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Acute Health Effects from Changes in Air

Pollution and Weather in Heart Failure

Mark Goldberg, PhDDepartment of Medicine

McGill University

Findings for Postmenopauasal

Breast Cancer

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Total Cardiovascular Mortality (ICD9: 400-440)

• PM2.5: 12% (95%CI: 1.09-1.15) increase in mortality rate for an increase of 10 μg/m3

• other pollutants: no strong evidence of association

Research Questions for Acute Effects•Does the number of adverse health

events on a particular day increase if environmental conditions change on that day or on previous days?

•How far back in time (lag) do these changes affect health?

•If yes, are there certain populations particularly susceptible to these conditions?

Donora, Pennsylvania (Oct 26-31, 1948)

14,000 residents 20 people died and over 7,000

were hospitalized

London, UK (Dec 5-9, 1952)

3,000 more deaths

Air Pollution Episodes

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Aug 14 2002: PM2.5=37μg/m3

~72 times lower than the 1952 London episode

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Aug 27 2002: PM2.5=3μg/m3

Air Pollution Episode London, 1958-1959

Flu epidemicFeb 18-20

Excess mortality~200-250

NB: Mortality after removing 15-day running average

Estimated attributable number of deaths in various smog episodes occurring in London,

England, 1948-1962

YearDates of episode

Number of days

Estimated attributable deaths

Maximum 24-hour pollution (μg/m3)

British smoke SO2

1948 Nov 26 – Dec 1 6 700-800 2780 2150

1952 Dec 5 – Dec 8 4 4,000 4460 3830

1956 Jan 3 – Jan 6 4 1,000 2830 1430

1957 Dec 2 – Dec 5 4 700-800 2417 3335

1959 Jan 26 – Jan 31 6 200-250 1723 1850

1962 Dec 3 – Dec 7 5 700 3144 3834

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Studies in Montreal

•Daily nonaccidental mortality in Montreal, from Quebec death certificates, 1984-2002

•Daily weather conditions recorded at Dorval International Airport, 1984-2002

•Daily average concentrations of air pollutants (e.g., NO2, O3) from the various monitoring stations in Montreal

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Principal Air Pollution Monitors in Montreal

Time Series for Ozone, 1984-2002, Montreal.

The solid line represents the long-term trend in the data.

Time Series for NO2, 1984-2002, Montreal.

The solid line represents the long-term trend in the data.

Daily Nonaccidental Mortality, 1984-2002, Montreal

The solid line represents the long-term trend in the data.

Temporal Cycles in Mortality

Filtered Mortality Time Series:Nonaccidental Causes

Montreal 1984-1993

Daily Maximum Temperature, 1984-2002, Montreal.

The solid line represents the long-term trend in the data.

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Air Pollution is a Complex Mixture

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Nonaccidental Mortality and Ozone

Pooled Estimates of the Percent Increase in Daily

MortalityPollutant

Change in daily average concentration

Studies not using GAMs

Studies using GAMs

Percent increase

95% CI Percent increase

95% CI

PM10 31.3 μg/m3 1.3 0.8-1.9 2.2 1.6-2.8

CO 1.1 ppm 4.7 1.1-8.4 1.6 1.1-2.1

NO2 24.0 ppb 1.0 0.3-1.8 3.4 2.5-4.2

O3 31.2 ppb 1.4 0.4-2.4 1.7 1.1-2.2

SO2 9.4 ppb 0.9 0.6-1.2 1.0 0.7-1.4

From: Stieb et al. J Air Waste Manag.Assoc. 2003;53:258-61

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Susceptible Populations: Time Series Study of Non-

accidental Mortality Among Persons With

Specific Health Conditions

Congestive Heart Failure

-10

-5

0

5

10

15

20

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COH Extinction Predicted PM2.5

SO2 O3

Warm Cold

CONO2Predicted Sulfatefrom PM2.5

SuttonSulfate

Mea

n P

erce

nt

Ch

ang

e in

Dai

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orta

lity

-10

0

10

20

30

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COH Extinction Predicted PM2.5

SO2 O3CONO2Predicted Sulfatefrom PM2.5

SuttonSulfate

Warm

Cold

Mea

n P

erce

nt

Ch

ange

in

Dai

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orta

lity

Diabetes and Cardiovascular Disease

Possible Mechanisms

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Particle Retention in Human Lungs

Mexico Cityair sample

Lung of Mexico City

resident

1 μm

Data from Michael Brauer, U. of British Columbia.

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Controlled Human Exposure Studies

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Human Exposure Facility at theGage Occupational and

EnvironmentalHealth Unit of the University of

Toronto

Direct controlled human exposurestudies to determinedose-response relationships ofindividual pollutants (if any) anduncover biological mechanisms.

Findings:Inflammatory response after exposureThickening of arterial walls

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Possible Mechanisms

Source: Brook et al 2004 CirculationSource: Brook et al 2004 Circulation

Effects of Temperature

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Myocardial Infarction Hospitalizations and Maximum Temperature

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Climate Change

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Changes in the Distribution of Weather

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Mortality from the 2003 Heat Wave

Country DateEstimated no. of

attributable deathsItaly July-Aug 20,089

France Aug 19,490Germany August 5,250

UK August 2,045Portugal August 2,007

India/Bangla-desh/

Pakistan

May-June 1,472

Switzerland

July 1,039

Netherlands

August 1,200

Belgium August 150

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Montreal: Recent Trends (April to September, inclusive)

Red = Maximum temperatureBlue = No. of days >25°C

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Distribution of Maximum Daily Temperature, Montreal, 2003

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Sometime in the Future when Mean Global Temperatures have Increased by 3°C

Excess Mortality from Climate Change, Montreal, Spring-

Summer

•2001 (57 days >25°C):

•Excess no. of deaths on days >25°C = 212

•Projected to 2100 (97 days >25°C):

•Excess no. of deaths on days >25°C = 454

•Attributable to Global Warming (3°C): 454 - 212 = 242 deaths ~1.3 deaths/day during the “warm” season

Daily Diary Study of Congestive Heart Failure

•Nadia Giannetti, McGill

•Rick Burnett, Health Canada

•Nancy Mayo, McGill

•Marie-France Valois, McGill

•Jay Brophy, McGill

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Objective

•To determine whether daily exacerbations in essential signs, symptoms, and physiologic indicators are associated with daily variations in concentrations of ambient air pollution and changing weather patterns

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Design•Daily diary of signs and symptoms

•Daily measurements of:

•oxygen saturation, pulse rate

•weight

•blood pressure

•Daily measurements of air pollutants and weather conditions from fixed-site stations

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Design

•~2 months duration per subject

•Very poor pumping of heart (ventricular ejection fraction <35%)• Published: Occupational and Environmental Medicine

2008;65:659-6 and Environ Res 2009;109:166-174

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Go Back

Pulse Oximeter

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Results

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New Panel Study

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Modifications

• Increased sample size

• Expanded daily diary

• Environmental measurements inside and outside of the home

• Temperature, RH

• CO, PM2.5, NOX

• Air infiltration rates

• GPS device to estimate exposures outside of home

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GPS Outdoor

Indoor