Sabit Cakmak

Effects of particulate and gaseous air pollution on cardiorespiratory hospitalizations.

We obtained data on daily numbers of admissions to hospital in Toronto, Canada, from 1980 to 1994 for respiratory, cardiac, cerebral vascular, and peripheral vascular diseases. We then linked the data to daily measures of particulate mass less than 10 microns in aerodynamic diameter (PM10), particulate mass less than 2.5 microns in aerodynamic diameter (PM2.5), and particulate mass between 2.5 and 10 microns in aerodynamic diameter (PM10-2.5), ozone, carbon monoxide, nitrogen dioxide, and sulfur dioxide. Air pollution was only associated weakly with hospitalization for cerebral vascular and peripheral vascular diseases. We controlled for temporal trends and climatic factors, and we found that increases of 10 microg/m3 in PM10, PM2.5, and PM10-2.5 were associated with 1.9%, 3.3%, and 2.9% respective increase in respiratory and cardiac hospital admissions. We further controlled for gaseous pollutants, and the percentages were reduced to 0.50%, 0.75%, and 0.77%, respectively. Of the 7.72 excess daily hospital admissions in Toronto attributable to the atmospheric pollution mix, 11.8% resulted from PM2.5, 8.2% to PM10-2.5, 17% to carbon monoxide, 40.4% to nitrogen dioxide, 2.8% to sulfur dioxide, and 19.8% to ozone.

ASSOCIATION BETWEEN PARTICULATE- AND GAS-PHASE COMPONENTS OF URBAN AIR POLLUTION AND DAILY MORTALITY IN EIGHT CANADIAN CITIES

Although some consensus has emerged among the scientific and regulatory communities that the urban ambient atmospheric mix of combustion related pollutants is a determinant of population health, the relative toxicity of the chemical and physical components of this complex mixture remains unclear. Daily mortality rates and concurrent data on sizefractionated particulate mass and gaseous pollutants were obtained in eight of Canadas largest cities from 1986 to 1996 inclusive in order to examine the relative toxicity of the components of the mixture of ambient air pollutants to which Canadians are exposed. Positive and statistically significant associations were observed between daily variations in both gas- and particulate-phase pollution and daily fluctuations in mortality rates. The association between air pollution and mortality could not be explained by temporalvariation in either mortality rates or weather factors. Fine particulate mass (less than 2.5 μm in average aerometric diameter) was a stronger predictor of mortality than coarse mass (between 2.5 and 10 μm). Size-fractionated particulate mass explained 28% of the total health effect of the mixture, with the remaining effects accounted for by the gases. Forty-seven elemental concentrations were obtained for the fine and coarse fraction using nondestructive x-ray fluorescence techniques. Sulfate concentrations were obtained by ion chromatography. Sulfate ion, iron, nickel, and zinc from the fine fraction were most strongly associated with mortality. The total effect of these four components was greater than that for fine mass alone, suggesting that the characteristics of the complex chemical mixture in the fine fraction maybe a better predictor of mortality than mass alone. However,the variation in the effects of the constituents of the fine fraction between cities was greater than the variation in the mass effect, implying that there are additional toxic components of fine particulate matter not examined in this study whose concentrations and effects vary between locations. One of these components, carbon, represents half the mass of fine particulate matter. We recommend that measurements of elemental and organiccarbon be undertaken in Canadian urban environments to examine their potential effects on human health.

The Association between Ambient Carbon Monoxide Levels and Daily Mortality in Toronto, Canada

The role of ambient levels of carbon monoxide (CO) in the exacerbation of heart problems in individuals with both cardiac and other diseases was examined by comparing daily variations in CO levels and daily fluctuations in nonaccidental mortality in metropolitan Toronto for the 15-year period 1980-1994. After adjusting the mortality time series for day-of-the-week effects, nonparametic smoothed functions of day of study and weather variables, statistically significant positive associations were observed between daily fluctuations in mortality and ambient levels of carbon monoxide, nitrogen dioxide, sulfur dioxide, coefficient of haze, total suspended particulate matter, sulfates, and estimated PM2.5 and PM10. However, the effects of this complex mixture of air pollutants could be almost completely explained by the levels of CO and total suspended particulates (TSP). Of the 40 daily nonaccidental deaths in metropolitan Toronto, 4.7% (95% confidence interval of 3.4%-6.1%) could be attributable to CO while TSP contributed an additional 1.0% (95% confidence interval of 0.2-1.9%), based on changes in CO and TSP equivalent to their average concentrations. Statistically significant positive associations were observed between CO and mortality in all seasons, age, and disease groupings examined. Carbon monoxide should be considered as a potential public health risk to urban populations at current ambient exposure levels.

Associations between short-term changes in nitrogen dioxide and mortality in Canadian cities.

The association between daily variations in ambient concentrations of nitrogen dioxide (NO2) and mortality was examined in 12 of Canadas largest cities, using a 19-yr time-series analysis (from 1981-1999). The authors employed parametric statistical methods that are not subject to the recently discovered convergence and error estimation problems of generalized additive models. An increase in the 3-d moving average of NO2 concentrations equivalent to the population-weighted study mean of 22.4 ppb was associated with a 2.25% (t = 4.45) increase in the daily nonaccidental mortality rate and was insensitive to adjustment for ozone, sulfur dioxide, carbon monoxide, coefficient of haze, size-fractionated particulate mass, and the sulfate ion measured on an every-6th-day sampling schedule. The 3-d moving average of NO2 was sensitive to adjustment for fine particulate matter measured daily during the 1998-2000 time period.

Long-term fine particulate matter exposure and mortality from diabetes in Canada.

OBJECTIVE Recent studies suggest that chronic exposure to air pollution can promote the development of diabetes. However, whether this relationship actually translates into an increased risk of mortality attributable to diabetes is uncertain. RESEARCH DESIGN AND METHODS We evaluated the association between long-term exposure to ambient fine particulate matter (PM2.5) and diabetes-related mortality in a prospective cohort analysis of 2.1 million adults from the 1991 Canadian census mortality follow-up study. Mortality information, including ∼5,200 deaths coded as diabetes being the underlying cause, was ascertained by linkage to the Canadian Mortality Database from 1991 to 2001. Subject-level estimates of long-term exposure to PM2.5 were derived from satellite observations. The hazard ratios (HRs) for diabetes-related mortality were related to PM2.5 and adjusted for individual-level and contextual variables using Cox proportional hazards survival models. RESULTS Mean PM2.5 exposure levels for the entire population were low (8.7 µg/m3; SD, 3.9 µg/m3; interquartile range, 6.2 µg/m3). In fully adjusted models, a 10-µg/m3 elevation in PM2.5 exposure was associated with an increase in risk for diabetes-related mortality (HR, 1.49; 95% CI, 1.37–1.62). The monotonic change in risk to the population persisted to PM2.5 concentration <5 µg/m3. CONCLUSIONS Long-term exposure to PM2.5, even at low levels, is related to an increased risk of mortality attributable to diabetes. These findings have considerable public health importance given the billions of people exposed to air pollution and the worldwide growing epidemic of diabetes.

Air pollution and mortality in Chile: susceptibility among the elderly.

Objective The estimated mortality rate associated with ambient air pollution based on general population studies may not be representative of the effects on certain subgroups. The objective of the present study was to determine the influence of relatively high concentrations of air pollution on mortality in a general population sample and in the very elderly. Study design Daily time-series analyses tested the association between daily air pollution and daily mortality in seven Chilean urban centers during 1997–2003. Results were adjusted for day of the week and humidex. Results Daily averaged particulate matter with aerodynamic matter < 10 μm (PM10) was 84.88 μg/m3, sulfur dioxide was 14.08ppb, and carbon monoxide was 1.29 ppb. The 1-hr maximum ozone was 100.13 ppb. The percentage increases in nonaccidental mortality associated with an increase in PM10 equivalent to its mean were 4.53 (t-ratio 1.52) for those < 65 years and 14.03 (3.87) for those > 85 years. Respective values were 4.96 (1.17) and 8.56 (2.02) for O3; 4.77 (2.50) and 7.92 (3.23) for SO2; and 4.10 (2.52) and 8.58 (4.45) for CO. Conclusion Our results suggest that the very elderly are particularly susceptible to dying from air pollution. Concentrations deemed acceptable for the general population may not adequately protect the very elderly.

Further interpretation of the acute effect of nitrogen dioxide observed in Canadian time-series studies.

In this paper, the pooled NO2 association with nonaccidental mortality is examined across 10 cities in Canada in single- and two-pollutant time-series models. The results reaffirm that NO2 has the strongest association with mortality, particularly in the warm season. Although attributing such effects to NO2 cannot be ruled out, it is plausible that NO2 is acting as an indicator for some other exposure affecting the population. This could include PM2.5, as has been suggested from some personal exposure data, but it could also be indicating a more specific type of PM2.5, such as traffic-related particles, given that in cities the main source of NO2 is motor vehicle exhaust. NO2 could also be acting as a surrogate for other pollutant(s) originating from motor vehicles or high-temperature combustion, such as volatile organic compounds (VOCs) or polycyclic aromatic hydrocarbons. Another possibility is other oxidized nitrogen species (“NOz”) or photochemically produced pollutants that can co-vary with NO2, especially during urban stagnation events. Data to test these different possibilities across several Canadian cities are examined. The focus is on correlations in time or space between NO2 and other pollutants that are more strongly linked to vehicle emissions. The results support the hypothesis that NO2 is a better indicator than PM2.5 of a range of other toxic pollutants. This includes VOCs, aldehydes, NOz and particle-bound organics in motor vehicle exhaust. Thus, overall, the strong effect of NO2 in Canadian cities could be a result of it being the best indicator, among the pollutants monitored, of fresh combustion (likely motor vehicles) as well as photochemically processed urban air.

Effect of airborne allergens on emergency visits by children for conjunctivitis and rhinitis

The effect of fungal spores and pollen grains on morbidity from childhood conjunctivitis and rhinitis is mostly unknown. We therefore studied the association between daily concentrations of these airborne allergens and daily emergency visits to a children hospital between 1993 and 1997. An increase of 551 basidiomycetes spores per m(3), or of 72 ragweed grains per m(3), was associated with an increase of about 10% in visits for conjunctivitis and rhinitis (p<0.01). Our results suggest that conjunctivitis and rhinitis could be caused by fungal spores and pollens in the air.

Does air pollution increase the effect of aeroallergens on hospitalization for asthma

BACKGROUND Clinical experiments demonstrate that the asthmatic response to an aeroallergen can be enhanced by prior exposure to an air pollutant. OBJECTIVE We sought to compare the effects of ambient aeroallergens on hospitalization for asthma between high and low air pollution days in 11 large Canadian cities. METHODS Daily time-series analysis was used, and results were adjusted for day of the week, temperature, barometric pressure, and relative humidity. RESULTS The relative risk of admission for an interquartile increase in tree pollen levels was 1.124 (95% CI, 1.101-1.147) on days of lower values of fine particulate matter with a median aerodynamic diameter less than or equal to 2.5 μm (PM(2.5)) compared with 1.179 (95% CI, 1.149-1.21) on days of higher PM(2.5) values. Significant (P ≤ .05) differences in the relative risks of admission between lower versus higher values of particulate matter with a median aerodynamic diameter less than or equal to 10 μm in diameter were 1.149 (95% CI, 1.118-1.181) versus 1.210 (95% CI, 1.161-1.261) for ascomycetes, 1.112 (95% CI, 1.085-1.14) versus 1.302 (95% CI, 1.242-1.364) for basidiomycetes, 1.159 (95% CI, 1.125-1.195) versus 1.149 (95% CI, 1.129-1.169) for deuteromycetes, and 1.061 (95% CI, 1.016-1.107) versus 1.117 (95% CI, 1.092-1.143) for weeds. CONCLUSION We identified an association between aeroallergens and hospitalizations for asthma, which was enhanced on days of higher air pollution. Minimizing exposure to air pollution might reduce allergic exacerbations of asthma.

Risk assessment for cardiovascular and respiratory mortality due to air pollution and synoptic meteorology in 10 Canadian cities.

Synoptic weather and ambient air quality synergistically influence human health. We report the relative risk of mortality from all non-accidental, respiratory-, and cardiovascular-related causes, associated with exposure to four air pollutants, by weather type and season, in 10 major Canadian cities for 1981 through 1999. We conducted this multi-city time-series study using Poisson generalized linear models stratified by season and each of six distinctive synoptic weather types. Statistically significant relationships of mortality due to short-term exposure to carbon monoxide, nitrogen dioxide, sulphur dioxide, and ozone were found, with significant modifications of risk by weather type, season, and mortality cause. In total, 61% of the respiratory-related mortality relative risk estimates were significantly higher than for cardiovascular-related mortality. The combined effect of weather and air pollution is greatest when tropical-type weather is present in the spring or summer.