IOM Singapore: Institute of Occupational Medicine - Health Risks … - Health... · 2015. 9....
Transcript of IOM Singapore: Institute of Occupational Medicine - Health Risks … - Health... · 2015. 9....
INSTITUTE OF OCCUPATIONAL MEDICINE www.iom-world.sg
Health Risks of Combustion Generated Particulate Matter, including Biomass
Combustion
Rob Aitken, Michael Riediker
NYP 15th Sept 2015
IOM Singapore
• Multidisciplinary research, consultancy, training, occupational and environmental health, hygiene, risk
• Core values
• Independence, Impartiality, Authority
• Deep insight for
• Problem definition & evaluation
• Practical solutions
• Charitable status - not for profit
• 140 staff, Edinburgh HQ, other UK offices, international activity
• Since 1st September 2012IOM Singapore30 Raffles Place#17-08 Chevron HouseSingapore 048622
www.iom-world.sg2
Air pollution
Going…. going… gone!!!
4
Early evidence of health effects
London fog of 1952: > 4000 deaths
Logan, Lancet 1:336-8;1953
Who died?
www.kcl.ac.uk
Components of air pollution
Air pollution
Gases
Co2, CO
NO, O3
SO2
Volatile organic
compounds
Quinones, PAH,
Benzenes, Toluenes
Particulates
Carbon, nitrates,
sulphates, metals
7
Plinius the older (1st AD):
"when well shafts have
been sunk deep, fumes
of sulfur or alum rush up
to meet the diggers and
kill them"
Paracelsus (16th AD):
"Silicosis is a consequence of bad substances present in the air of mines."
Air Pollution in historic times: Particles kill
Many examples from workplaces
• Coal dust – coalminers, – pneumoconiosis, COPD
• Quartz – stoneworkers - silicosis, COPD
• Asbestos – mesothelioma, cancer, asbestosis
Six cities study
Docherty and Pope (1993)• Prospective cohort mortality study involving
8,111 randomly selected residents of six U.S. cities. The objective was to estimate the effects of air pollution on mortality while controlling for other risk factors such as the individuals’ smoking status and age.
Dockery D, Pope CA et al. "An association between air pollution
and mortality in six U.S. cities." N Eng J Med. 1993;
392(24):1753-1759
Laden and Schwartz (2006)
• Death from cardiovascular disease was positively associated with average PM2.5 over the entire follow-up (RR=1.28)
• Death from lung cancer was positively associated with average PM2.5 over the entire follow-up period (RR=1.27)
• Death from non-malignant respiratory diseases was positively associated with average PM2.5 over the entire follow-up period (RR=1.08,
Laden and Schwartz “Reduction in Fine Particulate Air
Pollution and Mortality: Extended Follow-up of the Harvard Six
Cities Study,” in the American Journal of Respiratory & Critical
Care Medicine (2006; 173: 667-672.)
Roads:
- Engine exhaust
- Road, tire and brake wear
- Re-suspension of street dust
Sources of fine particles
10
Industry:
- Energy and heat production
- Exhaust from production process
Harbour:
- Ship diesel emissions
- Bulk ship unloading
- Ground transport
Forest fires:
- Illegal burning
- Accidents, lighting
- Draught – climate change
Short term effects
11Haze over Singapore, © Soham Banerjee, Flickr: soham_pablo, reproduced under Creatives Commons Attribution License 2.0.
Heart infarction
Stroke
Increased arrhythmia
Increased blood pressure
Asthma
Allergy exacerbation
12
Short-term effects of particles in populations
Heart Rate Variability Gold et al. Circulation 2000;101:1267-1273
ST-Segment depression Pekkanen et al. Circulation 2002;106:933-
938
Cardiac arrhythmia Peters et al. Epidemiology 2000;11:11-17
C-reactive protein Peters et al. Eur Heart J 2001;22:1198-1204
Plasma fibrinogen Pekkanen et al. Occup Environ Med 2000;57:818-822
Red blood cells Seaton et al. Thorax 1999;54:1027-1032
13
Chronic effects: atherosclerosis
from Künzli et al. EHP 2005;113(2):201-206
Geo-coded PM2.5
Carotid intima-media thickness
Population: long-term mortality related to PM
14
U.S. Cancer II study x): causes of mortality
All cardiovascular plus diabetes (+12% per 10 μg/m3 PM2.5)
Ischemic heart disease (+18%)
Dysrhythmia, heart failure and cardiac arrest (+13%)
Hypertensive disease (only smokers, +57%)
x) Prospective, 10-14 years follow-up, 1.2 million adults in all U.S. states, Pope et al. Circulation 2004;109:71-77.
Seaton hypothesis
Epidemiological studies have consistently shown an association between particulate air
pollution and not only exacerbations of illness in people with respiratory disease but also rises
in the numbers of deaths from cardiovascular and respiratory disease among older people…
We propose that the explanation lies in the nature of the urban particulate cloud, which may
contain up to 100000 nanometer-sized particles per mL, in what may be a gravimetric
concentration of only 100-200 μg/m3 of pollutant. We suggest that such ultra-fine particles are
able to provoke alveolar inflammation, with release of mediators capable, in susceptible
individuals, of causing exacerbations of lung disease and of increasing blood coagulability,
thus also explaining the observed increases in cardiovascular deaths associated with urban
pollution episodes. This hypothesis is testable both experimentally and epidemiologically.
Global burden of disease
Source – WHO Global Health Observatory Data
Repository
“In 2012, ambient air pollution was responsible
for 3.7 million deaths, representing 6.7% of the
total deaths. Worldwide, ambient air pollution is
estimated to cause about 16% of the lung
cancer deaths, 11% of chronic obstructive
pulmonary disease (COPD) deaths, more than
20% of ischaemic heart disease and stroke,
and about 13% of respiratory infection deaths”
3.7 million deaths, representing 6.7% of the total deaths
Global burden
Biomass burning
• Should we expect any difference?• High concentration PM2.5
• Ultrafine particles
• Similar composition
• Short term effects• Elevated hospital
admissions
• Increased myocardial infarction, stroke
• Long term effects• Increased COPD, ischemic
heart disease, cancer
Thank you for listening
Clear sky’s ahead?