ambient air toxics & acute human health effects air toxics: what we know, what we don’t know,...

Ambient Air Toxics & Ambient Air Toxics & Acute Human Health Effects Acute Human Health Effects

Air Toxics: What We Know, What We Don’t Know, and What We Need to KnowAir Toxics: What We Know, What We Don’t Know, and What We Need to KnowUniversity of Houston Hilton, Houston, TexasUniversity of Houston Hilton, Houston, Texas

October 17-18, 2005October 17-18, 2005

Winifred J. Hamilton, PhD, SMWinifred J. Hamilton, PhD, SMAssistant Professor and DirectorAssistant Professor and Director

Environmental Health SectionEnvironmental Health SectionChronic Disease Prevention and Control Research CenterChronic Disease Prevention and Control Research Center

Baylor College of Medicine, Houston, TexasBaylor College of Medicine, Houston, Texas713.798.1052; [email protected]; [email protected]

Ambient Air Toxics & Acute Human Health EffectsAmbient Air Toxics & Acute Human Health Effects

OUTLINEOUTLINE1.1. AIR TOXICS…WHAT ARE THEY?AIR TOXICS…WHAT ARE THEY?

2.2. HOW DO WE MEASURE EXPOSURE?HOW DO WE MEASURE EXPOSURE?

3.3. ACUTE VS CHRONIC DISEASE?ACUTE VS CHRONIC DISEASE?

4.4. HOW DO WE STUDY HEALTH EFFECTS?HOW DO WE STUDY HEALTH EFFECTS?

5.5. THE 3 WORKSHOP QUESTIONSTHE 3 WORKSHOP QUESTIONS Do better exposure estimates lead to stronger associations?Do better exposure estimates lead to stronger associations? Is it preferable to focus on acute or chronic health effects?Is it preferable to focus on acute or chronic health effects? Do diseases correlate with exposure?Do diseases correlate with exposure?

6.6. SELECTED AAT HEALTH STUDIESSELECTED AAT HEALTH STUDIES

7.7. BCM HC AP & ADMITS STUDYBCM HC AP & ADMITS STUDY

8.8. THE “AH, DUH” FACTORTHE “AH, DUH” FACTOR

1. AIR TOXICS…WHAT ARE THEY?1. AIR TOXICS…WHAT ARE THEY? Air Toxics (ATs)Air Toxics (ATs)

Definition:Definition: “Gaseous, aerosol or particulate pollutants (other than “Gaseous, aerosol or particulate pollutants (other than the six criteria pollutants) which are present in the air in low the six criteria pollutants) which are present in the air in low concentrations with characteristics such as toxicity or concentrations with characteristics such as toxicity or persistence so as to be a hazard to human, plant or animal life” persistence so as to be a hazard to human, plant or animal life” (EPHC NEPM, Australia)(EPHC NEPM, Australia)

Lists of key ATs vary and change:Lists of key ATs vary and change:- HAPs (~ ATs N = 188) - HAPs (~ ATs N = 188) - NATA (N = 33)- NATA (N = 33)

- TRI (N = 650)- TRI (N = 650) - NEPM-AT (N = 6)- NEPM-AT (N = 6)

- Calif TACs (N = 224)- Calif TACs (N = 224) - Calif “Hot Spot” Program (N - Calif “Hot Spot” Program (N = 18)= 18)

- Manmade chemicals on the market (N ~ 60,000)- Manmade chemicals on the market (N ~ 60,000)

Criteria Air Pollutants (CAPs)Criteria Air Pollutants (CAPs) O3, NO2, SO2, CO, PM, PbO3, NO2, SO2, CO, PM, Pb What differentiates the 6 CAPs from the ATs?What differentiates the 6 CAPs from the ATs?

The 188 HAPSThe 188 HAPS73.73.Dimethyl phthalate Dimethyl phthalate PP

74.74.Dimethyl sulfateDimethyl sulfate AA

75.75.4,6-dinitro-o-cresol, 4,6-dinitro-o-cresol, and salts and salts PP

76.76.2,4-dinitrophenol 2,4-dinitrophenol PP

77.77.2,4-dinitrotoluene2,4-dinitrotoluene78.78.1,4-dioxane 1,4-dioxane PP

79.79.1,2-diphenylhydrazine1,2-diphenylhydrazine80.80.Epichlorohydrin Epichlorohydrin PP

81.81.1,2-epoxybutane1,2-epoxybutane82.82.Ethyl acrylate Ethyl acrylate PP

83.83.Ethyl benzene Ethyl benzene PP

84.84.Ethyl carbamate Ethyl carbamate 85.85.Ethyl chloride Ethyl chloride PP

86.86.Ethylene dibromideEthylene dibromide PP

87.87.Ethylene dichlorideEthylene dichloride PP 88.88.Ethylene glycol Ethylene glycol PP

89.89.Ethylene imineEthylene imine AA

90.90.Ethylene oxideEthylene oxide AA

91.91.Ethylene thiourea Ethylene thiourea PP

92.92.Ethylidene dichloride Ethylidene dichloride 93.93.FormaldehydeFormaldehyde AA CC PP

94.94.Glycol ethers Glycol ethers PP

95.95.Heptachlor Heptachlor PP

96.96.HexachlorobenzeneHexachlorobenzene PP

49.49.Cresols/Cresylic acid Cresols/Cresylic acid CC PP

50.50.o-Cresol o-Cresol CC PP

51.51.m-Cresol m-Cresol CC PP

52.52.p-Cresol p-Cresol CC PP

53.53.Cumene Cumene PP

54.54.Cyanide Compounds Cyanide Compounds PP

55.55.2,4-D, salts and esters 2,4-D, salts and esters PP

56.56.DDE DDE PP

57.57.Diazomethane Diazomethane AA

58.58.DibenzofuransDibenzofurans59.59.1,2-dibromo-3-chloropropane 1,2-dibromo-3-chloropropane AA

60.60.Dibutylphthalate Dibutylphthalate AA

61.61.1,4-dichlorobenzene1,4-dichlorobenzene62.62.3,3-dichlorobenzidene3,3-dichlorobenzidene63.63.Dichloroethyl ether Dichloroethyl ether PP 64.64.1,3-dichloropropene1,3-dichloropropene PP

65.65.Dichlorvos Dichlorvos PP

66.66.DiethanolamineDiethanolamine AA PP

67.67.N,N-diethyl anilineN,N-diethyl aniline68.68.Diethyl sulfate Diethyl sulfate PP

69.69.3,3-dimethoxybenzidine3,3-dimethoxybenzidine70.70.Dimethyl aminoazobenzeneDimethyl aminoazobenzene71.71.Dimethyl carbamoyl chlorideDimethyl carbamoyl chloride72.72.1,1-dimethyl hydrazine1,1-dimethyl hydrazine

25.25.BromoformBromoform26.26.1,3-butadiene1,3-butadiene CC

27.27.Cadmium compoundsCadmium compounds AA CC PP

28.28.Calcium cyanamide Calcium cyanamide PP

29.29.CaprolactamCaprolactam AA 30.30.Captan Captan PP

31.31.Carbaryl Carbaryl AA PP

32.32.Carbon disulfide Carbon disulfide PP

33.33.Carbon tetrachlorideCarbon tetrachloride PP

34.34.Carbonyl sulfide Carbonyl sulfide CC

35.35.Catechol Catechol CC

36.36.Chloramben Chloramben PP

37.37.Chlordane Chlordane PP

38.38.Chlorine Chlorine AA PP

39.39.Chloroacetic acid Chloroacetic acid PP

40.40.2-chloroacetophenone2-chloroacetophenone41.41.Chlorobenzene Chlorobenzene PP

42.42.Chlorobenzilate Chlorobenzilate PP

43.43.ChloroformChloroform PP

44.44.Chloromethyl methyl Chloromethyl methyl etherether AA

45.45.ChloropreneChloroprene46.46.Chromium compoundsChromium compounds AA CC PP

47.47.Cobalt compounds Cobalt compounds AA PP

48.48.Coke oven emissionsCoke oven emissions AA

= 32/33 NATA HAPs (33 = diesel PM); = 32/33 NATA HAPs (33 = diesel PM); AA = Leikauf list of asthma HAPs; = Leikauf list of asthma HAPs; CC = In cigarette smoke; = In cigarette smoke; PP = Pesticide active ingredient (PAN) = Pesticide active ingredient (PAN)

1. 1. AcetaldehydeAcetaldehyde AA CC PP

2.2.Acetamide Acetamide PP

3.3.AcetonitrileAcetonitrile4.4.Acetophenone Acetophenone PP

5.5.2-acetylaminofluorene2-acetylaminofluorene6.6.AcroleinAcrolein AA CC PP

7.7.Acrylamide Acrylamide PP

8.8.Acrylic acid Acrylic acid PP

9.9.AcrylonitrilAcrylonitril PP

10.10.Alkyl chloride Alkyl chloride PP

11.11.4-aminobiphenyl 4-aminobiphenyl CC

12.12.Aniline Aniline CC PP

13.13.o-Anisidineo-Anisidine14.14.Antimony compounds Antimony compounds PP

15.15.Arsenic compoundsArsenic compounds PP 16.16.Asbestos Asbestos PP

17.17.BenzeneBenzene AA CC PP 18.18.BenzidineBenzidine19.19.BenzotrichlorideBenzotrichloride20.20.Benzyl chloride Benzyl chloride PP

21.21.Beryllium compoundsBeryllium compounds22.22.Biphenyl Biphenyl PP

23.23.Bis(2-ethylhexyl) Bis(2-ethylhexyl) phthalate (DEHP)phthalate (DEHP)24.24.Bis(chloromethyl)ether Bis(chloromethyl)ether PP

The 188 HAPSThe 188 HAPS continued continued121.121.Methyl iodide Methyl iodide PP

122.122.Methyl isobutyl ketone Methyl isobutyl ketone PP 123.123.Methyl isocyanate Methyl isocyanate AA PP

124.124.Methyl methacrylate Methyl methacrylate AA

125.125.Methyl tert butyl etherMethyl tert butyl ether126.126.4,4-methylene bis 4,4-methylene bis PP

127.127.Methylene chlorideMethylene chloride PP

128.128.Methylene diphenyl Methylene diphenyl diisocyanate diisocyanate PP 129.129.4,4-methylenedianiline4,4-methylenedianiline130.130.Mineral fibers, fineMineral fibers, fine131.131.Naphthalene Naphthalene PP

132.132.Nickel compoundsNickel compounds AA CC PP

133.133.Nitrobenzene Nitrobenzene PP

134.134.4-nitrobiphenyl4-nitrobiphenyl135.135.4-nitrophenol4-nitrophenol136.136.2-nitropropane2-nitropropane137.137.N-nitroso-n-methylureaN-nitroso-n-methylurea138. 138. N-N-nitrosodimethylamine nitrosodimethylamine CC

139.139.N-nitrosomorpholineN-nitrosomorpholine140.140.Parathion Parathion PP

141.141.PentachloronitrobenzenePentachloronitrobenzene142.142.Pentachlorophenol Pentachlorophenol PP

143.143.Phenol Phenol CC

144.144.p-phenylenediaminep-phenylenediamine

145.145.Phosgene Phosgene AA

146.146.Phosphine Phosphine AA PP

147.147.Phosphorus Phosphorus PP

148.148.Phthalic anhydride Phthalic anhydride PP

149.149.Polychlorinated biphenylsPolychlorinated biphenyls150.150.Polycyclic organic matterPolycyclic organic matter CC

151.151.1,3-propane sultone1,3-propane sultone152.152.beta-propiolactonebeta-propiolactone153.153.Propionaldehyde Propionaldehyde CC PP

154.154.Propoxur (Baygon) Propoxur (Baygon) PP

155.155.Propylene dichloride Propylene dichloride 156.156.Propylene oxide Propylene oxide PP

157.157.1,2-propylenimine 1,2-propylenimine 158.158.QuinolineQuinoline CC PP

159.159.Quinone Quinone PP

160.160.Radionuclides Radionuclides CC

161.161. Selenium compounds Selenium compounds PP

162.162.StyreneStyrene AA CC

163.163.Styrene oxideStyrene oxide164.164.2,3,7,8-tetrachlorodibenzo2,3,7,8-tetrachlorodibenzo-p-dioxin-p-dioxin AA CC

165.165.1,1,2,2-tetrachloroethane1,1,2,2-tetrachloroethane PP

166.166.Tetrachloroethylene (perc)Tetrachloroethylene (perc) PP

167.167.Titanium tetrachlorideTitanium tetrachloride168.168.Toluene Toluene CC PP

169.169.2,4-toluene diamine2,4-toluene diamine170.170.2,4-toluene 2,4-toluene diisocyanatediisocyanate AA PP

171.171.o-toluidine o-toluidine CC

172.172.Toxaphene Toxaphene PP 173.173.1,2,4-1,2,4-trichlorobenzene trichlorobenzene PP

174.174.1,1,2-trichloroethane1,1,2-trichloroethane175.175.TrichloroethyleneTrichloroethylene176.176.2,4,5-trichlorophenol 2,4,5-trichlorophenol AA PP

177.177.2,4,6-trichlorophenol 2,4,6-trichlorophenol AA PP

178.178.Triethylamine Triethylamine PP

179.179.Trifluralin Trifluralin PP

180.180.2,2,4-2,2,4-trimethylpentanetrimethylpentane181.181.Vinyl acetate Vinyl acetate PP

182.182.Vinyl bromideVinyl bromide183.183.Vinyl chloride Vinyl chloride PP

184.184.Vinylidene chlorideVinylidene chloride185.185.Xylenes (isomers Xylenes (isomers and mixture)and mixture)186.186.o-xyleneso-xylenes187.187.m-xylenesm-xylenes188.188.p-xylenesp-xylenes

= 32/33 NATA HAPs (33 = diesel PM); = 32/33 NATA HAPs (33 = diesel PM); AA = Leikauf list of asthma HAPs; = Leikauf list of asthma HAPs; CC = In cigarette smoke; = In cigarette smoke; PP = Pesticide active ingredient (PAN) = Pesticide active ingredient (PAN)

97.97.HexachlorobutadieneHexachlorobutadiene98.98.Hexachlorocyclopentadiene Hexachlorocyclopentadiene PP

99.99.Hexachloroethane Hexachloroethane PP

100.100.Hexamethylene-1,6-Hexamethylene-1,6-diisocyanatediisocyanate101.101.HexamethylphosphoramideHexamethylphosphoramide102.102.HexaneHexane103.103.HydrazineHydrazine AA CC PP

104.104.Hydrochloric acid Hydrochloric acid AA

105.105.Hydrogen fluoride Hydrogen fluoride AA

106.106.Hydrogen sulfide Hydrogen sulfide AA PP

107.107.Hydroquinone Hydroquinone CC PP

108.108.Isophorone Isophorone PP

109.109.Lead compoundsLead compounds PP

110.110.Lindane Lindane PP

111.111.Maleic anhydride Maleic anhydride PP

112.112.Manganese compoundsManganese compounds AA PP

113.113.Mercury compoundsMercury compounds AA PP

114.114.Methanol Methanol PP

115.115.Methoxychlor Methoxychlor PP

116.116.Methyl bromide Methyl bromide PP

117.117.Methyl chlorideMethyl chloride CC PP

118.118.Methyl chloroform Methyl chloroform 119.119.Methyl ethyl ketone Methyl ethyl ketone PP 120.120.Methyl hydrazineMethyl hydrazine

Survey (eg, use of pesticides)Survey (eg, use of pesticides)

Microenvironments (eg, RIOPA)Microenvironments (eg, RIOPA) Personal monitorsPersonal monitors

All outdoors (eg, Six City)All outdoors (eg, Six City) Ambient monitoring networkAmbient monitoring network

GeospatialGeospatial Proximity, dispersion, CMAQ, TRI Proximity, dispersion, CMAQ, TRI

facilities, roadways…facilities, roadways…

Variables that affect exposureVariables that affect exposure ““Events” (accidents, fireworks…)Events” (accidents, fireworks…) Activity, vehicle use, age, smoking…Activity, vehicle use, age, smoking…

Which chemicals? What Which chemicals? What averaging schemas?...averaging schemas?...

Benzene 6 am Benzene 3 pm

2. HOW DO WE MEASURE EXPOSURE?2. HOW DO WE MEASURE EXPOSURE?

http://www.epa.gov/triexplorer

COUNTYCENSUS 2000POPULATION

2003 TRI ON-SITE RELEASES (LB)

# FAC

PER CAPITA (LB)

Austin 23,497 44,748 2 1.90

Brazoria 241,769 39,115,132 35 161.79

Chambers 26,031 386,193 9 14.84

Colorado 20,390 35,673 4 1.75

Fort Bend 354,452 2,234,522 15 6.30

Galveston 250,158 13,699,267 16 54.76

Harris 3,400,578 42,853,740 334 12.60

Liberty 70,154 38,413 4 0.55

Matagorda 37,957 352,651 2 9.29

Montgomery 293,768 722,517 14 2.46

Walker 61,758 14,173 2 0.23

Waller 32,663 12,131 3 0.37

Wharton 41,188 89,093 4 2.16

TOTAL 4,854,363 99,598,253 444 20.52

Hardin 48,073 27,176 5 0.57

Jefferson 252,051 23,267,161 49 92.31

Orange 84,966 5,912,238 12 69.58

TOTAL 385,090 29,206,575 66 75.84

Population density, TRI & NPL Sites

13.45 ug/m3 = 13.45 ug/m3 = 6.1 ppbV 6.1 ppbV 1,3-butadiene1,3-butadiene


Monitored Concentrations of Outdoor HAPsMonitored Concentrations of Outdoor HAPs

STANDARDS (ppbV) MAXIMUM 24-HOUR AVG AT ANY MONITOR (ppbV) HAP AND COUNTY

(# sites in 2004, hourly) TxESL 1-hr

TxESL Ann

EPA Bench

WHO-EU

2000 2001 2002 2003 2004

BENZENE 25.0 1.0 ~.07 RB Note: EPA DB in ppbC (divide by 6 carbon for ppbV)

Harris (13,4) 52.2 44.3 41.0 70.9 73.5

Jefferson (7,1) 9.6 8.6 9.1 19.4 49.4

Los Angeles (8,0) 6.9 3.8 4.0 5.4 2.9

1,3-BUTADIENE 50.0 5.0 0.0 RB Note: EPA DB in ppbC (divide by 4 carbon for ppbV)

Harris (13,4) 48.8 87.6 49.5 72.2 37.4

Jefferson (7,1) 14.0 37.0 9.2 14.8 22.4

Los Angeles (4,0) 0.9 1.2 1.0 0.8 0.5

FORMALDEHYDE 12.0 1.2 0.1 80** Note: EPA DB in ppbC (divide by 1 carbon for ppbV)

Harris (3,0) 78.0 15.8 17.5 51.3 20.1

Jefferson (0,0) ND ND ND ND ND

Los Angeles (7,0) 38.1 44.6 41.2 46.0 15.5

The Big Three…The Big Three…HC a strong contender…BUT lower PM levels…?HC a strong contender…BUT lower PM levels…?

http://www.epa.gov/air/data/geosel.html; **=30 minutes; ESL=Effect Screening Level; ND=No Data; RB=Risk Basedhttp://www.epa.gov/air/data/geosel.html; **=30 minutes; ESL=Effect Screening Level; ND=No Data; RB=Risk Based

Measuring RiskMeasuring Risk U.S. Rating SystemsU.S. Rating Systems

EPA’s NAAQSsEPA’s NAAQSs OSHA/NIOSHOSHA/NIOSH LD50LD50 EPA’s IRISEPA’s IRIS TCEQ’s ESLsTCEQ’s ESLs

InternationalInternational WHO (IARC)WHO (IARC) Australia’s EPHC is developingAustralia’s EPHC is developing

NEPM standards for 5 ATs: benzene, NEPM standards for 5 ATs: benzene, formaldehyde, benzo(a)pyrene, formaldehyde, benzo(a)pyrene, toluene and xylenestoluene and xylenes

Weak areas in our understandingWeak areas in our understanding Low exposure, long durationLow exposure, long duration Subtle effects (cognition, endocrine disruption...)Subtle effects (cognition, endocrine disruption...) Multipollutant and cumulative effectsMultipollutant and cumulative effects Windows of harm, latency, lag timesWindows of harm, latency, lag times Differences in susceptibility Differences in susceptibility

Measuring Health Risk from Air ToxicsMeasuring Health Risk from Air Toxics National Air Toxics Assessment (NATA)National Air Toxics Assessment (NATA)

Assesses risk from 32 of the 188 HAPS, plus diesel PMAssesses risk from 32 of the 188 HAPS, plus diesel PM Air Toxics Emissions InventoryAir Toxics Emissions Inventory…?…? Estimate ambient concentrations across USEstimate ambient concentrations across US…?…? Estimate population exposures across USEstimate population exposures across US…?…? Characterize public health risk (cancer and noncancer)Characterize public health risk (cancer and noncancer)…?…?

Relationship of Relationship of estimated cancer estimated cancer risk from air toxics risk from air toxics with median with median household income household income among Maryland among Maryland census tracts, 2000 census tracts, 2000 (Apelberg 2005) (Apelberg 2005)

http://www.epa.gov/ttn/atw/nata/ http://www.epa.gov/ttn/atw/nata/

3. ACUTE VS CHRONIC DISEASE3. ACUTE VS CHRONIC DISEASE Acute Disease / Health EffectsAcute Disease / Health Effects

An illness or clinical symptoms that have a rapid onset and short An illness or clinical symptoms that have a rapid onset and short but often severe course (eg, asthma or heart attack)but often severe course (eg, asthma or heart attack)

Chronic Disease / Health EffectsChronic Disease / Health Effects An illness or clinical symptoms that are prolonged, do not An illness or clinical symptoms that are prolonged, do not

resolve spontaneously, and are rarely cured completely (eg, resolve spontaneously, and are rarely cured completely (eg, diabetes, cancer, multiple sclerosis, hypertension)diabetes, cancer, multiple sclerosis, hypertension)

What differentiates chronic from acute disease?What differentiates chronic from acute disease? Reversibility? Easier causal connection? Reversibility? Easier causal connection? Considerable blurringConsiderable blurring

Exacerbations (acute) often require chronic disease substrateExacerbations (acute) often require chronic disease substrate What of acute exposure (eg, Bhopal) that leads to subsequent What of acute exposure (eg, Bhopal) that leads to subsequent

chronic disease state (eg, emphysema and CHF)?chronic disease state (eg, emphysema and CHF)? Is premature death an acute or chronic effect?Is premature death an acute or chronic effect?


Measuring DiseaseMeasuring Disease What endpoint?What endpoint?

Biomarkers Biomarkers BLLs, cotinine, DNA damage, PSA…BLLs, cotinine, DNA damage, PSA…

Community health questionnaire / surveyCommunity health questionnaire / survey Medication usageMedication usage Clinic VisitClinic Visit

Signs (measurable, eg, FEV, eosinophils)Signs (measurable, eg, FEV, eosinophils) Symptoms (questionnaire, medical history)Symptoms (questionnaire, medical history) DiagnosisDiagnosis

HospitalizationHospitalization Emergency room visit Emergency room visit DeathDeath

Who, What, When and Where?Who, What, When and Where?

4. THE E-D RELATIONSHIP4. THE E-D RELATIONSHIPExample: 1,3-ButadieneExample: 1,3-Butadiene

ProgressionDiseaseAltered structure-function

Early response

Biologically effective

dose

Internal dose

Exposure (BD, EB, EBdiol, DEB)

• SurveySurvey• EH HistoryEH History• Ambient Ambient

monitorsmonitors• ProximityProximity• Personal Personal

monitors monitors • Chamber Chamber

studiesstudies

• Alveolar Alveolar uptakeuptake

• Other Other pathways?pathways?

Simulations (PBPK modeling)Simulations (PBPK modeling)

• Metabolites Metabolites in blood or in blood or urineurine

• BD in fatBD in fat

?• Inflammatory Inflammatory

or immune or immune responseresponse

• DNA adductsDNA adducts• Hb adductsHb adducts• Gene Gene

mutationsmutations• SCEsSCEs

• Malformed Malformed spermsperm

• Germ cell Germ cell mutationsmutations

• DyspneaDyspnea• Neurologic Neurologic

manifestationsmanifestations• TumorsTumors• LeukemiasLeukemias• LymphomasLymphomas• Congenital Congenital

abnormalitiesabnormalities

Differences in susceptibility, detoxification and repairDifferences in susceptibility, detoxification and repair

Risk Risk modelingmodeling

• DeathDeath


4. THE E-D RELATIONSHIP4. THE E-D RELATIONSHIP continued continued

Types of studiesTypes of studies Experimental and clinical trialsExperimental and clinical trials Population (epidemiologic) studies Population (epidemiologic) studies

Case-control (retrospective)Case-control (retrospective) Cohort (prospective)Cohort (prospective) EcologicEcologic MixedMixed

Study methodologiesStudy methodologies Randomization, matching, spatial Randomization, matching, spatial

patterns, time-series, surveillance, patterns, time-series, surveillance, questionnaire, molecular changes, questionnaire, molecular changes, controlling for confounding…controlling for confounding…

Money, time and availability of data are major constraintsMoney, time and availability of data are major constraints

Take an environmental health / exposure history! Use Take an environmental health / exposure history! Use a standardized form.a standardized form.


5. THE 3 WORKSHOP QUESTIONS5. THE 3 WORKSHOP QUESTIONS Do better exposure estimates lead to stronger Do better exposure estimates lead to stronger

associations?associations? Probably…if you’re measuring the right things, if you understand the Probably…if you’re measuring the right things, if you understand the

causal pathway (if it exists), if you adjust for confounders, if you have causal pathway (if it exists), if you adjust for confounders, if you have sufficient numbers….sufficient numbers….

Guard against waiting for the definitive study…Guard against waiting for the definitive study…

Is it preferable to focus on acute or chronic health Is it preferable to focus on acute or chronic health effects?effects? Intertwined. Chronic disease is of more public health importance, but Intertwined. Chronic disease is of more public health importance, but

acute effects easier and cheaper to measure and more likely to find acute effects easier and cheaper to measure and more likely to find useful associations for regulatory decisions.useful associations for regulatory decisions.

Do mortality and morbidity correlate with exposure?Do mortality and morbidity correlate with exposure? Correlation with CAPs, esp PM, strong across studies.Correlation with CAPs, esp PM, strong across studies. CAPs may in part be surrogates for ATs.CAPs may in part be surrogates for ATs. AT risk analyses suggest yes, but epi studies conflictingAT risk analyses suggest yes, but epi studies conflicting

6. SELECTED HEALTH STUDIES6. SELECTED HEALTH STUDIES CAP Major Prospective Studies CAP Major Prospective Studies

CAPs ~ ATTs?CAPs ~ ATTs? Ongoing methodological Ongoing methodological

refinement; confounder controlrefinement; confounder control Harvard 6-Cities StudyHarvard 6-Cities Study

(Dockery 1992, Lippman 2003, Krewski 2004) (Dockery 1992, Lippman 2003, Krewski 2004)

8,111 adults in 6 US cities8,111 adults in 6 US cities FU 14-16 yr initial (b 1974-77)FU 14-16 yr initial (b 1974-77) ~ 26% ~ 26% mortality PM, sulfates mortality PM, sulfates Re-analyses find ~ sameRe-analyses find ~ same

American Cancer Society StudyAmerican Cancer Society Study (Pope 1994, Lippman 2003, Krewski 2004) (Pope 1994, Lippman 2003, Krewski 2004)

295,223 adults in 50 US cities295,223 adults in 50 US cities FU 6 yr initial (b 1982)FU 6 yr initial (b 1982) ~ 17% ~ 17% mortality PM mortality PM Re-analyses find ~ sameRe-analyses find ~ same

Update of 6 Cities and ACS StudiesUpdate of 6 Cities and ACS Studies

Mean increase and 95% CI for annual mortality increases per 10 µg.m3 increment of PM2.5 based on 16 yr of mortality data. PM2.5 and sulfates associated with increased mortality from cardiovascular and pulmonary causes, as well as lung cancer.

6. SELECTED HEALTH STUDIES 6. SELECTED HEALTH STUDIES continuedcontinued

Major Retrospective StudiesMajor Retrospective Studies CAPs ~ ATTs?; Large Ns; refinement of methodologiesCAPs ~ ATTs?; Large Ns; refinement of methodologies APHEA: Air Pollution and Health - European ApproachAPHEA: Air Pollution and Health - European Approach

30 European cities, extensive shared db and methodologies30 European cities, extensive shared db and methodologies Multiple studies, publications (> 40), re-analyses…Multiple studies, publications (> 40), re-analyses…

NMMAPS: National Morbidity, Mortality, and Air Pollution StudyNMMAPS: National Morbidity, Mortality, and Air Pollution Study 90 US cities chosen by size; ~ 14-yr period90 US cities chosen by size; ~ 14-yr period Multiple studies, publications, re-analysesMultiple studies, publications, re-analyses

10-ppb 10-ppb O3 in previous week = 0.52% O3 in previous week = 0.52% mortality mortality (Bell 2004) (Bell 2004)

0.41% 0.41% mortality per 10 µg/m3 mortality per 10 µg/m3 in PM10 (old GAM); 0.27% (new GAM); in PM10 (old GAM); 0.27% (new GAM); 0.21% (GLM)0.21% (GLM) (Dominici 2005) (Dominici 2005)

Samoli 2003Samoli 2003 Le Tertre 2003 Le Tertre 2003

(right) % (right) % hospital hospital admissions for ischemic admissions for ischemic heart disease in persons heart disease in persons >65 yr per 10 >65 yr per 10 µµg/m3 g/m3 PM10 PM10 for 0 & 1 average lagfor 0 & 1 average lag


6. SELECTED HEALTH STUDIES6. SELECTED HEALTH STUDIES continued continued

Ambient Air ToxicsAmbient Air Toxics Paucity of studies…focus on clarifying exposurePaucity of studies…focus on clarifying exposure Oxygenated urban air toxics and asthma variability in middle Oxygenated urban air toxics and asthma variability in middle

school children: A panel studyschool children: A panel study (Delclos G, in review) (Delclos G, in review)

29 labile asthmatic children, age 10-13, in the Aldine school district. 29 labile asthmatic children, age 10-13, in the Aldine school district. Examines measures of lung function with personal exposure to air Examines measures of lung function with personal exposure to air toxics, especially aldehydes. Confounders measured included other toxics, especially aldehydes. Confounders measured included other indoor and outdoor pollutants, air exchange rate, temperature, indoor and outdoor pollutants, air exchange rate, temperature, humidity and activity level. humidity and activity level.

Increased risk of preterm delivery among people living near the Increased risk of preterm delivery among people living near the three oil refineries in Taiwanthree oil refineries in Taiwan (Yang 2004) (Yang 2004) Compared 7,095 first-parity singleton births to mothers living within Compared 7,095 first-parity singleton births to mothers living within

3 km (1.86 miles) of 3 refineries with 10% random sample of births 3 km (1.86 miles) of 3 refineries with 10% random sample of births in rest of Taiwan (N=50,388) between 1/1/1994 and 12/31/1997. in rest of Taiwan (N=50,388) between 1/1/1994 and 12/31/1997. Controlled for multiple confounders. Controlled for multiple confounders.

Outcome variable of interest = preterm delivery (< 37 weeks).Outcome variable of interest = preterm delivery (< 37 weeks). AOR = 1.14 (1.01-1.28)AOR = 1.14 (1.01-1.28)


Ambient Air ToxicsAmbient Air Toxics continued continued The impact of polycyclic aromatic hydrocarbons and fine The impact of polycyclic aromatic hydrocarbons and fine

particles on pregnancy outcomeparticles on pregnancy outcome (Dejmek 2000) (Dejmek 2000)

Compared birth outcomes (IUGR) in two communitiesCompared birth outcomes (IUGR) in two communities Teplice and Prachatice; N = 3378 and 1505Teplice and Prachatice; N = 3378 and 1505 Similar levels of c-PAHs but Teplice has higher PM2.5Similar levels of c-PAHs but Teplice has higher PM2.5 Similar results: for each 10 Similar results: for each 10 ng ng c-PAH in first gestational month, AOR c-PAH in first gestational month, AOR

1.22 (1.07 – 1.39) for IUGR1.22 (1.07 – 1.39) for IUGR

Suggests earlier association seen with PM due to PAH componentSuggests earlier association seen with PM due to PAH component

AORs of IUGR by exposure to c-PAH in different months of gestation, adjusted for parity, maternal age and height, prepregnancy weight, education, marital status, month-specific maternal smoking, season, rhythm, and year of the study.


Ambient Air ToxicsAmbient Air Toxics continued continued

Asthma symptoms in Hispanic children and daily ambient Asthma symptoms in Hispanic children and daily ambient exposures to toxic and criteria air pollutantsexposures to toxic and criteria air pollutants (Delfino 2003) (Delfino 2003) Panel study of 22 Hispanic asthmatic adolescents in LAPanel study of 22 Hispanic asthmatic adolescents in LA

Measured CAPs plus Measured CAPs plus EC-OC, 10 ATs, asthma symptoms Significant AORs of asthma exacerbation associated with interquartile

increase in pollutant concentrations included1.27 (1.05-1.54) for 8-hr NO2 1.23 (1.02-1.48) for benzene1.37 (1.04-1.80) for formaldehyde 1.85 (1.11-3.08) for EC1.88 (1.12-3.17) for OC

6. SELECTED HEALTH STUDIES 6. SELECTED HEALTH STUDIES continuedcontinued

Ambient Air ToxicsAmbient Air Toxics Effect of motor vehicle emissions on respiratory health in Effect of motor vehicle emissions on respiratory health in

an urban area an urban area (Buckeridge 2002)(Buckeridge 2002)

SE Toronto. Ecologic study designSE Toronto. Ecologic study design Age- and gender-adjusted Age- and gender-adjusted

1990-1992 hospital admission 1990-1992 hospital admission (respiratory vs genitourinary) (respiratory vs genitourinary) rates by 334 EAsrates by 334 EAs

GIS used to create 10-m street GIS used to create 10-m street buffers to estimate EA PM2.5 buffers to estimate EA PM2.5 exposure based on daily traffic exposure based on daily traffic countscounts

Adjusted for SESAdjusted for SES RR = 1.24 (1.05-1.45) for RR = 1.24 (1.05-1.45) for

respiratory subset (asthma, respiratory subset (asthma, bronchitis, COPD, pneumonia, bronchitis, COPD, pneumonia, URI) for log10 URI) for log10 in PM2.5 in PM2.5


7. BCM HC AP & ADMITS STUDY7. BCM HC AP & ADMITS STUDY ObjectiveObjective

To analyze spatial relationships between hospital admissions To analyze spatial relationships between hospital admissions and air pollution, with special attention to air toxics, in 337 4 x 4 and air pollution, with special attention to air toxics, in 337 4 x 4 km domains in Harris County, Texas.km domains in Harris County, Texas.

Year 1 August 2000; year 2 August – October 2000Year 1 August 2000; year 2 August – October 2000

Study DesignStudy Design Mixed-level ecologic correlation analysisMixed-level ecologic correlation analysis

Coordinate System: Coordinate System: NAD 1983, State Plane Texas,NAD 1983, State Plane Texas,South Central, FIPS 4204, FeetSouth Central, FIPS 4204, Feet

Projection: Projection: Lambert Conformal ConicLambert Conformal Conic

337 4x4-km cells intersect Harris County337 4x4-km cells intersect Harris County


7. BCM HC AP & ADMITS STUDY 7. BCM HC AP & ADMITS STUDY continuedcontinued

Key collaboratorsKey collaborators Baylor College of Medicine (Hamilton WJ, Ningthoujam SS)Baylor College of Medicine (Hamilton WJ, Ningthoujam SS) University of Houston (Byun DW, Coarfa V, Kim S)University of Houston (Byun DW, Coarfa V, Kim S) UT School of Public Health (Chan W, Li Y)UT School of Public Health (Chan W, Li Y) US Environmental Protection Agency (Ching JKS)US Environmental Protection Agency (Ching JKS)

Data sourcesData sources Hospital admissions from THCIC RUDFHospital admissions from THCIC RUDF Pollutant concentrationsPollutant concentrations

CMAQ-AT model hourly concentrations for each cellCMAQ-AT model hourly concentrations for each cell Concentrations from are monitors (TCEQ)Concentrations from are monitors (TCEQ)

Census 2000 dataCensus 2000 data Median household income, % minority, housing…Median household income, % minority, housing…

IRB approvals from TDSHS and BCMIRB approvals from TDSHS and BCM



Hospital AdmissionsHospital Admissions Hospital coverageHospital coverage

95 hospitals (77.6% of 95 hospitals (77.6% of hospitals, 96.0% of beds)hospitals, 96.0% of beds)

Two significant omissions: Two significant omissions: LBJ (324 beds)LBJ (324 beds)Quentin Meese (75 beds)Quentin Meese (75 beds)

HC residents admitted = HC residents admitted = 44,07844,078

Exclusions = 7,350Exclusions = 7,350 Newborns = 6,885Newborns = 6,885 Accidents = 465Accidents = 465

No discharge diagnosis = 40No discharge diagnosis = 40 Total for geocoding = 36,688Total for geocoding = 36,688 Total geocoded Total geocoded = 29,900

(81.5%) N = 36,688N = 36,688


Geocoded hospital admissions (N = 29,900)Geocoded hospital admissions (N = 29,900)

CardiovascularCardiovascular6,284 (17.1%)6,284 (17.1%)

RespiratoryRespiratory2,946 (8.0%)2,946 (8.0%)

CardiorespiratoryCardiorespiratory7,467 (20.4%)7,467 (20.4%)

OtherOther22,433 (61.2%)22,433 (61.2%)


EPA’s CMAQ-AT EPA’s CMAQ-AT Eulerian nested Eulerian nested photochemical modelphotochemical model MM5 meteorologyMM5 meteorology NEI99, augmented by NEI99, augmented by

NTI99 and TEI2000NTI99 and TEI2000 SMOKESMOKE SAPRC99 SAPRC99

BCM receives text files BCM receives text files for each pollutant with for each pollutant with hourly concentrationshourly concentrations

Generate for each cell Generate for each cell for August 2000for August 2000 Mean maximum Mean maximum Mean of 24-hr avgMean of 24-hr avg 12-hr AM (6 a – 6 p)12-hr AM (6 a – 6 p) 12-hr PM (6 p – 6 a)12-hr PM (6 p – 6 a) AT score from rankingsAT score from rankings


Pollutant concentrations from area monitorsPollutant concentrations from area monitors

Use IDL to run correlationsUse IDL to run correlations

0

0.5

1

1.5

2

2.5

3

3.5

4

co

nc (

pp

bV

)

Clinton CMAQ-AT vs ObsClinton CMAQ-AT vs Obs


Mean 24-hour CMAQ-AT generated ozone concentrations on August 1, 2000, in 337 4 x 4-km cells in Harris County. Red denotes the highest concentrations (35-45 ppbv) and the dark green denotes the lowest (9-25 ppbv).

7. BCM HC AP & ADMITS STUDY7. BCM HC AP & ADMITS STUDY continuedcontinued

Median household income by cell. Dark green = < 25,000; red = > 70,000.

THE “AH, DUH” FACTORTHE “AH, DUH” FACTOR Convincing research is helpful…Convincing research is helpful…

Drives regulations Drives regulations Significantly increases complianceSignificantly increases compliance Great education toolGreat education tool

However…However… Research should not be used to delay implementation of Research should not be used to delay implementation of

commonsense regulations or education to reduce exposurecommonsense regulations or education to reduce exposure Incentives for conservation, decreased vehicle use, decreased Incentives for conservation, decreased vehicle use, decreased

emissionsemissions Elimination of unnecessary toxic processes / practicesElimination of unnecessary toxic processes / practices Education about personal exposureEducation about personal exposure

$ and political leadership needed to implement the $ and political leadership needed to implement the “Ah, Duh” Stuff, now, while continuing research“Ah, Duh” Stuff, now, while continuing research

Selected SourcesSelected Sources Apelberg BJ, Buckley TJ, White RH. Socioeconomic and racial disparities in cancer risk from air toxics in Maryland. Apelberg BJ, Buckley TJ, White RH. Socioeconomic and racial disparities in cancer risk from air toxics in Maryland. Environ Health Environ Health

PerspectPerspect 113:693-9(2005) 113:693-9(2005) Australia’s EPHC NEPM-AT program Australia’s EPHC NEPM-AT program http://http://www.ephc.gov.au/nepms/air/air_toxics.htmlwww.ephc.gov.au/nepms/air/air_toxics.html EPA’s HAPs Database EPA’s HAPs Database http://www.epa.gov/air/data/http://www.epa.gov/air/data/ Buckeridge DL, Glazier R, Harvey BJ, et al. Effect of motor vehicle emissions on respiratory health in an urban area. Buckeridge DL, Glazier R, Harvey BJ, et al. Effect of motor vehicle emissions on respiratory health in an urban area. Environ Health Environ Health

PerspectPerspect 110:293-300.(2002) 110:293-300.(2002) Delfino RJ, Gong H, Jr., Linn WS, Pellizzari ED, Hu Y. Asthma symptoms in Hispanic children and daily ambient exposures to toxic and Delfino RJ, Gong H, Jr., Linn WS, Pellizzari ED, Hu Y. Asthma symptoms in Hispanic children and daily ambient exposures to toxic and

criteria air pollutants. criteria air pollutants. Environ Health PerspectEnviron Health Perspect 111:647-56(2003) 111:647-56(2003) Dominici F, McDermott A, Daniels M, Zeger SL, Samet JM. Revised analyses of the National Morbidity, Mortality, and Air Pollution Dominici F, McDermott A, Daniels M, Zeger SL, Samet JM. Revised analyses of the National Morbidity, Mortality, and Air Pollution

Study: mortality among residents of 90 cities. Study: mortality among residents of 90 cities. J Toxicol Environ Health AJ Toxicol Environ Health A 68:1071-92(2005) 68:1071-92(2005) EPA’s Integrated Risk Information System EPA’s Integrated Risk Information System http://www.epa.gov/iris/http://www.epa.gov/iris/ EPA’s TRI Explorer EPA’s TRI Explorer http://www.epa.gov/triexplorer/http://www.epa.gov/triexplorer/ Leikauf GD. Hazardous air pollutants and asthma. Leikauf GD. Hazardous air pollutants and asthma. Environ Health PerspectEnviron Health Perspect 110 Suppl 4:505-26(2002) 110 Suppl 4:505-26(2002) Le Tertre A, Medina S, Samoli E, et al. Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities. Le Tertre A, Medina S, Samoli E, et al. Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities.

J Epidemiol Community Health 56:773-9(2002)J Epidemiol Community Health 56:773-9(2002) Lippmann M, Frampton M, Schwartz J, et al. The U.S. Environmental Protection Agency Particulate Matter Health Effects Research Lippmann M, Frampton M, Schwartz J, et al. The U.S. Environmental Protection Agency Particulate Matter Health Effects Research

Centers Program: A midcourse report of status, progress, and plans. Centers Program: A midcourse report of status, progress, and plans. Environ Health PerspectEnviron Health Perspect 111:1074-92(2003) 111:1074-92(2003) National Air Toxics Assessment (NATA) National Air Toxics Assessment (NATA) http://www.epa.gov/ttn/atw/nata/http://www.epa.gov/ttn/atw/nata/ Payne-Sturges DC, Burke TA, Breysse P, Diener-West M, Buckley TJ. Personal exposure meets risk assessment: a comparison of Payne-Sturges DC, Burke TA, Breysse P, Diener-West M, Buckley TJ. Personal exposure meets risk assessment: a comparison of

measured and modeled exposures and risks in an urban community. measured and modeled exposures and risks in an urban community. Environ Health PerspectEnviron Health Perspect 112:589-98(2004) 112:589-98(2004) Yang CY, Chang CC, Chuang HY, Ho CK, Wu TN, Chang PY. Increased risk of preterm delivery among people living near the three oil Yang CY, Chang CC, Chuang HY, Ho CK, Wu TN, Chang PY. Increased risk of preterm delivery among people living near the three oil

refineries in Taiwan. refineries in Taiwan. Environ IntEnviron Int 30:337-42(2004) 30:337-42(2004)

http://www.ephc.gov.au/nepms/air/air_toxics.html

http://www.ephc.gov.au/nepms/air/air_toxics.html

http://www.epa.gov/air/data/

http://www.epa.gov/iris/

http://www.epa.gov/triexplorer/

http://www.epa.gov/ttn/atw/nata/

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