Air pollution and disease: are we asking the right questions?

Dr Alex G Stewart

CHaMPs July 2011

Local authority level 1998 to 2004

Levels of PM10 & 03

associated with mortality

Effect estimate considerably higher than previous

estimates

CO NO2 PM10

O3 All cause mortality

(2007) CASEpaper, 128. Centre for Analysis of Social Exclusion, London School of Economics and Political Science, London

VOC – greater varietyPM10 as mass masks increase in fines (<1µm) – numbers matter

MASS

AIRPORT POLLUTION SIGNAL

Post-1975 national airport activity and Oglet Pb flux

Worsley & Powell also showed an increase in lead flux at Oglet near Liverpool airportWhich they related to the increase in air travel.

Passenger transport by mode in Great Britain in billion passenger kilometre1952–2007.

Douglas M J et al. J Public Health 2011;33:160-169

© The Author 2011, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Data Source: Transport Statistics Great Britain, 2009.

Chris Crosby, working with Prof Worsley of Edge Hill universityHas been able to measure concentrations of road dustEvery 5m along main roads.

Magnentic concentration – metals in PM – rapid, simple, cheap

Mersey Basincross-regional signal

Lower Mersey Regional cross-section shows, in pond sediments, the ability to lookat temporal and spatial magnetic records, thus allowing a profile of metal depositionto be developed.

Worsley & Powell

Ormskirk

Liverpool

Industrial sitesC&M

COMAH

Deprivation

NWPHO

Particles (estimated) & Deprivation

PM10 IMD

Classic diseases of air pollutionAyres et al. “Environmental Medicine” 2010

• Asthma exacerbation

• Chronic Obstructive Pulmonary Disease (COPD) exacerbation & death

• Cardiovascular deaths, admissions,arrythmias

• PM2.5 SO2 NO2 O3

• PM10 SO2 NO2

• PM10 SO2 O3 PM10 (not O3)PM10 PM2.5 NO2

Other recorded diseases

• Lung cancer (small amount)

• All cause mortality

• Intra-uterine death

• Birth defects

• Pre-eclampsia

• Diabetes mellitus

• Predisposition to asthma?

• Ear infections?

• Lower respiratory infections <5y olds

Polycyclic Aromatic HydrocarbonsPAHs

carcinogenic, mutagenic, teratogenic

• Neurological development

• Predispose to asthma

• Preterm delivery (Af-Am)

• Small for gestational age

• Head/weight ratio

What about transgenerational effects?

Most disease is multi-factorial

Stone? Sponge?

What about lifestyle diseases?

Canada (Jerrett et al. JECH, 2004)Less Social Stress More Social Stress

Lower air pollution - Health effect

Higher air pollution Health effect Increased effect

Stress

RATS (Clougherty et al. EHP, 2010)No Social Stress Social Stress

No PM - Respiration effects

PM Respiration effects Inflammatory Response

Social Stress = deprivation (measured by low education & high manufacturing employment)

(1) Addition: workplace exposures + ambient exposures(2) Lower educated less mobile => less measurement error => less bias(3) Manufacturing & education = proxy for material deprivation => susceptibility

Increases risk of lung cancer X2 - X9 fold

Radon

Could other pollutants?

Great Sankey North

Great Sankey South

Whitecross

Kingsway

Hough Green

Riverside

Poulton South

Hulme

Culcheth & Glazebury

Daresbury

Heath

Halton Brook

Castlefields

Stockton Heath & Walton

Ditton

Brookfields

Rixton and Woolston

AppletonBroadheath

Clough

Farnworth

Grange

Hale

Halton

Murdishaw

Appleton and Stretton

Bewsey

Booths Hill

BurtonwoodCroft

Fairfield

Grappenhall and Thelwall

Heatley

Howley

Latchford

Longford

Lymm

Orford

StathamWesty

Winwick

Map 6: Renal disease in north Cheshire: age-sex standardised admission ratio 1996 to 2002 [1991 census wards] – this study

Renal Admission Ratio

150 to 204125 to 150100 to 12575 to 1000 to 75

1991 ward boundaries Warrington

Halton

Source: Hospital Admission Statistics; ONS

NW EnglandPoor health 100 years

Pollution?Poverty?Lifestyle?

Generational effect?

A mixture of all?

http://www.apho.org.uk/resource/view

Acknowledgements

Apologies

Public Health

Environmental Scientists

Epidemiologists

Clinicians

Geographers

……..