Health Effects of Air Pollution

Michael Brauer

School of Population and Public Health

Tokyo, 2009G20 2019 Transport Task Group Meeting, Tokyo, October 30, 2019

Particulate Matter (PM) Ozone (O3)

Nitrogen Dioxide (NO2)

Jorge Uzon—AFP/Getty Images

Key pollutants for health impacts

Air pollution and health

• Ambient air pollution (individual) risk is small…but large exposed population = large population risk

• Diseases impacted by air pollution have other causes…

• …Air pollution as a contributing risk factor

3

• On days with worse air quality, more people die*

Larrieu et al. Am J Epidemiol, 2009

*out-of-hospital, >65 yrs

Air pollution and health

• On days with worse air quality, more people die*

• In more polluted cities, people die earlier than in less polluted cities…

Larrieu et al. Am J Epidemiol, 2009

*out-of-hospital, >65 yrs

Air pollution and health

• 10 km satellite-based estimates + surface measurements

• ~190,000 men > 40 years, 45 locations randomly selected from 145 DSPs

• 15 year follow-upYin P, Brauer M, Cohen A, Burnett RT, Liu J, Liu Y, Liang R, Wang W, Qi J, Wang L, Zhou M. Environmental Health Perspectives. 2017

Long-term fine particulate matter exposure and non-accidental and cause-specific mortality in a large national cohort of Chinese men

No evidence of threshold

Pappin et al., 2019; Christidis et al., 2019

• On days with worse air quality, more people die*

• In more polluted cities, people die earlier than in less polluted cities…

• …and, in the most polluted areas of cities, there is an increased risk of dying

Larrieu et al. Am J Epidemiol, 2009

*out-of-hospital, >65 yrs

Air pollution and health

Traffic-related air pollution

10Henderson SB et al. Environmental Science and Technology. 2007; 41 (7):2422 -2428; Gan WQ et al. Changes in residential proximity to road traffic and the risk of death from coronary heart disease. Epidemiology. 2010 Sep;21(5):642-9.

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≤ 150 m

vs > 150 m

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Coronary heart disease (CHD) mortality

• On days with worse air quality, more people die*

• In more polluted cities, people die earlier than in less polluted cities…

• …and, in the most polluted areas of cities, there is an increased risk of dying

Larrieu et al. Am J Epidemiol, 2009

*out-of-hospital, >65 yrs

Air pollution and health

Air pollution reduces

lung function growth in

children…

…which leads to

earlier than normal

disability/death

Gauderman et al. NEJM. 2004.

Lung growth and decline

Air pollution reduces

lung function growth in

children…

…which leads to

earlier than normal

disability/death

Gauderman et al. NEJM. 2004.

Lung growth and decline

AHA, 2010

Systemic effects

WHO REVIHAAP (2013): Cardiovascular and Respiratory Mortality and

Morbidity

Growing evidence for birth outcomes and childhood respiratory disease

Possible links with neurodevelopment and cognitive function, diabetes

IARC (2013): Air pollution (and PM specifically) carcinogenic (lung cancer)

Beyond the heart and lung

USEPA Pregnancy and Birth Outcomes: Suggestive of, but not sufficient

Brauer et al., 2012; Brauer et al., 2016; Shaddick et al. 2017. Shaddick et al., 2018.

95% of population exposed above WHO Guideline

Road injuries

~9% of all deaths

2.9 M deaths PM2.5

1.6 M deaths Household470 K deaths Ozone

$5 trillion/yr welfare losses$225 billion/yr lost labour income

World Bank. 2016. The cost of air pollution : strengthening the economic case for actionhttps://vizhub.healthdata.org/gbd-compare/

+ Low Birthweight/Short Gestation (added in GBD2019)

Road injuries

$5 trillion/yr welfare losses$225 billion/yr lost labour income

https://vizhub.healthdata.org/gbd-compare/

Stroke (15%)440K

Ischemic Heart Disease (33%)980K

COPD (22%)630K

Lower Respiratory Infections (15%)

430K

Lung Cancer (9%)

270K

Diabetes (2%)180K

Apte JS, Brauer M, Cohen AJ, Ezzati M, Pope CA. Ambient PM2.5 Reduces Global and Regional Life Expectancy. Environ. Sci. Technol. Lett., 2018, 5 (9), pp 546–551.DOI: 10.1021/acs.estlett.8b00360

+ Low Birthweight/Short Gestation

stateofglobalair.org

Ozone Trends

Preliminary Results, GBD 2019

stateofglobalair.org

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Demographics plays a key role

Cohen, Brauer, et al., Lancet 2017.

stateofglobalair.org

stateofglobalair.org

Adverse reproductive outcomesGestational Age Birthweight

Preliminary Results, GBD 2019

What’s missing?

Larrieu et al. Am J Epidemiol, 2009

Incident childhood asthma and NO2

per 4 μg/m3 NO2

Exposure to traffic-related air pollution and risk of development of childhood asthma: A systematic review and meta-analysis. Khreis H, et al. Environ Int. 2017. doi: 10.1016/j.envint.2016.11.012.

Ambient NO2 and Pediatric Asthma

• 4.0 (1.8 - 5.2) million new pediatric asthma cases annually

• 13% (5.8 - 16%) of global incidence

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Achakulwisut et al. Global, national, and urban burdens of paediatric asthma incidence attributable to ambient NO2 pollution: estimates from global datasets. Lancet Planetary Health DOI: (10.1016/S2542-5196(19)30046-4)

In high and low income country cities, NO2 pollution is an important risk factor for pediatric asthma incidence

125 major cities, % of new pediatric asthma cases attributable to NO2:• Range: 6% (Orlu, Nigeria) to

48% (Shanghai, China).• Exceeded 20% in 92 cities,

in high and low income countries.

• Highest in 8 cities in China, in Moscow, and Seoul.

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Chen H et al. Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study.Lancet. 2017 Feb 18;389(10070):718-726. doi: 10.1016/S0140-6736(16)32399-6.

Traffic proximity and dementia

Yuchi et al. 2019. Submitted

Yuchi et al., 2019. Submitted

Autism Spectrum Disorder

Vancouver BC: 132,256 births, 1307 children (1.0%) diagnosed with ASD by age 5

Pagalan L, Bickford C, Weikum W, Lanphear B, Brauer M, Lanphear N, Hanley GE, Oberlander TF, Winters M. Association of Prenatal Exposure to Air Pollution With Autism Spectrum Disorder. JAMA Pediatr. 2019 Jan 1;173(1):86-92. doi: 10.1001/jamapediatrics.2018.3101.

Traffic-related air pollution: Health Impacts

HEI 2010

33

Health Outcome Causality (strength of association)

Asthma exacerbation Sufficient

Asthma onsetChildrenAdults

SufficientSuggestive, but insufficient

Lung function decrements (children, chronic exposure)

Suggestive, but insufficient

Lung Cancer Suggestive, but insufficient

CVD mortality (chronic and acute exposure)

Suggestive, but insufficient

CVD morbidity MI onsetAtherosclerosis progression

Suggestive, but insufficientSuggestive, but insufficient

Pregnancy outcomes Inadequate and insufficient

Allergy Inadequate and insufficient

childhood leukemia, cancer Inadequate and insufficient

COPD Inadequate and insufficient

Traffic-related air pollution: Health Impacts

34

Selected health outcomes:*All cause and cause-specific mortality

•Respiratory (Chronic Obstructive Pulmonary Disease, Acute Lower Respiratory

Infections)

•Circulatory (Ischemic Heart Disease, Stroke)

•Diabetes

•Lung cancer

Respiratory effects

•Asthma

•Chronic Obstructive Pulmonary Disease

•Acute Lower Respiratory Infections

Cardiovascular effects

•Coronary events

•Stroke

•Hypertension

•Type 2 diabetes

Birth outcomes

•Low birth weight

•Preterm

HEI 2020

Thank you

35michael.brauer@ubc.ca