AIR POLLUTION(PPT) AND HEALTH

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Slide 1 : AIR POLLUTION AND HEALTH MEDICAL EVIDENCE SUMMARY Clay Ballantine, M.D.
Slide 2 : Medical Studies Peer-reviewed journals Thousands of studies Physiology Epidemiology Government databases Dose-Response relationship
Slide 3 : Causes of Death in U.S. 1. Cardiovascular Disease 2. Cancer 3. Lung Disease
Slide 4 : Annual Deaths Air Pollution 23,000 Drunk Driving 17,000 Murder 20,000
Slide 5 :
Slide 6 : NC Medical Society Resolution 2001 House of Delegates unanimously adopted a resolution sponsored by the Buncombe Co. Medical Society, urging all branches of state government to work toward cleaner air because of the large public health impact of air pollution exposure.
Slide 7 : 4 Main Pollutants Ozone Particulates, especially PM 2.5 Air-borne toxics Mercury
Slide 8 : RISK Assumed vs. Imposed
Slide 9 : Who is at Risk? Children Elderly Prior heart or lung disease patients Diabetics Persons who work/exercise outdoors Otherwise healthy adults and children
Slide 10 : Health Problems Impaired fertility Birth Defects Respiratory Infections Asthma Emphysema Lung Cancer Heart attacks Strokes Premature Death
Slide 11 : “Pyramid of Effects”
Slide 12 :
Slide 13 : Air Pollutants: Ground Level Ozone Ultra-violet light Volatile organics Nitrogen oxides
Slide 14 : Air Pollutants: Ground Level Ozone Nitrogen Oxides: 50% from traffic 50% from power plants and industry
Slide 15 : By 2010 vehicle use will grow 70% and electricity use 50%. By 2040 vehicle use will grow 170% and electricity 100%.
Slide 16 : Air Pollutants: Ground Level Ozone Seasonal variation Daily variation Outdoors Does not penetrate buildings
Slide 17 :
Slide 18 : Ozone’s physiology Caustic gas--clear , colorless, odorless Oxidizes proteins and lipids in the mucosal fluid layer Highly irritating to lung linings Increases lung secretions, decreases oxygenation Sets off airway bronchospasm Recruits inflammatory cells Increases responses to allergens Damages infection fighting responses Chronic lung damage/remodeling
Slide 19 : Asthma Epidemic 50 % in Children 100% in Adults
Slide 20 : Ozone and Asthma Attacks Hundreds of published studies from around the world all show the same results: More ozone pollution exposure leads to more asthma attacks. Dose = Response relationship
Slide 21 : Airway Obstruction
Slide 22 : Ozone Reduces Lung Function BASELINE 2HR 4HR FEV1, % CHANGE -60 -40 -20 0 M-10
Slide 23 : Asthma and Air Pollution Epidemiologic analysis of air quality data from 1997 and asthma rates showed: One third to one half of asthma attacks in North Carolina annually are due to air pollution exposure Abt Associates report, 1999
Slide 24 : North Carolina Summers Air pollution causes an EXTRA: 240,000 Asthma Attacks 6,300 ER Visits 1,900 Admissions (Abt Associates, 1999)
Slide 25 : Ozone Causes Asthma Exercising children exposed to ozone: a cohort study time outdoors = asthma McConnell, et al. Lancet 2002: 359: 386-91
Slide 26 : Ozone: Asthma Effects More people with asthma More asthma attacks More asthma medicine use More doctor, ER and Urgent Care visits More children and elderly in hospitals More school absences More lost work days
Slide 27 : Ozone: Other Effects allergy symptoms respiratory infections ear infections emphysema attacks overall death rates
Slide 28 : Ozone Pollution Health RisksThe ALA “Worst 25” Atlanta 6th Knoxville 8th Charlotte 9th Raleigh-Durham 13th Nashville 18th Memphis 19th New York 20th Birmingham 21st Greensboro-Winston 21st Macon 24th Chattanooga 24th
Slide 29 :
Slide 30 : Air Pollutants: Particulates Sulfates, nitrates, Polycyclic Aromatic Hydrocarbons (PAH), Soot / Carbon and Dust
Slide 31 : Particulate Components 34 Elemental Metals Sulfur oxides, nitrogen oxides, ammonia 9 Light PAHs 14 Heavy PAHs Bio-organics Traffic tracers: 2 Hopanes 4 Steranes
Slide 32 : Particulate Pollution
Slide 33 : Sulfate Emission Increases
Slide 34 : Particulate Physiology Penetrate deeply into lungs to alveoli Irritate lung linings-more asthma Stimulate immune system inflammatory proteins
Slide 35 : Air Pollutants: Particulates Year round exposures Penetrate buildings
Slide 36 : Two Different Immune System Responses Th1 = Normal infection fighting response Th2 = Allergic/Asthmatic response
Slide 37 : Diesel Exhaust Permanently Changes Immune Response More Asthmatic and Allergic responses Increases Th2 Decreases Th1 Polycyclic aromatic hydrocarbons (PAH) are the culprits Diesel and vehicle exhaust and coal smoke Nel, A.E., et al., J of Allergy and Clinical Immunology, 2001
Slide 38 : Particulates and Asthma Multiple studies show direct correlation between exposure to particulates and increases in asthma attacks and hospitalization rates Effects seen in adults and especially pronounced in children
Slide 39 : PAH and Allergies PAH exposure increases the physiological responses to allergens Allergy symptoms scores worse 3-fold Diaz-Sanchez J. All. Clin. Immun. Dec 2000 106
Slide 40 :
Slide 41 : Particulates: Cardiac Effects Vascular inflammation Blood clotting protein levels Cardiac arrhythmias Blood pressure Heart rate variability Alters cardiac conduction
Slide 42 : Particulates: Cardiac Effects Vascular inflammation is more important than cholesterol in development of cardio-vascular disease
Slide 43 : Air Pollution and Next-Day Heart Attacks Short term exposure to particulates (PM2.5) increases the incidence of heart attacks for one day following exposure As air pollution goes up the risk of heart attack goes up Increased Particulate Air Pollution and the Triggering of Myocardial Infarction Peters, et al.; Circulation, June 12, 2001, vol. 103
Slide 44 : Traffic Emissions and Death Near-road group had: Almost double the death rate from heart and lung disease 1.4 times higher overall death rate Hoek, G., et al. “Association between Mortality and Indicators of Traffic-related Air Pollution in the Netherlands: A Cohort Study” Lancet 360 (2002) 1203
Slide 45 : Tunnel WorkersParticulate Exposure Study Swedish automobile tunnel workers Higher incidences of cardiac events (heart attacks and deaths) due to exposure to particulates at tunnel work stations Bellander, T.,Dept. of Environmental Health, Sweden, WHO/HEI Conference March, 2001
Slide 46 :
Slide 47 : Lung Cancer, Cardiopulmonary Mortality, and Long-term Exposure to Fine Particulate Air Pollution American Cancer Society’s Cancer Prevention II study 1.2 million adults enrolled in 1982 500,000 adults matched to available air pollution data in U.S. Extensive risk factor questionnaires Pope, et al. JAMA 2002 ;287:1132-1141
Slide 48 : Lung Cancer… (Pope, et al) For every increase in particulate exposure of 10 mcg/m3, there was increased risk of: 4% All cause mortality 6% Cardiopulmonary mortality 8% Lung cancer mortality Pope, et al. JAMA 2002 ;287:1132-1141
Slide 49 : Lung Cancer… (Pope, et al) Risk increase: Same as living with a smoker (second-hand smoke exposure) Pope, et al. JAMA 2002 ;287:1132-1141
Slide 50 : Air Pollution and Stroke Deaths Fine particulate matter and gaseous pollutants are significant risk factors for acute stroke death Women and the elderly are most susceptible to the effects of particulate air pollutants More air pollution exposure=more acute stroke deaths Effect of Air Pollutants on Acute Stroke Mortality. Hong, et al. Feb., 2002; Environmental Health Perspectives, v. 110. no.2
Slide 51 : Long-term Effects of Particulate Pollution Exposure Up to 4% of all US deaths 1 to 3 year drop in life expectancy (smokers lose ~4 years) 5% of all cardiac hospitalizations Effects on healthy people as well
Slide 52 : Lack of Threshold Effect: Nowhere to hide Daniels et al “NMMAPS” Am J Epidemiology v.152, no. 5. (2000)
Slide 53 : Effects on Otherwise Healthy People Asthma rates in adults Pneumonia and respiratory infections Lung cancer rates similar to living with a smoker Overall death rates Faster decline in lung function with age
Slide 54 : Area Cities at Risk>15 mcg/m3 PM 2.5 Weighted Annual Mean Asheville = 15.1 Charlotte = 17.2 Raleigh = 16.5 Greensboro = 17.8 Atlanta = 21.4 Greenville, SC = 16.5 Johnson City, TN = 16.4 EPA data 2000
Slide 55 : WNC Health Lowest overall mortality in state Lower lung cancer death rates (low cigarette use) Higher mortality from lung diseases pneumonia and emphysema Higher levels of fine particulate and air toxics air pollution than state or US NC State Center for Health Statistics, 1998
Slide 56 : Effects on Children--A Generation at Risk-- Multiple birth defects-heart, neural tube Higher infant mortality More asthma Impaired lung development Premature emphysema Increased respiratory infections Higher health care expenditures
Slide 57 : Childhood asthma Increased by 55% from 1982-1996 #1 cause of hospitalization (< 18 yrs) #1 health care cost for childhood diseases #1 cause lost school days (chronic illness ) 1/2 to 1/3 of NC asthma due to air pollution
Slide 58 : Asthma in Buncombe County 10% Children diagnosed with asthma 25-30% Asthma symptoms Similar results in all North Carolina counties NC Dept. HHS-Div. Of Public Health, 2001
Slide 59 :
Slide 60 : Ozone Causes Asthma Exercising children exposed to ozone: a cohort study time outdoors = asthma McConnell, et al. Lancet 2002: 359: 386-91
Slide 61 : Air Pollution and Lung Function Growth-Part 1 1700 4th graders followed for 4 years 10% lower lung function for children growing up in more polluted air Most time in polluted air = worst impairment of lung growth Association between Air Pollution and Lung Function Growth in Southern California Children. Gauderman, W., et al., Am J Respiratory and Critical Care Medicine, vol.166 (2002) pp.76-84.
Slide 62 : Air Pollution and Lung Function Growth-Part 2 1700 4th graders followed for 8 years 20% lower lung function for children growing up in more polluted air The Effect of Air Pollution on Lung Development from 10 to 18 Years of Age Gauderman, W., et al., New England Journal of Medicine Vol. 351 (2004) pp 1057-1067
Slide 63 :
Slide 64 : Results of Clean-up 1996 Atlanta Summer Olympics, reduced ozone levels due to transit system changes led to a significant drop in children’s asthma. After German reunification, pollution dropped and children’s respiratory symptoms decreased dramatically. Friedman, M.S., et al. JAMA, V. 285, No. 7, 2001 Heinrich, J., et al., Am. J. Resp. and Crit. Care Med., V.161, 2000
Slide 65 : Results of Clean-up Ireland banned coal burning: Cardiovascular death rates dropped 10.5% Hong Kong banned high-sulfur fuel oil: Cardiovascular death rates dropped 2.5%
Slide 66 : Air Pollution and Medical Care Costs Millions of Medicare records for 183 U.S. Cities (patient ages 65-84) Analyzed for Medicare costs and air pollution exposure levels, city by city Controlled for other illnesses, smoking, and economic status Air Pollution and Medical Care Use by Older Americans: A Cross Area Analysis. Fuchs, Victor and Rosen, Sarah Health Affairs, vol. 21, no. 26 pp207-214
Slide 67 : Air Pollution and Medical Care Costs Every 10 ppb particulates= $177 extra cost to Medicare per patient per year Air Pollution and Medical Care Use by Older Americans: A Cross Area Analysis. Fuchs, Victor and Rosen, Sarah Health Affairs, vol. 21, no. 26 pp207-214
Slide 68 : Air Pollution and Medical Care Costs Charlotte= $94 Million extra Medicare costs per year
Slide 69 : Air Pollution and Medical Care Costs Rowan County= $5.7 Million extra Medicare costs per year
Slide 70 : Annual Asthma Costs NC 7th & 8th Graders: $14 million Hospitalizations $ 1.4 million E.R. visits All NC children: $100 million Add M.D. visits, prescription costs, wages lost by parents who miss work, and costs for other children’s age groups NC Dept. HHS-Div. Of Public Health, 2001
Slide 71 : Asthma in Buncombe County ~50% Children in BC are on Medicaid 25-30% Asthma symptoms (10% diagnosed) $400,000 BCHD budget devoted to asthma care per year NC Dept. HHS-Div. Of Public Health, 2001
Slide 72 : Cost Shifting-We all pay Health care costs not paid by the auto, trucking, oil and electric utilities that generate pollution Private insurance premiums Lost school revenue for absences Federal taxes for Medicare (especially for the elderly) State taxes for Medicaid (especially for children and disabled) County taxes for BCHD Hospital and health care providers pass on the costs of the uninsured
Slide 73 : Southeast Region 33,000,000 people living in significant air pollution 11,000 excess deaths yearly due to air pollution $20 billion in excess health care costs per year
Slide 74 : SAMI Data Independent analysis EPA, NPS, USFS commissioned separate, more comprehensive (but still very limited) health impact assessment of SAMI data, $11.5 billion to $44 billion annual health care savings in SE U.S. depending on degree of PM 2.5 reduction by 2010
Slide 75 : Impaired Visibility = Particulates
Slide 76 : SAMI Data Independent analysis $1 billion to $3 billion annual recreation and tourism benefits lost due to air pollution and haze
Slide 77 : 5 Pieces to the Pollution Puzzle: Our Smokestacks Regional Smokestacks Vehicles Land Use and Transportation Planning—containing sprawl 5 Non-road engines—lawn, farm, marine, rail, construction, recreation and industrial
Slide 78 : 5 Pieces to the Pollution Puzzle: Our Smokestacks Clean Smokestacks legislation We are paying to clean up our power plants Energy efficiency
Slide 79 : 5 Pieces to the Pollution Puzzle: Regional Smokestacks Strengthen and enforce the Clean Air Act at the federal level Negotiate with our neighboring states/TVA Sue Thy Neighbor
Slide 80 : 5 Pieces to the Pollution Puzzle: Vehicles Car purchase is the most important environmental decision you will make Alternative fuel / hybrid cars Convert vehicle fleets Low sulfur fuel—statewide at all grades Enforce diesel improvements/decrease truck stop idling
Slide 81 : 5 Pieces to the Pollution Puzzle: Land Use and Transportation Planning More lanes=more sprawl (Atlanta) Better “Transportation” solutions Decrease Vehicle miles traveled Mass Transit funding Bikeways, sidewalks, greenways an integral part of the transport plan (obesity epidemic)
Slide 82 : 5 Pieces to the Pollution Puzzle: 5 Non-road engines—lawn, farm, marine, rail, construction, recreation and industrial Federal regulation of all forms of diesel and gas engines Retrofit with catalytic converters
Slide 83 : Final Points Health and economic issue Prioritize air quality improvement in decision making Over half the problem is traffic Massive hidden health costs in transportation and power pollution

 


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