiene and Health, Johns Hopkins ,ytisrevinU 516 North Wolfe Street/Suite 7006, ,eromitlaB MD 21205-2179, USA Jane E. Gallagher, Human Studies Division (MD-58c), National Health and Environmental Effects Research Laboratory, SU Environmental Protection ,ycnegA hcraeseR Triangle Park, NC 27711, ASU Andrew J. Ghio, National Health and Environmental Effects Research Laboratory (MD-58d), SU Environmental Protection Agency, Research Triangle Park, NC 27711, ASU Lester D. Grant, National Center rof Environmental Assessment, RTP Division (MD- 52), SU Environmental Protection ,ycnegA hcraeseR Triangle Park, NC 27711, ASU Roy M. Harrison, Environmental Health, Institute of Public and Environmental Health, The University of Birmingham, Edgbaston, Birmingham B 51 2TT, UK Milan J. Hazucha, Department of ,enicideM noisiviD of Pulmonary sesaesiD and Center rof Environmental Medicine and Lung ,ygoloiB ytisrevinU of North Carolina, Chapel ,lliH 401 Mason Farm Road, Chapel Hill, NC 27599-7310, ASU Claire Holman, SENCO, Brook Cottage, Elberton, Olveston, Bristol BS35 4AQ, UK Kazuhiko lto, Department of Environmental Medicine, New kroY University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, NY 10987, ASU Jouni J.K. Jaakkola, Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, 615 North Wolfe Street/Suite W6041, ,eromitlaB MD 21205-2179, ASU .T Elise Jackson, Chemical Industry Institute of ,ygolocixoT PO xoB 12137, 6 Davis Drive, hcraeseR Triangle Park, NC 22709-2137, ASU Peter K. Jeffery, Lung Pathology Unit, Department of Histopathology, National Heart and Lung Institute, Imperial College, Sydney Street, Royal Brompton Hospital, London 3WS 6NP, UK Frank J. Kelly, The Rayne Institute, tS Thomas' Campus, Kings College London, Lambeth ecalaP Road, London 1ES 7EH, UK Urmila .P Kodavanti, Pulmonary ygolocixoT Branch (MD-82), Experimental ygolocixoT Division, National Health and Environmental Effects Research Laboratory, SU Environmental Protection ,ycnegA Research Triangle Park, NC 27711, ASU Hillel .S Koren, Human Studies Division (MD-58A), National Health and Environmental Effects Research Laboratory, SU Environmental Protection ,ycnegA hcraeseR Triangle Park, NC 27711, USA Contributors ix Michal Krzyzanowski, WHO European Centre rof Environmental Health, Bilthoven Division, PO xoB ,01 3730 AA De Bih, The Netherlands Morton Lippmann, Nelson Institute of Environmental Medicine, New kroY University loohcS of Medicin William MacNee, ELEGI, Colt hcraeseR Labs., Wilkie Building, Medical School, toiveT ,ecalP Edinburgh EH8 9AG, UK Michael C. Madden, Human Studies Division (MD-58C), National Health and Environmental Effects Research Laboratory, SU Environmental Protection ,ycnegA hcraeseR Triangle Park, NC 27711, ASU David Maddison, Centre for Social and Economic Research Global Environment, University College London, Gower Street, London WC1E 6BT, UK Robert .L Maynard, Department of Heahh, Room 658C, Skipton House, 08 London Road, London 1ES 6LH, UK Roger O. McClellan, Chemical Industry Institute of ;ygolocixoT PO xoB 12137, 6 sivaD Drive, Research Triangle Park, NC 27709-2137, ASU Glenn R. McGregor, School of Geography and Environmental ,secneicS The University of Birmingham, Edgbaston Park Road, Birmingham B 51 2TT, UK David M. Mills, Stratus Consulting Inc., 1881 Ninth Street, Suite 201, Boulder, CO 80302, ASU Milagros Milne, School of Engineering, Materials and Minerals Engineering Division, University of Wales Cardiff, Queen's Buildings, The Parade, PO xoB 685, Cardiff CF2 3TA, UK Kristen Nikula, Biopersistent Particle Center, ecalevoL Respiratory Research Institute, PO xoB 5890, Albuquerque, NM 87185, USA Terry .L Noah, Department of Pediatrics and the Center for Environmental Medicine and Lung Biology, University of North Carolina, Chapel Hill, NC 27599-7310, USA Bart D. Ostro, Office of Environmental Health Hazard Assessment, California Environmental Protection ,ycnegA ,yelekreB ,AC 94611 USA Halfik Ozkaynak, Department of Environmental Health, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA Renee C. Paige, Department of Anatomy, Physiology and Cell ,ygoloiB University of California Davis, Davis, CA 95616, ASU David Pearce, Centre rof laicoS and Economic hcraeseR Global Environment, ytisrevinU egelloC London, Gower Street, London WC E1 6BT, UK David B. Peden, Department of scirtaideP and Center for Environmental Medicine and Lung ,ygoloiB University of North Carolina School of Medicine, 401 Mason Farm Road, Chapel Hill, NC 27599-7310, USA Charles G. Hopper, Department of Anatomy, Physiology and Cell ,ygoloiB University of California Davis, Davis, CA 95616, ASU Frederick D. Pooley, School of Engineering, Materials and Minerals Engineering Division, University of Wales Cardiff, Queen's Buildings, The Parade, PO xoB 685, Cardiff CF2 3TA, UK C. Arden Pope III, Department of Economics, Brigham Young ;ytisrevinU 241 Faculty Office Building, PO xoB 22363, Provo, UT 84602-2363, USA Regula Rapp, Institute for Social and Preventive Medicine, University of ,lesaB Steinengraben 49, CH-4051 ,lesaB dnalreztiwS x Author Names Roy Richards, School ofBiosciences, Cardiff ,ytisrevinU Museum ,eunevA PO xoB 911, Cardiff CF 1 3US, UK Lesley Rushton, MRC Institute rof Environment and Health, University of ,retsecieL 49 Regent Road, ,retsecieL 1EL 7DD, UK James M. Samet, National Health and Environmental Effects Research Laboratory, SU Environmental Protection ,ycnegA Research Triangle Park, NC 27711, ASU Jonathan M. Samet, Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, 516 North Wolfe Street/Suite W6041, ,eromitlaB MD 21205-2179, ASU Richard .B Schlesinger, Department of Environmental Medicine, New kroY University loohcS of Medicine, 75 Old Forge Road, Tuxedo, YN 10987, ASU Dieter Schwela, World Health Organization Division of Operational Support in Environmental Health, Urban Environmental Health, 02 Avenue Appia, CH 1121 Geneva ,72 dnalreztiwS Chon R. Shoaf, National Center for Environmental Assessment (MD-52), SU Environmental Protection ,ycnegA Research Triangle Park, NC 27711, ASU Frank E. Speizer, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, AM 02115-5804, ASU Peter .T Thomas, Director of ,ygolocixoT Covance Laboratories, Madison, WI ASU George D. Thurston, Department of Environmental Medicine, New York University loohcS of Medicine, Nelson Institute of Environmental Medicine, ,odexuT YN ,78901 ASU AndrewWadge, Department of Health, Room 642B, Skipton House, 08 London ,daoR London 1ES 6LH, UK Robert Waller, 72 King William Drive, Charlton Park, Cheltenham GL53 ,PR7 UK Ann M. Watldns, SU Environmental Protection ,ycnegA 401M St., ,WS Washington, DC 20460, ASU Albert H. Wehe, Office of Air Quality Planning and Standards (MD-13), SU Environmental Protection ,ycnegA hcraeseR Triangle Park, NC 27711, ASU John Widdicombe, Sherrington School of ,ygoloisyhP tS Thomas' Hospital (UMDS), Lambeth Palace Road, London 1ES 7EH, UK Martin .L Williams, AEQ, Department of the Environment, Transport and eht ,snoigeR 4/E14 Ashdown House, 321 Victoria Street, London SW1E 6DE, UK Judith .T Zelikoff, Department of Environmental Medicine, New kroY ytisrevinU loohcS of Medicine, New ,kroY ,YN ASU Introduction DAVI D .V BATES University of British Columbia, Vancouver, ,CB adanaC It si not surprising that the study of the effects of air pollution on human populations began with major episodes of increased mortality, in which the cause and effect relation- ship between the dramatic episode and its consequences could not be doubted. The episodes in the Meuse Valley in 1930, in the small town of Donora in Pennsylvania in 1948, and the London episode of December 1952 provided unequivocal evidence of that kind. The city Ordinance against air pollution passed in Pittsburgh in 1946 was carried through by concerned citizens, but no scientific evidence of the impact of current air pol- lution levels on the population had been secured (Bates, 1994). The development of epidemiological studies can be properly dated from the London episode; it was natural to ask the question of what effects, other than acute mortality, the air pollution might be causing. A linkage between air pollution levels in different parts of the London Metropolitan region, and the occurrence of bronchitis quickly emerged, but it was not until 1965 that Holland and Reid established the model for many future stud- ies. This was a cross-sectional comparison of lung function of postal workers in London compared with that of others in different country towns in which the pollution level was known to be much lower. The socioeconomic level of the workers was the same in both locations; non-smokers, ex-smokers, and smokers at three different levels of intensity were characterized; and there were no climatic differences between the different regions. The results showed a clear decrement of function in lla of these categories between the London and provincial workers. We now know that the forced expiratory volume in 1 s (FEV1), which with the peak expiratory flow rate (PEFR), was the test used in that study to characterize function, si closely related to survival; hence we can now infer that residence in more polluted regions of Britain involved a lower survival expectancy. Recent studies of non-smoking women in Beijing, and early cross-sectional studies in France, both showed decrements of FEV 1 in AIR POLLUTION AND HEALTH Copyright (cid:14)9 1999 Academic sserP ISBN 0-12-352335-4 All sthgir of noitcudorper in any form devreser 2 D.V. Bates those living in more polluted regions, but we still do not have a precise interpretation of what this finding means in structural terms. Is there a higher degree of airway respon- siveness? sI the induced bronchitis responsible for small airway disease? sI the degree of emphysema more severe? It si also quite possible that the lower FEV 1 in adults in more polluted regions si due to the fact that growing up in such locations meant that lung growth was altered, so that the initial FEV 1 (say at age )81 was never sa high sa it was in those growing up in cleaner locations. It was the concomitant increase in cigarette smoking in most countries that confused the understanding of air pollution effects. Indeed, the relevant literature of the period might be interpreted sa showing that all chronic lung disease was attributable to ciga- rette smoking, and that air pollution only exerted an effect by increasing the mortality in acute episodes. Although this si biologically inherently unlikely to be true, it was the study of Holland and Reid that first indicated that air pollution might be causing long-term chronic effects of some significance. We can now summarize the effects of air pollution due to uncontrolled coal burning sa being responsible for enhancing the risk of chronic obstructive pulmonary disease in smokers and its severity, increasing the prevalence of chronic bronchitis and sputum production, and possibly, sa discussed below, increasing the risk of lung cancer. Surprisingly, the prevalence of asthma does not seem to be related to this type of air pollution. Acute episodes in which particulates and acid aerosols are at high levels increase mortality from respiratory disease in all age groups. It was in 1952, the year of the major London episode, that Hagen-Smidt in Los Angeles showed that tropospheric ozone was formed when oxides of nitrogen and hydro- carbons were both in the air and subjected to sunlight. He was investigating the adverse effects of photochemical air pollution on citrus fruit. The study of the acute effects of ozone on lung function did not start until 10 years later, but by 1970 it had become clear that ozone was an intensely irritant gas, and that normal subjects showed a wide variation in sensitivity to it. Ten years after that, a series of studies of children at summer camps documented the fall in lung function that commonly occurred in summer outdoor con- ditions. Two other developments were crucial in establishing the importance of ozone sa an air pollutant. One was the demonstration that an induced fall in forced vital capacity (FVC) after ozone breathing was accompanied by evidence from bronchial lavage that inflammation had occurred in the lung; and the other was the study of large banks of hos- pital admission data that showed a significant association between summer ozone levels and hospital admissions for acute respiratory disease. In the northeast of North America, where these studies were conducted, ozone was closely correlated with aerosol sulfates in the summer. The difficulty with ozone si that any biological effect or mechanism si theoretically pos- sible. Increased airway reactivity, small airway inflammation, pneumonia, damage from oxygen radicals, and even induced neoplasia can all be postulated. Interference with normal lung growth si also a possibility. The main acute effects that have been demon- strated are acute reductions in lung function, aggravation of asthma (an effect still ignored in much contemporary literature), an increased risk of pneumonia in the elderly, and hos- pital admissions for acute respiratory disease in all age groups, including those in infants under the age of 1 year. As far sa chronic effects are concerned, we have evidence from one study of incoming Berkeley students that lifetime ozone exposure might be associated with a significant reduction in terminal airflow velocity (Kunzli et al., 1997). More work 1 Introduction 3 on possible chronic effects of ozone exposure must be done before we can be confident that our knowledge si complete. Finally, the past 01 years have seen a remarkable 'avalanche' of studies incriminating urban particles in the respirable range (less than 10 lam in diameter, or PM10). The first data showed that in time-series analysis, there was an association between daily mortality, excluding accidents and suicides, and the level of PM10 prior to the relevant date. This association has now been shown to be robust to different methods of accounting for weather variations; in many different populations (over 30 at last count); and when other pollutants such sa SO 2 or ozone or acid aerosols are virtually absent. There si also strik- ing coherence, in that PMI0 levels have been shown to be associated with function test decline in children, hospital admissions for respiratory disease, aggravation of asthma, increased school absences, and lower lung function in children. There si general evi- dence- not complete because of the relative scarcity of monitoring data- that lla of these associations are stronger ifPM2. 5 instead of PM10 si considered. In contrast to the situation with regard to ozone, the mechanism of these effects si not precisely understood. Although the associations have been shown to occur when pollution levels never exceed a PMa0 value of 150 lag/m 3 for any hour in the monitoring period, these are still very low levels of exposure compared with those to which workers in many occupations are exposed. Indoor PM10 si increased considerably when there si a cigarette smoker in the house, and there si a possibility that it si the particulate component which si responsible for these effects. The observation that exposure to passive cigarette smoke increases the risk of lung cancer in non-smokers si one of the pieces of information that suggests that outdoor expo- sure to particles derived from combustion products emitted from vehicles might also increase the risk of lung cancer. So powerful si the effect of cigarette smoking in increas- ing the risk of lung cancer that the unequivocal demonstration of an enhancement of risk by air pollutants si difficult. The evidence on which such an opinion must be based si drawn together in this book. The study of the adverse health effects of air pollution has come a long way since 1952. Much more powerful tools are available for data collection and analysis; far more data are available; there si a much greater understanding of the power and limitations of statisti- cal methods; and the economic costs of increasingly strict regulation are such that there si a willingness (albeit reluctant) to invest in research programs designed to answer some of the outstanding important questions. Although it can point to an honorable past, envi- ronmental epidemiological studies of air pollution and its effects can be expected to have a distinguished future. One of the reasons why research in this field si such an interesting challenge si that the field has such breadth that many disciplines are involved in its full understanding. This si well exemplified by the multi-disciplinary focus of the different sec- tions in this book. In some scientific fields, the contemporary focus seems to get narrower and narrower; but an understanding of the effects of air pollutants on the human respi- ratory, and possibly also cardiovascular systems, necessitates a broadening of the approach sa the complexity of the questions becomes apparent. It si this aspect of the field that ensures its continuing interest. 4 D.V, Bates REFERENCES Bates DV (1994) Environmental Health Risks and Public Policy; Decision-making in Free Societies. Seattle: Washington University Press, p. 117. Holland WW and Reid DD (1965) The urban factor in chronic bronchitis. Lancet :1 445-448. Kunzli N, Lurmann ,F Segal M et .la (1997) Association between lifetime ambient ozone exposure and pulmonary function in college freshmen - results of a pilot study. Environ seR 72: 8-23.
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