Air pollution and disease: are we asking the right questions? Dr Alex G Stewart CHaMPs July 2011
Mar 26, 2015
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
……..