1 Acute Health Effects from Changes in Air Pollution and Weather in Heart Failure Mark Goldberg, PhD...
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Transcript of 1 Acute Health Effects from Changes in Air Pollution and Weather in Heart Failure Mark Goldberg, PhD...
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Acute Health Effects from Changes in Air
Pollution and Weather in Heart Failure
Mark Goldberg, PhDDepartment of Medicine
McGill University
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Total Cardiovascular Mortality (ICD9: 400-440)
• PM2.5: 12% (95%CI: 1.09-1.15) increase in mortality rate for an increase of 10 μg/m3
• other pollutants: no strong evidence of association
Research Questions for Acute Effects•Does the number of adverse health
events on a particular day increase if environmental conditions change on that day or on previous days?
•How far back in time (lag) do these changes affect health?
•If yes, are there certain populations particularly susceptible to these conditions?
Donora, Pennsylvania (Oct 26-31, 1948)
14,000 residents 20 people died and over 7,000
were hospitalized
London, UK (Dec 5-9, 1952)
3,000 more deaths
Air Pollution Episodes
Air Pollution Episode London, 1958-1959
Flu epidemicFeb 18-20
Excess mortality~200-250
NB: Mortality after removing 15-day running average
Estimated attributable number of deaths in various smog episodes occurring in London,
England, 1948-1962
YearDates of episode
Number of days
Estimated attributable deaths
Maximum 24-hour pollution (μg/m3)
British smoke SO2
1948 Nov 26 – Dec 1 6 700-800 2780 2150
1952 Dec 5 – Dec 8 4 4,000 4460 3830
1956 Jan 3 – Jan 6 4 1,000 2830 1430
1957 Dec 2 – Dec 5 4 700-800 2417 3335
1959 Jan 26 – Jan 31 6 200-250 1723 1850
1962 Dec 3 – Dec 7 5 700 3144 3834
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Studies in Montreal
•Daily nonaccidental mortality in Montreal, from Quebec death certificates, 1984-2002
•Daily weather conditions recorded at Dorval International Airport, 1984-2002
•Daily average concentrations of air pollutants (e.g., NO2, O3) from the various monitoring stations in Montreal
Time Series for Ozone, 1984-2002, Montreal.
The solid line represents the long-term trend in the data.
Time Series for NO2, 1984-2002, Montreal.
The solid line represents the long-term trend in the data.
Daily Nonaccidental Mortality, 1984-2002, Montreal
The solid line represents the long-term trend in the data.
Daily Maximum Temperature, 1984-2002, Montreal.
The solid line represents the long-term trend in the data.
Pooled Estimates of the Percent Increase in Daily
MortalityPollutant
Change in daily average concentration
Studies not using GAMs
Studies using GAMs
Percent increase
95% CI Percent increase
95% CI
PM10 31.3 μg/m3 1.3 0.8-1.9 2.2 1.6-2.8
CO 1.1 ppm 4.7 1.1-8.4 1.6 1.1-2.1
NO2 24.0 ppb 1.0 0.3-1.8 3.4 2.5-4.2
O3 31.2 ppb 1.4 0.4-2.4 1.7 1.1-2.2
SO2 9.4 ppb 0.9 0.6-1.2 1.0 0.7-1.4
From: Stieb et al. J Air Waste Manag.Assoc. 2003;53:258-61
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Susceptible Populations: Time Series Study of Non-
accidental Mortality Among Persons With
Specific Health Conditions
Congestive Heart Failure
-10
-5
0
5
10
15
20
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COH Extinction Predicted PM2.5
SO2 O3
Warm Cold
CONO2Predicted Sulfatefrom PM2.5
SuttonSulfate
Mea
n P
erce
nt
Ch
ang
e in
Dai
ly M
orta
lity
-10
0
10
20
30
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COH Extinction Predicted PM2.5
SO2 O3CONO2Predicted Sulfatefrom PM2.5
SuttonSulfate
Warm
Cold
Mea
n P
erce
nt
Ch
ange
in
Dai
ly M
orta
lity
Diabetes and Cardiovascular Disease
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Particle Retention in Human Lungs
Mexico Cityair sample
Lung of Mexico City
resident
1 μm
Data from Michael Brauer, U. of British Columbia.
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Controlled Human Exposure Studies
.
Human Exposure Facility at theGage Occupational and
EnvironmentalHealth Unit of the University of
Toronto
Direct controlled human exposurestudies to determinedose-response relationships ofindividual pollutants (if any) anduncover biological mechanisms.
Findings:Inflammatory response after exposureThickening of arterial walls
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Mortality from the 2003 Heat Wave
Country DateEstimated no. of
attributable deathsItaly July-Aug 20,089
France Aug 19,490Germany August 5,250
UK August 2,045Portugal August 2,007
India/Bangla-desh/
Pakistan
May-June 1,472
Switzerland
July 1,039
Netherlands
August 1,200
Belgium August 150
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Montreal: Recent Trends (April to September, inclusive)
Red = Maximum temperatureBlue = No. of days >25°C
Excess Mortality from Climate Change, Montreal, Spring-
Summer
•2001 (57 days >25°C):
•Excess no. of deaths on days >25°C = 212
•Projected to 2100 (97 days >25°C):
•Excess no. of deaths on days >25°C = 454
•Attributable to Global Warming (3°C): 454 - 212 = 242 deaths ~1.3 deaths/day during the “warm” season
Daily Diary Study of Congestive Heart Failure
•Nadia Giannetti, McGill
•Rick Burnett, Health Canada
•Nancy Mayo, McGill
•Marie-France Valois, McGill
•Jay Brophy, McGill
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Objective
•To determine whether daily exacerbations in essential signs, symptoms, and physiologic indicators are associated with daily variations in concentrations of ambient air pollution and changing weather patterns
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Design•Daily diary of signs and symptoms
•Daily measurements of:
•oxygen saturation, pulse rate
•weight
•blood pressure
•Daily measurements of air pollutants and weather conditions from fixed-site stations
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Design
•~2 months duration per subject
•Very poor pumping of heart (ventricular ejection fraction <35%)• Published: Occupational and Environmental Medicine
2008;65:659-6 and Environ Res 2009;109:166-174
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Modifications
• Increased sample size
• Expanded daily diary
• Environmental measurements inside and outside of the home
• Temperature, RH
• CO, PM2.5, NOX
• Air infiltration rates
• GPS device to estimate exposures outside of home