Final Report: A Case-Crossover Analysis of Fine Particulate Matter Air Pollution and Out-of-Hospital Sudden Cardiac Arrest
EPA Grant Number: R828112C099Subproject: this is subproject number 099 , established and managed by the Center Director under grant R828112
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
Center: Health Effects Institute
Center Director: Greenbaum, Daniel S.
Title: A Case-Crossover Analysis of Fine Particulate Matter Air Pollution and Out-of-Hospital Sudden Cardiac Arrest
Investigators: Checkoway, Harvey
Institution: University of Washington
EPA Project Officer: Katz, Stacey
Project Period: April 1, 2000 through March 31, 2005
RFA: Health Effects Institute (1996)
Research Category: Particles and Diesel Engine Exhaust , Public/Private Partnership Center
Description:
Objective:Epidemiologic studies have reported associations between short-term increases in particulate matter (PM) air pollution and increased daily mortality and morbidity from respiratory and cardiovascular diseases. Although these studies suggest that persons with preexisting disease are most susceptible to the effects of small increases in PM, the specific clinical conditions that confer increased risk have been unclear. Because most studies use mortality data from death certificates, clinical conditions at the time of death have not been known. Dr Checkoway and his colleagues proposed to investigate a previously uninvestigated association between sudden cardiac arrest and fine particulate air pollution. Such an association would have important public health implications because sudden cardiac arrest is most often observed as sudden cardiac death, responsible for almost 10% of total US mortality. Summary/Accomplishments (Outputs/Outcomes):
The primary hypothesis that Dr Checkoway and colleagues tested was that increases in daily fine particle levels were related to increased risk of out-of- hospital sudden cardiac arrest. Sudden cardiac arrest and questionnaire data collected for a different purpose were used for this study in conjunction with exposure data available from the Puget Sound Clean Air Agency (Seattle WA).
The investigators used a case-crossover study design in which only case subjects were studied (rather than cases and control subjects); their exposure at the time when the health outcome of interest (sudden cardiac arrest) occurred was compared with some estimate of their typical level of exposure measured at another time. The case-crossover method can be used to investigate whether a recent exposure has triggered or is related to the occurrence of an event?here, whether levels of PM are related to sudden cardiac arrest.
In this study, for each case of sudden cardiac arrest, a time period when the person was disease free was selected as a matched "referent" period. The exposure status at the time of disease onset, the "hazard" period, was compared with exposure during the referent period for that subject. (The authors also examined potential sources of bias in case-crossover studies of air pollution [Appendix A].)
Analyses were conducted for models that included a single pollutant (one of two sizes of PM) and multiple pollutants (in which SO2 , CO, or both were added). The relative risk estimates for sudden cardiac arrest, which considered exposure to pollutants on the day of the outcome event and up to 5 days before the event, showed no evidence of an increase in risk. Furthermore, these results did not change when either SO2 or CO exposure were included in the analyses. The investigators also examined several factors that might modify the results, including season, time of entry into the study, age, and risk factors for sudden cardiac arrest, such as diet, education, and smoking. These analyses showed no modification of the results; in addition, stratifying the subjects by age and other cardiovascular disease risk factors did not identify possible susceptible subgroups of the population studied.
Dr Checkoway and his colleagues made good use of a unique but small dataset, collected for a different purpose, to examine the association between PM and sudden cardiac arrest, a well-defined and specific health outcome. This outcome is of interest because of the associations between cardiovascular deaths and PM levels reported in other studies. The study results are sufficiently precise to rule out a 50% increase in risk of sudden cardiac arrest from exposure to PM in Seattle residents with no prior history of heart disease. It should be understood, however, that a lack of association between sudden cardiac arrest and PM in this study does not rule out an association between other cardiac or cardiovascular disease outcomes and PM. Epidemiologic and laboratory studies currently under way will add to our current knowledge about the possible PM effects on potentially susceptible individuals.
Supplemental Keywords:Air, ambient air quality, air toxics, epidemiology, health effects, particulate matter, biochemistry, motor vehicle emissions, diesel exhaust, human health risk assessment, mortality, human exposure. , Air, Scientific Discipline, Health, RFA, indoor air, Risk Assessments, Health Risk Assessment, Epidemiology, air toxics, Biochemistry, particulate matter, Environmental Chemistry, mobile sources, exposure and effects, case crossover analysis, ambient air quality, cardiovascular disease, coronary artery disease, indoor air quality, inhalation, epidemelogy, inhalation toxicology, cardiac arrest, air quality, ambient air, cardiotoxicity, indoor exposure, environmental health effects, automobiles, emissions, human health risk, lung inflammation, lung injury, air pollutants, engines, human health effects, particulates, motor vehicles, ambient particle health effects, air pollution, cardiac arrhythmias, inhalability, inhaled, lung, human health, human exposure, particulate exposure
Progress and Final Reports:
Original Abstract
Main Center Abstract and Reports:
R828112 Health Effects Institute
Subprojects under this Center:
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R828112C042 Does Inhalation of Methanol Vapor Affect Human Neurobehavior?
R828112C043 Human Responses to Nitrogen Dioxide
R828112C044 The Role of Inflammation in Ozone-Induced Lung Injury
R828112C045 How Does Exercise Affect the Dose of Inhaled Air Pollutants?
R828112C046 How Do Chemicals in Diesel Engine Exhaust Damage DNA?
R828112C047 Effect of Nitrogen Dioxide on Bacterial Respiratory infection
in Mice
R828112C048 Effects of Ozone Exposure on Airway Epithelium
R828112C049 Inhalation of Aldehydes and Effects on Breathing
R828112C050 Does Ozone Cause Precancerous Changes in Cells?
R828112C051 Effects of Formaldehyde on Human Airway Epithelial Cells Exposed in a Novel Culture System
R828112C052 Carbon Monoxide and Cardiac Arrhythmias
R828112C053 Effects of Formaldehyde and Particle-Bound Formaldehyde on Lung Macrophage Functions
R828112C054 Mechanisms for Protecting Lung Epithelial Cells Against Oxidant Injury
R828112C055 Relationship of Nitropyrene-Derived DNA Adducts to Carcinogenesis
R828112C056 Particle Trap Effects on Heavy-Duty Diesel Engine Emissions
R828112C057 Carbon Monoxide and Atherosclerosis
R828112C058 Nitrogen Dioxide and Respiratory Illness in Children
R828112C059 Noninvasive Methods for Measuring Ventilation in Mobile Subjects
R828112C060 Oxidant Air Pollutants and Lung Cancer: An Animal Model
R828112C061 Detection of Carcinogen-DNA Adducts: Development of New Methods
R828112C062 Effects of Carbon Monoxide on Heart Muscle Cells
R828112C063 Development of Personal Ozone Samplers: Three Approaches
R828112C064 Development of Biomarkers to Monitor Carcinogen Exposure
R828112C065 Effects of Prolonged Ozone Inhalation on Collagen Structure and Content in Rat Lungs
R828112C065II Prolonged Ozone Exposure and the Contractile Properties of Isolated Rat Airways
R828112C065III Changes in Complex Carbohydrate Content and Structure in Rat Lungs Caused by Prolonged Ozone Inhalation
R828112C065IV Genetic Control of Connective Tissue Protein Synthesis After Prolonged Ozone Inhalation
R828112C065V Pulmonary Function Alterations in Rats After Chronic Ozone Inhalation
R828112C065VII Prolonged Ozone Exposure Leads to Functional and Structural Changes in the Rat Nose
R828112C065VIII - IX Studies of Changes in Lung Structure and Enzyme Activities
in Rats After Prolonged Exposure to Ozone
R828112C065X An Innovative Approach to Analyzing Multiple Experimental Outcomes: A Case Study of Rats Exposed to Ozone
R828112C065XI The Consequences of Prolonged Inhalation of Ozone on Rats:
An Integrative Summary of the Results of Eight Collaborative Studies
R828112C066 Interactive Effects of Nitropyrenes in Diesel Exhaust
R828112C067 Detection of FormaldehydeDNA Adducts: Development of New Methods
R828112C068I Comparison of the Carcinogenicity of Diesel Exhaust and Carbon Black in Rat Lungs
R828112C068II An Investigation of DNA Damage in the Lungs of Rats Exposed to Diesel Exhaust
R828112C068III No Evidence For Genetic Mutations Found In Lung Tumors From Rats Exposed To Diesel Exhaust or Carbon Black
R828112C069 Noninvasive Determination of Respiratory Ozone Absorption: The Bolus-Response Method
R828112C070 The Effects of Inhaled Oxidants and Acid Aerosols on Pulmonary Function
R828112C071 Biochemical Consequences of Ozone Reacting with Membrane Fatty Acids
R828112C072 DNA Mutations in Rats Treated with a Carcinogen Present in Diesel Exhaust
R828112C073 Developmental Neurotoxicity of Inhaled Methanol in Rats
R828112C074 Methanol Distribution in Non Pregnant and Pregnant Rodents
R828112C075 Is Increased Mortality Associated with Ozone Exposure in Mexico City?
R828112C076 Effects of Fuel Modification and Emission Control Devices on Heavy-Duty Diesel Engine Emissions
R828112C077 Metabolic Studies in Monkeys Exposed to Methanol Vapors
R828112C078 Effects of Ozone on Pulmonary Function and Airway Inflammation in Normal and Potentially Sensitive Human Subjects
R828112C079 Improvement of a Respiratory Ozone Analyzer
R828112C080 Mechanism of Oxidative Stress from Low Levels of Carbon Monoxide
R828112C081 Long-Term Exposure to Ozone: Development of Methods to Estimate Past Exposures and Health Outcomes
R828112C082 Effects of Ambient Ozone on Healthy, Wheezy, and Asthmatic Children
R828112C083 Daily Changes in Oxygen Saturation and Pulse Rate Associated with Particulate Air Pollution and Barometric Pressure
R828112C084 Evaluation of The Potential Health Effects of the Atmospheric Reaction Products of Polycyclic Aromatic Hydrocarbons
R828112C085 Mechanisms of Response to Ozone Exposure: The Role of Mast Cells in Mice
R828112C086 Statistical Methods for Epidemiologic Studies of the Health Effects of Air Pollution
R828112C087 Development of New Methods to Measure Benzene Biomarkers
R828112C088 Alveolar Changes in Rat Lungs After Long-Term Exposure to Nitric Oxide
R828112C089 Effects of Prenatal Exposure to Inhaled Methanol on Nonhuman Primates and Their Infant Offspring
R828112C090 A Pilot Study of Potential Biomarkers of Ozone Exposure
R828112C091 Effects of Concentrated Ambient Particles on the Cardiac and Pulmonary Systems of Dogs
R828112C092 Cancer, Mutations, and Adducts in Rats and Mice Exposed to Butadiene and Its Metabolites
R828112C093 Effects of Concentrated Ambient Particles in Rats and Hamsters: An Exploratory Study
R828112C094I The National Morbidity, Mortality, and Air Pollution Study: Methods and Methodologic Issues
R828112C094II The National Morbidity, Mortality, and Air Pollution Study: Morbidity and Mortality from Air Pollution in the United States
R828112C095 Association of Particulate Matter Components with Daily Mortality and Morbidity in Urban Populations
R828112C096 Acute Pulmonary Effects of Ultrafine Particles in Rats and Mice
R828112C097 Identifying Subgroups of the General Population That May Be Susceptible to Short-Term Increases in Particulate Air Pollution
R828112C098 Daily Mortality and Fine and Ultrafine Particles in Erfurt, Germany
R828112C099 A Case-Crossover Analysis of Fine Particulate Matter Air Pollution and Out-of-Hospital Sudden Cardiac Arrest
R828112C100 Effects of Mexico City Air on Rat Nose
R828112C101 Penetration of Lung Lining and Clearance of Particles Containing Benzo[a]pyrene
R828112C102 Metabolism of Ether Oxygenates Added to Gasoline
R828112C103 Characterization and Mechanisms of Chromosomal Alterations Induced by Benzene in Mice and Humans
R828112C104 Acute Cardiovascular Effects in Rats from Exposure to Urban Ambient Particles
R828112C105 Genetic Differences in Induction of Acute Lung Injury and Inflammation in Mice
R828112C106 Effects on Mice of Exposure to Ozone and Ambient Particle Pollution
R828112C107 Emissions from Diesel and Gasoline Engines Measured in Highway Tunnels