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Particulate Matter Air Pollution: Science, Controversy, and Impact on Public Health C. Arden Pope III, PhD Mary Lou Fulton Professor of Economics Presented at the Western States Air Resources Council (WESTAR) Denver, Colorado November 7, 2013

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Particulate Matter Air Pollution: Science,

Controversy, and Impact on Public Health

C. Arden Pope III, PhD

Mary Lou Fulton Professor of Economics

Presented at the

Western States Air Resources Council (WESTAR)

Denver, Colorado

November 7, 2013

Illustration for Charles Dickens’

Sketches by Boz, by

George Cruikshank, 1838

The chimney, smoke Stack, and

smoke and fog (smog) have long

played important iconic roles in the art

and literature of London.

Coffee Stall by

Gustave Doré,

In a description of a

representative London Fog day

(April 6, 1870) Doré’s friend

Blanchard Jerrold say’s of an

experience with Doré:

“We were well into the morning—

and it was as dark as the darkest

midnight. . . It was choking: it

made the eyes ache.”

From:

London: A pilgrimage, 1872 and

Doré’s London: All 180

illustrations from London, A

Pilgrimage, 2004

Claude

Monet,

Houses of

Parliament,

London,

1903

Houses of Parliament (Palace of Westminster) , London

Claude

Monet,

Houses of

Parliament,

London,

1904

Claude Monet, Waterloo Bridge, London, 1903

Waterloo Bridge, London, July 2006 (St Paul’s Cathedral, Tower 42, 30 St Mary Axe)

Meuse Valley, Belgium Smog, December 1-5, 1930

--60 deaths, 10 time expected

Donora, PA (Severe episode, Oct. 27-31, 1948)

From, Public Health Service,

Bulletin No. 306, 1949

Danora, PA. Noon, Oct 29, 1948.

http://www.weather.com/multimedia/videoplayer.html?clip=12603&collection=257&fro

m=sitemap

Donora, PA—administering oxygen

--Approx. 20 deaths, 6 times expected

London, England (Dec. 5-9, 1952)

London Fog Episode, Dec. 1952

From: Brimblecombe P. The Big Smoke, Methuen 1987

The killer episodes spurred air pollution policies in the U.S.

Killer Smog (and related research)

Public Policy Results 1955-1967: Air pollution control

acts

1967, 1970: Clean Air Act,

Major Amendments, National

Environmental Policy Act

1977 & 1990: Major

Amendments to Clean Air Act

1980’s: Elimination of

extreme “Killer Smog”

episodes & Improved air

quality

1930: Meuse Valley, Belgium

1948: Donora, PA

1952: London, England

By the 1980’s, many thought the air pollution problem

had been solved…

Geneva Steel, Utah Valley, 1989 (PM10 = 150 mg/m3)

Utah Valley, 1989, (PM10 = 220 mg/m3)

Particulate matter air

pollution is a mixture of

particles suspended in

the air. These particles

vary in:

-Size,

-Shape,

-Surface area,

-Chemical composition,

-Solubility, and

-Origin.

Electron Microscope images of soot

particles From: Park K, Cao F,

Kittelson DB, McMurry PH. Environ

Sci Technol 2003

How small are fine particles?

Human Hair

(60 mm diameter)

PM10

(10 mm)

PM2.5

(2.5 mm)

Magnified ambient particles (www.nasa.gov/vision/earth/environment)

Utah Valley, 1980s

• Winter inversions trap local pollution

• Natural test chamber

• Local Steel mill contributed ~50% PM2.5

• Shut down July 1986-August 1987

• Natural Experiment

mg

/m3/N

um

be

rs o

f A

dm

issio

ns

0

50

100

150

200

250

300

PM10 concentrations Children's respiratory hospital admissions

Mean PM10

levels forMonthsIncluded

Mean HighPM

10

levels forMonthsIncluded

PneumoniaandPleurisy

Bronchitisand Asthma

Total

Children's Respiratory Hospital AdmissionsFall and Winter Months, Utah Valley

Sources: Pope. Am J Pub Health.1989; Pope. Arch Environ Health. 1991

When the steel mill was open, total children’s hospital

admissions for respiratory conditions approx. doubled. m

g/m

3/N

um

bers

of A

dm

issio

ns

0

50

100

150

200

250

300

PM10 concentrations Children's respiratory hospital admissions

Mean PM10

levels forMonthsIncluded

Mean HighPM

10

levels forMonthsIncluded

PneumoniaandPleurisy

Bronchitisand Asthma

Total

Children's Respiratory Hospital AdmissionsFall and Winter Months, Utah Valley

Sources: Pope. Am J Pub Health.1989; Pope. Arch Environ Health. 1991

Mill

Open

Mill

Closed

Health studies take advantage of highly variable air

pollution levels that result from inversions.

98 99 00 01 02 03 04 05 06 07 08 09 10

0

10

20

30

40

50

60

70

80

90

100

98 99 00 01 02 03 04 05 06 07 08 09 10

0

10

20

30

40

50

60

70

80

90

100

PM2.5 concentrations January 1 1998-December 12 2009. Black dots, 24-hr PM2.5; Red line, 30-day moving average PM2.5;

Green line, 1-yr moving average PM2.5.

Utah Valley (Lindon Monitor)

g/m

3

Salt Lake Valley (Hawthorn Monitor)

g/m

3

Salt Lake Valley (Hawthorn Monitor)

Daily changes in air pollution daily death counts

Time (days)

# o

f D

ea

ths

Utah Valley

Poisson Regression

Count data (non-negative integer values). Counts of independent and

random occurrences classically modeled as being generated by a Poisson

process with a Poisson distribution:

Prob (Y = r) = e(-λ)

Note: λ = mean and variance. If λ is constant across time, we have a

stationary Poisson process. If λ changes over time due to changes in

pollution (P), time trends, temperature, etc., this non-stationary Poisson

process can model as:

ln λt = α + β(w0Pt + w1Pt-1 + w2Pt-2 + . . .) + s1(t) + s2(tempt) + . . .

λr

r!

How to construct

the lag structure?

(MA, PDL, etc.)

How aggressive do you

fit time? (harmonics vs

GAMs, df, span, loess,

cubic spline, etc.)

How to control for

weather? (smooths of

temp & RH, synoptic

weather, etc.)

Modeling

controversies

Also: How to combine or integrate information from multiple cities

% incre

ase in m

ort

alit

y

0

1

2

3

Estimates frommeta analysis

Estimates from Multicity studies

29 c

itie

s(L

evy e

t a

l. 2

00

0)

GA

M-b

ase

d s

tud

ies

(Stie

b e

t a

l. 2

00

2,

200

3)

Un

ad

juste

d(A

nd

ers

on

et

al. 2

00

5)

6 U

.S.

citie

s(K

lem

m a

nd

Ma

so

n 2

00

3)

8 C

ana

dia

n c

itie

s(B

urn

ett

an

d G

old

be

rg 2

00

3)

9 C

alif

orn

ian c

itie

s(O

str

o e

t a

l. 2

00

6)

10 U

.S c

itie

s(S

ch

wa

rtz 2

00

0,

200

3)

14 U

.S c

itie

s,

ca

se

-cro

sso

ve

r(S

ch

wa

rtz 2

00

4)

NM

MA

PS

, 2

0-1

00

U.S

. citie

s(D

om

inic

i e

t a

l. 2

00

3)

AP

HE

A-2

, 1

5-2

9 E

uro

pe

an

citie

s(K

ats

ouya

nn

i e

t a

l. 2

00

3)

9 F

rench

citie

s(L

e T

ert

re e

t a

l. 2

00

2)

13 J

apa

ne

se

citie

s(O

mo

ri e

t a

l. 2

00

3)

No

n G

AM

-base

d s

tud

ies

(Stie

b e

t a

l. 2

00

2,

200

3)

Pub

lica

tio

n b

ias a

dju

ste

d

(And

ers

on

et

al. 2

00

5)

7 K

ore

an

citie

s(L

ee

et

al. 2

00

0)

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

10

g/m

3 P

M2.5

20

g/m

3 P

M1

0

10

g/m

3 P

M2.5

10

g/m

3 P

M2.5

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 B

S

40

g/m

3 T

SP

20

g/m

3 S

PM

Re

vie

w o

f A

sia

n L

it.-

-8 s

tudie

s(H

EI

Re

po

rt,

Ta

ble

TS

2)

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

20

g/m

3 P

M1

0

Estimates frommeta analysisfrom Asian Lit

PA

PA

Stu

die

s--

4 s

tudie

s(H

EI

Re

po

rt,

Ta

ble

TS

2)

Asia

n L

it.

inco

rpora

tin

g P

AP

A s

tud

ies

(HE

I R

epo

rt,

Ta

ble

TS

2)

18 L

atin

Am

. stu

die

s

(PA

HO

20

05)

20

g/m

3 P

M1

0

10 mg/m3 PM2.5 or 20 mg/m3 PM10 → 0.4% to 1.5%

increase in relative risk of mortality—Small but

remarkably consistent across meta-analyses and multi-city studies.

Daily time-series studies ***of over 200 cities***

Methods:

Case-crossover study of acute

ischemic coronary events (heart

attacks and unstable angina) in

12,865 well-defined and followed up

cardiac patients who lived on Utah’s

Wasatch Front

…and who underwent coronary

angiography

Jeffrey Anderson

2006;114:2443-48

yt

0

1

t

Binary Data, classic time-series

yt

0

1

t

Binary Data, case-crossover

Conditional Logistic Reg.

Each subject serves as his/her own control.

Control for subject-specific effects, day of week, season,

time-trends, etc.—by matching

Prob (Yt = 1)

1 - Prob (Yt = 1)

α1 + α2 + α3 + . . . + α12,865 + β(w0Pt + w1Pt-1 + w2Pt-2 + . . .)

Control by matching for:

All cross-subject differences

(in this case, 12,865 subject-level fixed effects),

Season and/or month of year,

Time trends,

Day of week

( ) = ln

Conditional logistic regression:

Modeling controversies: How to select control or referent periods. Time

stratified referent selection approach (avoids bias that can occur due to time

trends in exposure) (Holly Janes, Lianne Sheppard, Thomas Lumley

Statistics in Medicine and Epidemiology 2005)

%

0.00

5.00

10.00

15.00

Figure 1. Percent increase in risk (and 95% CI) of acute coronary

events associated with 10 g/m3 of PM

2.5, or PM

10 for

different lag structures.

Co

ncu

rre

nt d

ay

Co

ncu

rre

nt d

ay

1-d

ay

lag

1-d

ay

lag

2-d

ay

lag

2-d

ay

lag

3-d

ay

lag

3-d

ay

lag

2-d

ay

mo

vin

g a

v.

2-d

ay

mo

vin

g a

v.

4-d

ay

mo

vin

g a

v.

3-d

ay

mo

vin

g a

v.

3-d

ay

mo

vin

g a

v.

4-d

ay

mo

vin

g a

v.

PM2.5

PM10

%

-10.00

-5.00

0.00

5.00

10.00

15.00

20.00

Figure 2. Percent increase in risk (and 95% CI) of acute coronary events associated with

10 mg/m3 of PM

2.5, stratified by various characteristics.

All

acu

te c

oro

na

ry

Su

bse

que

nt M

I

Un

sta

ble

An

gin

a

Ag

e<

65

Ag

e>

=6

5

Ma

le

Fem

ale

Sm

okin

g

No

n S

mo

kin

g

BM

I<3

0

BM

I>=

30 C

HF

,ye

sC

HF

,no

Hyp

ert

ensio

n,y

es

Hyp

ert

ensio

n,n

o

Hyp

erlip

idem

ia,y

es

Hyp

erlip

idem

ia,n

o

Dia

be

tes,y

es

Dia

be

tes,n

o

Fam

ily h

isto

ry,y

es

Fam

ily h

isto

ry,n

o

# ofDiseasedVessels

# of Risk Factors

01

2

3

0

1

2

3

4+

Inde

x M

I

Short-term PM exposures contributed to acute coronary events,

especially among patients with underlying coronary artery disease.

Short-term changes in air pollution exposure

are associated with:

• Daily death counts (respiratory and cardiovascular)

• Hospitalizations

• Lung function

• Symptoms of respiratory illness

• School absences

• Ischemic heart disease

• Etc.

Longer-term air pollution exposure has

been linked to even substantially larger

health effects.

Median PM2.5

for aprox. 1980

8 10 12 14 16 18 20 22 24 26 28 30 32 34

Ad

juste

d M

ort

alit

y f

or

19

80

(D

ea

ths/Y

r/1

00

,00

0)

600

650

700

750

800

850

900

950

1000

Mean sulfate for aprox. 1980

4 6 8 10 12 14 16 18 20 22 24

Ad

juste

d M

ort

alit

y

for

19

80

(D

ea

ths/Y

r/1

00

,00

0)

600

650

700

750

800

850

900

950

1000

Mean PM2.5

for aprox. 1980

8 10 12 14 16 18 20 22 24 26 28 30 32 34

600

650

700

750

800

850

900

950

1000

Mean TSP for aprox. 1980

15 30 45 60 75 90 105 120 135 150 165

600

650

700

750

800

850

900

950

1000

Figure 1. Age-, sex-, and race-adjusted population-based mortality rates in U.S. cities for 1980 plotted over various indices of particulate air pollution.

Age-, sex-, and race- adjusted population-

based mortality rates in U.S. cities for 1980

plotted over various indices of particulate

air pollution (From Pope 2000).

An Association Between Air Pollution and

Mortality in Six U.S. Cities

1993

Dockery DW, Pope CA III, Xu X, Spengler JD,

Ware JH, Fay ME, Ferris BG Jr, Speizer FE.

Methods:

14-16 yr prospective follow-up of 8,111adults living in six

U.S. cities.

Monitoring of TSP PM10, PM2.5, SO4, H+, SO2, NO2, O3 .

Data analyzed using survival analysis, including

Cox Proportional Hazards Models.

Controlled for individual differences in: age, sex, smoking,

BMI, education, occupational exposure.

Average

Polluted

cities

Highly

Polluted

cities

Clean

cities

Cox Proportional Hazards Survival Model

Cohort studies of outdoor air pollution have commonly used the CPH Model

to relate survival experience to exposure while simultaneously controlling for

other well known mortality risk factors. The model has the form

)()()( )(0

)()( txexptt l

i

Tll

i

Hazard function

or instantaneous

probability of

death for the ith

subject in the lth

strata.

Baseline

hazard

function,

common to all

subjects within

a strata.

Regression equation that

modulates the baseline

hazard. The vector Xi(l)

contains the risk factor

information related to the

hazard function by the

regression vector β which

can vary in time.

Adjusted risk ratios (and 95% CIs) for

cigarette smoking and PM2.5

Cause of

Death

Current Smoker,

25 Pack years

Most vs. Least

Polluted City

All 2.00 (1.51-2.65)

1.26 (1.08-1.47)

Lung

Cancer

8.00 (2.97-21.6)

1.37 (0.81-2.31)

Cardio-

pulmonary

2.30 (1.56-3.41)

1.37 (1.11-1.68)

All

other

1.46 (0.89-2.39)

1.01 (0.79-1.30)

Particulate Air Pollution as a Predictor of Mortality in a

Prospective Study of U.S. Adults

Pope CA III, Thun MJ, Namboodiri MM,

Dockery DW, Evans JS, Speizer FE, Heath CW Jr.

1995

Methods: Linked and

analyzed ambient air

pollution data from 51-

151 U.S. metro areas

with risk factor data for

over 500,000 adults

enrolled in the ACS-

CPSII cohort.

Clark Heath Michael Thun

Adjusted mortality risk ratios (and 95% CIs) for cigarette

smoking the range of sulfates and fine particles

Cause of

Death

Current

Smoker

Sulfates Fine

Particles

All 2.07 (1.75-2.43)

1.15 (1.09-1.22)

1.17 (1.09-1.26)

Lung

Cancer

9.73 (5.96-15.9)

1.36 (1.11-1.66)

1.03 (0.80-1.33)

Cardio-

Pulmonary

2.28 (1.79-2.91)

1.26 (1.16-1.37)

1.31 (1.17-1.46)

All other 1.54 (1.19-1.99)

1.01 (0.92-1.11)

1.07 (0.92-1.24)

25 July 1997

Dan Krewski

Rick Burnett

Mark Goldberg

and 28 others

Legal uncertainty largely

resolved with 2001

unanimous ruling by the

U.S. Supreme Court.

Reduction in fine particulate air pollution: Extended follow-up of the Harvard Six Cities Study (Laden, Schwartz, Speizer, Dockery. AJRCCM 2006)

0.7

0.8

0.9

1.0

1.1

1.2

1.3

1.4

0 5 10 15 20 25 30 35

PM2.5 (mg/m3)

Mo

rtali

ty R

isk R

ati

o

Steubenville Topeka

Watertown

Kingston

St. Louis

Portage

Francine Laden Joel Schwartz

2004. R

R (

95

% C

I)

0.65

0.70

0.75

0.80

0.85

0.90

0.95

1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

1.40

All

Card

iovascula

rplu

s D

iabete

s

Ischem

ic h

eart

dis

ease

Dysrh

yth

mia

s,H

eart

failu

re,

Card

iac a

rrest

Hypert

ensiv

edis

ease

Oth

er

Ath

ero

scle

rosis

,aort

ic a

neury

sm

s

Cere

bro

-vascula

r

Oth

er

Card

io-

vascula

r

Dia

bete

s

Respirato

ryD

iseases

CO

PD

and

alli

ed c

onditio

ns

Pneum

onia

,In

fluenza

All

oth

er

respirato

ry

Figure 1. Adjusted relative risk ratios for cardiovascular and respiratory mortality associated with

a 10 mg/m3 change in PM

2.5 for 1979-1983, 1999-2000, and the average of the two periods.

(Relative size of the dots correspond to the relative number of deaths for each cause.)

John Godleski

Blood • Altered rheology

• Increased coagulability

• Translocated particles

• Peripheral thrombosis

• Reduced oxygen saturation

Systemic Inflammation

Oxidative Stress

• Increased CRP

• Proinflammatory mediators

• Leukocyte & platelet activation

PM Inhalation

Brain

• Increased cerebrovascular

ischemia

Heart

• Altered cardiac

autonomic function

• Increased dysrhythmic

susceptibility

• Altered cardiac

repolarization

•Increased myocardial

Ischemia

•Heart failure

exacerbation

Vasculature • Atherosclerosis,

accelerated progression of and

destabilization of plaques

• Endothelial dysfunction

• Vasoconstriction and Hypertension

Lungs • Inflammation

• Oxidative stress

• Accelerated progression

and exacerbation of COPD

• Increased respiratory symptoms

• Effected pulmonary reflexes

• Reduced lung function

Pope and Dockery,

JAWMA 2006.

The Global Burden of Disease 2010

Breathing contaminates contributes to global burden of disease (GBD)

Number of

attributable

deaths

Disability

adjusted

life-years

(DALYs)

Tobacco Smoking 5.7 mil. 5.7%

Second Hand Smoke 0.6 mil. 0.6%

Household air pollution from solid fuels 3.5 mil. 4.5%

Ambient PM air pollution 3.2 mil. 3.1%

Ambient Ozone 0.2 mil. 0.1%

So, an obvious question—

Has reducing air pollution resulted in

substantial and measurable

improvements in human health?

- Matching PM2.5 data for

1979-1983 and 1999-2000 in

51 Metro Areas

- Life Expectancy data for

1978-1982 and 1997-2001 in

211 counties in 51 Metro areas

- Evaluate changes in Life

Expectancy with changes in

PM2.5 for the 2-decade period

of approximately 1980-2000.

Fine-Particulate Air Pollution and Life

Expectancy in the United States

C. Arden Pope, III, Ph.D., Majid Ezzati, Ph.D., and Douglas W.

Dockery, Sc.D.

January 22, 2009

Do cities with bigger improvements in air quality have bigger

improvements in health, measured by life expectancy?

A 10 µg/m3 decrease in PM2.5 was associated with

a 7.3 (± 2.4) month increase in life expectancy.

This increase in life expectancy persisted even after controlling for

socio-economic, demographic, or smoking variables

Finally—

We seem to be making major progress

understanding the health effects of air

pollution.

In the U.S. reducing air pollution has

resulted in substantial and measurable

improvements in human health.

Good News, Right?

Smith and Stewart Subpoena EPA’s Secret Science Aug 2, 2013 Press Release (http://stewart.house.gov/)

Washington, D.C. – Science, Space, and Technology Committee Chairman Lamar Smith (R-Texas) and Environment Subcommittee Chairman Chris Stewart (R-Utah) issued a subpoena to the EPA, forcing the agency to release the secret science it uses as the basis for costly air regulations

House Subpoenas Personal Medical Information in Continued Assault on Clean Air Policies by Sam Abbott, 8/6/2013 Citizen Health & Safety, Safeguarding Public Health and the Environment, Setting and

Enforcing Regulations, Fostering Scientific Integrity, Environmental Protection Agency

(EPA)

Will House Science Panel Need an Ethical Review? Kelly Servick, Aug. 12, 2013

Eddie Bernice Johnson and Lamar Smith

Two Utahns have stake in pollution health data fight Environment » Is congressional inquiry into pollution-health studies after truth or partisan gain?

By Judy Fahys The Salt Lake Tribune Aug 27 2013

Chris Stewart

Harvard Six-Cities Study Dockery et al. New England Journal of Medicine (NEJM), 1993

ACS CPS-II Cohort Study Pope, et al. Am J Respir Crit Care Med (AJRCCM), 1995

Independent Re-analyses of Harvard Six-Cities and ACS CPS-II Studies Krewski et al. HEI Special Report , 2000; J Tox Enviro Health, Special Issue, 2003 3-yr reanalysis by a team of 31 independent researchers with oversight from a 9-member expert panel and peer review by a special panel of the HEI Health Review Committee. Included full data access that insured the privacy and confidentiality of research participants. Reanalyses include data audits, full replication and validation, and extensive sensitivity analyses.

Harvard Six-Cities and ACS CPS-II Cohort Studies of Air Pollution and Mortality: Initial, Independent, Extended, and Replicative Analyses

Extended analyses of Harvard Six-Cities study Laden et al. AJRCCM, 2006 Schwartz et al. EHP, 2008 Lepeule et al. EHP, 2012

Extended analyses of ACS CPS-II study Pope et al. JAMA, 2002; Pope et al. Circulation, 2004; Jerrett et al. Epidemiology, 2005; Krewski et al. HEI Rep. 2009 Jerrett et al. NEJM, 2009; Smith et al. Lancet, 2009 Turner et al. AJRCCM, 2011; Jerrett et al. AJRCCM, 2013

Replicative studies in other cohorts: Miller et al. (Women’s Health Initiative) NEJM, 2007; Beelen et al.

(Netherlands) EHP, 2008; Zeger et al. (U.S. National Medicare) EHP, 2008; Puett et al. (Nurses Health Study) EHP, 2009; Puett et al. (Health Professionals) EHP, 2011; Hart et al. (U.S. Truckers) AJRCCM, 2011; Lipsett et al. (California Teachers) AJRCCM, 2011; Crouse et al. (Canadian ) EHP, 2012; Cesaroni et al. (Rome) EHP, 2013

**See recent meta-analytic review by Hoek et al. Environ Health, 2013**

Working Draft, Aug. 2, 2013, C. Arden Pope III, PhD

Episode studies of morbidity and mortality Meuse Valley, Belgium, 1930 Donora, PA, 1948 London Smog, 1952

Cohort-based Mortality Studies

Population-based cross-sectional mortality studies Lave, Seskin. Science, 1970 Evans et al. Environ Int, 1984 Ozkaynak, Thurston. Risk Anal, 1987 --and others

Time-series and case-crossover daily mortality studies Dominici et al. (NMMAPS) HEI, 2003 Zanobetti et al. (112 US cities) EHP, 2009 Analitis et al. (15-29 Euro cities) Epi, 2006 Anderson et al. (meta anal) Epi. 2005 --and many, many others

Intervention/Natural Experiment studies -Intermittent operation of a steel mill. Pope AJPH, 1989, Ghio JAM, 2004 -US Life Expectancy and pollution reduction. Pope et al. NEJM, 2009 -Ireland coal ban. Dockery et al. HEI, 2013 -China Huai river RD. Chen et al. PNAS, 2013 --and others

Time-series and case-crossover hospitalization studies Schwartz (8 cities). Epi, 1999 Dominici et al. (204 US counties) JAMA, 2006 --and many others

Lung function/resp. symptoms studies Dockery et al. JAWMA, 1982 Pope et al. ARRD, 1991 Hoek et al. Eur Respir J, 1998 Gauderman et al. NEJM, 2004 --and many others

Others The literature is large, complex, and growing.

Cardio- and cerebrovascular disease events studies Peters et al. Circulation 2001 Pope et al. Circulation 2006 Wellenius, et al. Arch Intern Med, 2012 --and many others

Subclinical markers of cardiovascular health studies Including systemic inflammation, oxidative stress, endothelial cell activation, thrombosis and coagulation, vascular dysfunction and atherosclerosis, blood pressure, altered cardiac autonomic function/HRV, etc.) For overview see Brook et al. Circulation 2010

Controlled human exposure and animal toxicological studies For overview see Brook et al. Circulation 2010

A Broader View of the PM Air Pollution and Human Health Scientific Literature

Working Draft, Aug. 2, 2013, C. Arden Pope III, PhD

The assertion that the Harvard Six-Cities and the ACS cohort studies

are secret is simply false on its face. The methodology, protocol, and

results of these studies are openly published in peer-reviewed scientific

journals.

As is common in medical and public health studies, these studies

include analysis of some private data. Releasing private data is

generally unethical and often in violation of confidentiality agreements

with research participants, other data providers, and mandates of

Institutional Review Boards for human subjects.

For the Harvard Six-Cities and the ACS cohort studies, full data access

has been provided for independent data audits, validation, and

reanalysis under conditions that protected the privacy and

confidentiality of research subjects.

For approximately two decades, multiple research teams have been

actively involved in open, collaborative, extended analyses. Results of

the studies have been reproduced, replicated, extended, and

documented in multiple peer-reviewed publications.

Biggest criticisms regarding the overall results:

1. The effects aren’t big enough to be compelling (need RR > 2.0)

2. The effects are too large to be biologically plausible based on

an extrapolation of smoking literature.

0 60 120 180 240

Ad

juste

d R

ela

tive R

isk

1.0

1.5

2.0

estimated daily dose of PM2.5

, mg

18-22cigs/day

Pack-a-day smoker:

RR ~ 2

Daily inhaled dose ~ 240 mg

Live in polluted city or

With smoking spouse

RR ~ 1.15 – 1.35

Daily inhaled dose ~ 0.2–1.0 mg

0 60 120 180 240 300

Ad

jus

ted

Re

lati

ve

Ris

k

1.0

1.5

2.0

2.5

<3cigs/day

estimated daily dose of PM2.5

, mg

23+cigs/day

8-12cigs/day

13-17cigs/day

18-22cigs/day

4-7cigs/day

Pope, Burnett, Krewski, et al. 2009.

Figure 1. Adjusted relative

risks (and 95% CIs) of IHD

(light gray), CVD (dark

gray), and CPD (black)

mortality plotted over

estimated daily dose of

PM2.5 from different

increments of current

cigarette smoking.

Diamonds represent

comparable mortality risk

estimates for PM2.5 from air

pollution. Stars represent

comparable pooled relative

risk estimates associated

with SHS exposure from

the 2006 Surgeon

General’s report and from

the INTERHEART study.

0.1 1.0 10.0 100.0

Ad

jus

ted

Re

lati

ve

Ris

k

1.0

1.5

2.0

2.5

estimated daily dose of PM2.5

, mg

Exposure from

Second hand cigarette smoke: Stars, from 2006 Surgeon General Report and INTERHEART studyAnd air pollution: Hex, from Womens Health Initiative cohort Diamonds, from ACS cohort Triangles, Harvard Six Cities cohort

Exposure from smoking<3, 4-7, 8-12, 13-17, 18-22, and 23+

cigarettes/day

Figure 2. Adjusted relative

risks (and 95% CIs) of

ischemic heart disease

(light gray), cardiovascular

(dark gray), and

cardiopulmonary (black)

mortality plotted over

baseline estimated daily

dose (using a log scale) of

PM2.5 from current

cigarette smoking (relative

to never smokers), SHS,

and air pollution.

0 60 120 180 240 300 360 420 480 540

Ad

jus

ted

Re

lati

ve

Ris

k

1.0

1.5

2.0

2.5

3.0

(<3)

Estimated daily dose of PM2.5

, mg (cigarettes smoked per day)

(4-7)

Ad

jus

ted

Re

lati

ve

Ris

k

5

10

15

20

25

30

35

40

(8-12) (13-17) (18-22) (23-27) (28-32) (33-37) (38-42) (>42)

Lung Cancer

Ischemic heart (light gray)Cardiovascular (dark gray)Cardiopulmonary (black)

0.0 0.5 1.0

1.00

1.25

1.50

0.0 0.5 1.0

1.00

1.25

1.50

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Pollution Abatement

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC

Ambient Concentrations ( g/m3)

$

C* CH

Marginal Costsof Abatement

Marginal HealthCosts of Pollution

CNC