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Final Report: The National Morbidity, Mortality, and Air Pollution Study: Morbidity and Mortality from Air Pollution in the United States
EPA Grant Number: R828112C094IISubproject: this is subproject number 094II , 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: The National Morbidity, Mortality, and Air Pollution Study: Morbidity and Mortality from Air Pollution in the United States
Investigators: Samet, Jonathan M.
Institution: Johns Hopkins University
EPA Project Officer: Katz, Stacey
Project Period: April 1, 2000 through March 31, 2005
RFA: Health Effects Institute (1996)
Research Category: Health Effects
Description:
Objective:Epidemiologic time-series studies conducted in a number of cities have identified, in general, an association between daily changes in concentration of ambient particulate matter (PM) and daily number of deaths (mortality). Increased hospitalization (a measure of morbidity) among the elderly for specific causes has also been associated with PM. These studies have raised concerns about public health effects of particulate air pollution and have contributed to regulatory decisions in the United States. However, scientists have pointed out uncertainties that raise questions about the interpretation of these studies. One limitation to previous time-series studies of PM and adverse health effects is that the evidence for an association is derived from studies conducted in single locations using diverse analytic methods. Statistical procedures have been used to combine the results of these single location studies in order to produce a summary estimate of the health effects of PM. Difficulties with this approach include the process by which cities were selected to be studied, the different analytic methods applied to each single study, and the variety of methods used to measure or account for variables included in the analysis. These individual studies were also not able to account for the effects of gaseous air pollutants in a systematic manner. Summary/Accomplishments (Outputs/Outcomes):
HEI funded the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) to characterize the effects of airborne particles less than 10 ?m in aerodynamic diameter (PM10) alone and in combination with gaseous air pollutants in a consistent way in a large number of cities. The study was designed to select multiple locations based on the specific criteria of population size and availability of PM10 data from the US Environmental Protection Agency?s Aerometric Information Retrieval System (AIRS) database, and to apply the same statistical procedures to all locations. Dr Jonathan Samet and his colleagues at Johns Hopkins University conducted a time-series study of mortality effects in large US cities representing various levels of PM10 and gaseous pollutants. In their analysis, the investigators first estimated risk in each city using the same method and then combined these results systematically to draw more information than any single city could provide. The 20 and 90 largest cities were analyzed for effects of PM10 and other pollutants on mortality; the 90 largest cities were analyzed for possible modification of PM10 effects among cities by factors other than air pollutants. Dr Samet?s coinvestigators at Harvard University also applied a unified statistical method, although different from the one used in the mortality analysis, to 14 cities with daily PM10 data to examine effects on hospitalization among those 65 years of age or older.
NMMAPS has made a substantial contribution in addressing major limitations of previous studies. The mortality analysis used one analytic approach to examine the PM10 effect in many cities that cover a wide geographic area and have varying levels of different air pollutants. The results of both the 20 cities and 90 cities analyses are generally consistent with an average approximate 0.5% increase in overall mortality for every 10 mg/m3 increase in PM10 measured the day before death. This effect was slightly greater for deaths due to heart and lung disease than for total deaths. Effects of PM10 measured on the day of death or 2 days before did not vary substantially from one another for total or for heart and lung deaths. The PM10 effect on mortality also did not appear to be affected by other pollutants in the model.
Although individual estimates for each of the 90 cities varied, as expected, the strength of the analysis was in its ability to combine data from nearby cities in a particular region to estimate a PM10 effect. Combining the data in this systematic way provided additional statistical power to the analysis that is not available in single-city analyses. Some differences in PM10 effect on mortality were seen by region of the US: for the 90 cities, the largest effect was evident in the Northeast. The investigators did not identify any factor or factors that might explain these differences. This analysis is an important first step, and further evaluation of the reasons for these regional differences will advance our understanding of the association between PM10 and mortality. The heterogeneity of effect across cities offers the potential to identify factors that could influence the effects of PM10 on health and thus provide valuable insights into the mechanisms by which PM10 causes adverse health effects.
The morbidity analysis also used a unified analytic method to examine the association of PM10 with hospitalization of those 65 years of age or older in 14 cities with daily PM10 measurements. The results were consistent with an approximate 1% increase in admissions for cardiovascular disease and about a 2% increase in admissions for pneumonia and chronic obstructive pulmonary disease for each 10 ?g/m3 increase in PM10. A greater estimate of effect on hospitalizations at lower concentrations (less than 50 ?g/m3) was found for the three diagnoses considered, but the meaning of these findings should await completion of concentration-response analyses for mortality now under way using data from 20 cities.
NMMAPS has made substantial contributions to our understanding of the relationship between exposure to PM10 and health effects. Further analyses in these databases of regional differences, the effects on morbidity and mortality combined, and concentration-response relationships will enhance our understanding.
Supplemental Keywords:Air, ambient air quality, air toxics, epidemiology, health effects, particulate matter, biochemistry, motor vehicle emissions, diesel exhaust, human health risk assessment, mortality, disease, human exposure, mobile sources. , Air, Scientific Discipline, Health, RFA, Risk Assessments, Health Risk Assessment, air toxics, Atmospheric Sciences, Biochemistry, particulate matter, Environmental Chemistry, mobile sources, automotive exhaust, epidemiology, exposure assessment, exposure and effects, Acute health effects, ambient air quality, cardiovascular vulnerability, indoor air quality, mortality, cardiopulmonary mechanisms, diesel exhaust, cardiopulmonary responses, human health risk, lung inflammation, air pollutants, chronic health effects, human health effects, particulates, respiratory, diesel exhaust particles, ambient particle health effects, air pollution, environmental risks, methodologic issues, exposure, human health, human exposure, morbidity
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 Formaldehyde–DNA 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