01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH...
-
Upload
amie-parks -
Category
Documents
-
view
216 -
download
1
Transcript of 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH...
![Page 1: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/1.jpg)
01/22/2004
Assessing the Health Effects of Atlanta’s Air Pollution
Jennifer L. Peel, PhD, MPH
Emory University Rollins School of Public Health
01/22/2004
![Page 2: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/2.jpg)
Emory UniversityFunded by EPA, NIEHS, and EPRI
![Page 3: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/3.jpg)
01/22/2004
SOPHIA/APNEA Study Team
Paige Tolbert, PI Mitch Klein Jennifer Peel Kristi Metzger Dana Flanders Sarah Tinker Matt Strickland Jim Mulholland Ted Russell Knox Todd Lance Waller Bob Lyles
…And others!
![Page 4: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/4.jpg)
01/22/2004
Background:London Fog of 1952•Temperature
inversion concentrated smoke and other pollutants
•Mortality increased 200% in week following episode
• Cardiorespiratory conditions accounted for 81% of excess deaths (compared to usual 30%)
![Page 5: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/5.jpg)
01/22/2004
Unresolved Questions
NRC Research Priorities, 1998: Need to understand physicochemical characteristics of PM underlying observed associations of PM with cardiorespiratory outcomes
»Responsible components»Control for copollutants »Mechanism of injury
![Page 6: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/6.jpg)
01/22/2004
Aerial View of ARIES Monitoring Station, Atlanta, GA
![Page 7: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/7.jpg)
01/22/2004
ARIES Air Quality Data
• PM10 • PM2.5 • PM10-2.5 • PM2.5 components • Ultrafine PM • O3
• NO2
• CO • SO2 • Polar VOCs
SulfatesWater-soluble metalsAcidityOrganic carbonElemental carbon
![Page 8: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/8.jpg)
01/22/2004
Ongoing ARIES-Related Studies at Emory
ED study (NIH, EPA, EPRI) ICD study (EPRI) Medicare hospital admission
study (NIH) APNEA study (NIH)
![Page 9: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/9.jpg)
01/22/2004
ED Study: Methods Obtain air quality data
– ARIES monitor back to 8/98– state monitoring network back to 1/93
Collect billing records from all Atlanta EDs back to 1/93
Define multiple cardiorespiratory case groups based on ICD-9 codes
Examine relation of case counts with pollutant measures
![Page 10: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/10.jpg)
01/22/2004
Hospital Participation through 2000
![Page 11: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/11.jpg)
01/22/2004
![Page 12: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/12.jpg)
01/22/2004
Data Analysis
A priori model: Poisson model– GEE – GLM
3-day moving average (lag 0,1,2) for pollutant Control for time trends, day of week, hospital
entry/exit, holidays, mean temperature, mean dewpoint
Secondary models assessed (e.g., GAMs, alternative lag structures, season-specific)
![Page 13: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/13.jpg)
01/22/2004
Model specification based on literature– Air quality measures– Lag structure– Control for confounding
Reduce “data mining” for primary results
Reduce reporting bias based on “best” result
Use of A Priori Model
![Page 14: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/14.jpg)
01/22/2004
Explanation of Estimates
2.5% increase in all CVD ED visits per 20 ppb increase in NO2
Outcome
Pollutant Unit RR 95% CI
All CVD NO2 20 ppb 1.0251.012, 1.039
![Page 15: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/15.jpg)
01/22/2004
Results for All Respiratory Disease Visits through 2000
![Page 16: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/16.jpg)
01/22/2004
Results for RD Subgroupsthrough 2000
RD URIAsthm
aPneu
mCOPD
Finger Wound
s
PM10 + +
O3 + +
NO2 + + +
CO + + +
SO2
PM2.5
Coarse PM
Ultrafines
-
Metals
Sulfates
Acidity
OC +
EC
OHC
8/98
-8/0
01/
93-8
/00
![Page 17: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/17.jpg)
01/22/2004
Results for All CVD Visitsthrough 2000
![Page 18: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/18.jpg)
01/22/2004
Results for CVD Subgroupsthrough 2000
CVD DYS CA CHF IHD AMI PERIFingerWound
s
PM10
O3
NO2 + + +
CO + +
SO2
PM2.5 + + +
Coarse PM
Ultrafines
-
Metals
Sulfates
Acidity
OC + +
EC + +
OHC + +
8/98
-8/0
01/
93-8
/00
![Page 19: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/19.jpg)
01/22/2004
Findings (through 2000)
CVD outcomes– Observed associations with NO2,
CO, PM2.5, EC, OC, OHC
– Pollution from mobile sources may play important role
– Strongest effects with same-day levels
– Epidemiology 2004;15(1):46-56
![Page 20: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/20.jpg)
01/22/2004
Findings (through 2000)
Respiratory outcomes– Associations from a priori models
» All respiratory illness and URI: ozone, NO2, CO, PM10
» COPD: NO2, CO» Pneumonia: OC
– Strongest associations for all RD with pollution levels from recent days
– Asthma: strongest associations with pollution levels lagged 5-7 days
– In review, Epidemiology
![Page 21: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/21.jpg)
01/22/2004
Interpretation Issues
Ambient vs. personal exposure– Ambient exposure is of interest
» Population-level health effects» Regulatory purposes
– Personal behavior (e.g., air conditioning use, time spent outdoors)
» May affect personal exposure levels» May affect magnitude of associations when
compared to other locations with different behavior profiles
![Page 22: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/22.jpg)
01/22/2004
Measurement error in AQ data– Single, centrally-located monitor
» Instrument error»Error from local sources»Error due to spatial heterogeneity
– May attenuate estimates»Unlikely to lead to spurious results»Possible explanation where no effect
observed
Interpretation Issues (cont’d)
![Page 23: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/23.jpg)
01/22/2004
Interpretation Issues (cont’d)
Correlated co-pollutants acting as surrogates for less well-measured or unmeasured pollutant?– Relative amount of measurement error in
air quality measures important– Multi-pollutant models can be as
misleading as single- pollutant models
![Page 24: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/24.jpg)
01/22/2004
Current Work
Spatial analysis Measurement error assessment Source apportionment Alternative analyses
(e.g., distributed lag models, case-crossover)
Air quality data through 2002 Updating outcome databases for all
studies (ED, ICD, APNEA) through 2002
![Page 25: 01/22/2004 Assessing the Health Effects of Atlanta’s Air Pollution Jennifer L. Peel, PhD, MPH Emory University Rollins School of Public Health 01/22/2004.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649eb05503460f94bb5a16/html5/thumbnails/25.jpg)