HEALTH EFFECTS OF TRAFFIC AIR POLLUTION: new

findings for regulation

Jordi SunyerCREAL

June 2010

Known adverse effects of airborne particles (PM) on health WHO air quality guidelines - global update 2005

- Mortality and hospital admissions in chronic obstructive pulmonary disease patients

- Exacerbation of symptoms and increased use of therapy in asthma

- Mortality and hospital admissions in cardiovascular disease patients

- Mortality and hospital admissions in diabetes mellitus

- Increased risk for myocardial infarction

- Lung inflammation

- Systemic inflammation

- Endothelial and vascular dysfunction

- Development of atherosclerosis

- Increased incidence of infection

- Respiratory cancer

Ultrafine particles promote early atherosclerosis and systemic oxidative stress

Araujo et al. (Circ Research, 2008)

big3dist

s(bi

g3di

st, 3

)

0 100 200 300 400 500

-10

1

Distance to busy road0 100 200 300 400 500 meters

Ast

hma

risk

RR=1.0

Southern CaliforniaAssociation between residential distance to busy roads

and childhood asthma

McConnell et al, EHP2006

RR=1.4

Novel evidenceTraffic proximity and chronic disease

HEI report*

Exposure metricOutomceAuthor

Living ≤50m to major roadAsthma incidenceMorgenstern et al

2007 Munich, Germany

Living within 50m major roadsCoronory Heart diseaseHoffmann et al. 2009,Germany

Distance from freeway or main road (50m)

Cardiovascular mortalityCerebrovascular mortality

Fickelstein, Jerrett, & Sears 2005Ontario, Canada

*Source: Health Effects Institute panel on the health effects of traffic-related air pollution. Traffic-related air pollution: a critical review o the literature on emissions, exposure, and health effects.

New evidenceTraffic proximity and exposure

Beckerman et al. 2008

Particulate Matter and health effectsGaps of knowledge

• What is causing health effects?

• What are the sources of the most toxic agents?

• What are the biological mechanisms of toxicity of agents?

Outline

• 1. Size of PMs

• 2. Coarse PM and Saharan dust

• 3. New effects early in life

• 4. Impact assesment

Urban PM fractions and health effects in Barcelona Mass distribution

11.180.11.9(10.3)20.0931PM1 (µg/m3)

4.545.50.6(3.8)5.5931PM2.5-1 (µg/m3)

11.093.10.1(9.5)14.0931PM10-2.5 (µg/m3)

IQRMax.Min.(sd)MeannVariables

1.00PM1

0.241.00PM2.5-1

0.090.451.00PM10-2.5

PM1PM2.5-1PM10-2.5Correlation

Urban PM fractions and health effectsPerez et al.2009

Odds ratio per 10 ug/m3*

1.063(1.004-1.124)

Lag1

1.028(1.000-1.058)

Lag1Not significantPM1

Not significantNot significant1.206 (1.028-1.416)

Lag2PM2.5-1

1.098 (1.030-1.171)

Lag1

1.059 (1.026-1.094)

Lag1Not significantPM10-2.5

Cerebrovascularmortality

Cardiovascular mortality

Respiratory mortality

Fraction

*Only maximum lag effect for tri-pollutant model presented

PM fraction composition in BarcelonaElemental carbon

Adapted from Perez et al. Atmos. Environ. 2008

78%

PM fraction composition in BarcelonaMetals

Adapted Perez et al. Atmos. Environ. 2008

Combustion Break, tire and road erosion

Saharan dust outbreaks in Barcelona

•Occur 7-15 times a year•Predominant in spring and autumn•On average, outbreak lasts 3-5 days (Rodriguez et. al 2003)

Saharan dust and health effectsDistribution daily mass concentrations (µg/m3)

0.07-93.1

1.6-36.7

0.07-93.1

6.1-85.0

9.8-65.2

6.1-85.0

Min-Max

10.7

11.0

10.7

11.5

12.2

12.8

IQR

PM10-2.5

15.1 (9.7)602All days

16.4 (7.8)90Saharan dust days

14.9 (10.0)512Non Saharan dust days

24.0 (11.6)512Non Saharan dust days

29.9 (11.2)90Saharan dust days

24.9 (11.7)602All days

PM2.5

Mean (SD)nPollutant

R correlation PM2.5-PM10-2.5=0.34 (all days, Lag 1)

R correlation PM2.5-PM10-2.5=0.22 (Saharan dust days, Lag 1)

Saharan dust and health effectsResults-Total mortalityLag 1 per 10 µg/m3*

0.558

--

Pinteraction

Yes

No

1.084(1.015, 1.158)

1.050 (1.005, 1.097)

0.052

1.013 (0.992, 1.034)

1.035 (1.016, 1.055)

By Saharan dust days

--1.016

(0.996, 1.036)1.032

(1.015, 1.05)All days

P interaction

PM10-2.5PM2.5

*Two-pollutant model

Saharan dust and health effectsGrowing evidence

*: p <0.05 for comparision of mass adjusted concentrations

Chemical composition of PMs in BarcelonaSaharan dust days (n=9) vs Non-Saharan dust days (n=80)

TRAFFIC, SUSCEPTIBILITY AND

CHILDHOOD ASTHMA(McConell R; Env Health Persp 2006)

UFP and brain in rats• Intratracheal instillation of particles<100 nm labeled

with tech-99, radioactivity was subsequentlydetected in the brain (Nemmar AJRCCM 2001)

• Direct translocation Mn (8nm) in contralateralolfactory bulb (Elder EHP 2006)

• PM>200 nm (TiO2) may be phagocytized by macrophages and dendritic cells which may carrythe particles to lymph nodes in the lung or to thoseclosely associated with the lungs (Peters 2006)

• Oxidative stress and pro-inflammatory cytokinesoverexpressed in brain tissue (Calderon C 2008, Campbell 2009)

57 sampling points were selected to represent the gradient of exposure in the cohort

Cohort addressesSampling points500m- grid

1. SAMPLING SITES SELECTION

SPAINSabadell

SPAINSabadell

SPAINSabadell

Longitudinal growth curves

20

300

580

860

1140

1420

1700

1980

2260

2540

2820

3100

3380

3660

3940

Est

imat

ed

Fet

al W

eig

ht (

gr)

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40

gestational age (weeks)

female male30

70

110

150

190

230

270

310

350

Hea

d ci

rcum

fere

nce

(m

m)

10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40

gestational age (weeks)

female male

Head circumference Estimated fetal weight

BTEX

-59.7 (-130.9 to 11.5)

3rd

trimester

-101.9 (-176.2 to -27.6)

2nd

trimester

-52.5 (-125.8 to 20.8)

1st

trimester

-76.6 (-146.3 to -7.0)

9-month

Birth weight (g) for an IQR increase (µg/m3) in exposure to NO2 during pregnancy and each trimester (Aguilera 2009)

a Adjusted for child's sex, gestational age, season of conception, parity, maternal educational

level, maternal smoking, maternal height and pre-pregnancy weight and paternal height

Change in Z-scores of fetal size and growth for an IQR increase in exposure to NO2 (µg/m3) between

weeks 1-12(Aguilera, EHP2010)

* Adjusted for season of conception, parity, maternal education, and maternal smoking

-12

-10

-8

-6

-4

-2

0

2

4

6

8

10%

Cha

nge

FL HC AC BPD EFW

w_12 w_20 w_32 w_12_20 w_20_32

Mortality WHO scenario

2% (1%-2%)520 (350-690)Death due to acute exposure per year

15 (7-22)

3.500 (2.200-4.800)

Mean (95% CI)

13% (6%-19%)Infant deaths per year

Of which

12% (7%-16%)Deaths per year

% of total cases(95% CI)

Indicator

Morbidity per yearWHO scenario

Hospitalizations

Respiratory

3% (2%-5%)1.150 (630-1.670))Respiratory causes

2% (1%-3%)620 (310-930)Cardiovascular causes

11% (6%-14%)12.400 (6.400-15.200)Asthma attacks children

11% (6%-16%)41.500 (21.000-60.500)Asthma attacks adults

31.100 (17.500-40.500)

5.100 (550-8.500)

Mean (95% CI)

49% (28%-64%)Acute bronchitis children

25% (3%-41%)Chronic bronchitis adults

% of total cases(95% CI)

Indicator

Estimating impact of traffic exposurePopulation distribution from roads >10,000 vehicle/ day

Conclusions: Particle Size

– In urban areas, all PM size fractions have health effects.

– PMs generated by both traffic-related combustion and non-combustion processes may increase mortality.

– PMs generated by both traffic-related combustion and non-combustion processes may share a common mechanism of action.

Conclusions• Saharan dust

– In some areas exposure to coarse PMs from natural sources such as Saharan dust may increase daily mortality.

• Early life exposure – Provides unexpected new effects due to air

pollution

• Health impact assessment– Very likely have been underestimated

Thank youjsunyer@creal.cat

Perera FP. Env Health Persp2006;114:1287-92.

• PAH in particulate mode—collected with individual pumps during two consecutive days in 181 pregnant women from New York City (USA)— was associated to mental health measured at age 3 in the offspring

• Limitations: The short measurement of the exposure (only two days), their narrow variability (only low and high levels), and the poor specificity of PAH (the principal source is smoking)

Suglia SF. Am J Epidemiol2008;167:280-6.

• Average air pollution during childhood (carbon particles at home address derived by spatial modeling) to intelligence at age 9 in 202 children from Boston (USA)

• Limitations: follows only 20% of those recruited and did not measure prospectively the variations in air pollution or the time-activity patterns of the participants. No adjustment for noise.

3%Tire erosion

100%Total

30%Soil resuspension

6%Pavement erosion

5%Brake erosion

56%Combustion

% of PM10 emissions in Barcelona

Source

Source: Departament de Mediambient i Habitatge, 2007

Non-combustion traffic related particlesis an important source of health effects

PM10 in Barcelona metropolitanarea

** Mapa elaborado por el Departamento de Medio Ambi ente y Vivienda

Media anual de PM10 indicador de la contaminació atmosfèrica