Acute Effects of Ambient PM2.5 on All-Cause and Cause-Specific Emergency Ambulance Dispatches in Japan.
ABSTRACT: Short-term health effects of ambient PM2.5 have been established with numerous studies, but evidence in Asian countries is limited. This study aimed to investigate the short-term effects of PM2.5 on acute health outcomes, particularly all-cause, cardiovascular, respiratory, cerebrovascular and neuropsychological outcomes. We utilized daily emergency ambulance dispatches (EAD) data from eight Japanese cities (2007-2011). Statistical analyses included two stages: (1) City-level generalized linear model with Poisson distribution; (2) Random-effects meta-analysis in pooling city-specific effect estimates. Lag patterns were explored using (1) unconstrained-distributed lags (lag 0 to lag 7) and (2) average lags (lag: 0-1, 0-3, 0-5, 0-7). In all-cause EAD, significant increases were observed in both shorter lag (lag 0: 1.24% (95% CI: 0.92, 1.56)) and average lag 0-1 (0.64% (95% CI: 0.23, 1.06)). Increases of 1.88% and 1.48% in respiratory and neuropsychological EAD outcomes, respectively, were observed at lag 0 per 10 µg/m³ increase in PM2.5. While respiratory outcomes demonstrated significant average effects, no significant effect was observed for cardiovascular outcomes. Meanwhile, an inverse association was observed in cerebrovascular outcomes. In this study, we observed that effects of PM2.5 on all-cause, respiratory and neuropsychological EAD were acute, with average effects not exceeding 3 days prior to EAD onset.
Project description:In air pollution time-series studies, the temporal pattern of the association of fine particulate matter (PM2.5; particulate matter ? 2.5 µm in aerodynamic diameter) and health end points has been observed to vary by disease category. The lag pattern of PM2.5 chemical constituents has not been well investigated, largely because daily data have not been available.We explored the lag structure for hospital admissions using daily PM2.5 chemical constituent data for 5 years in the Denver Aerosol Sources and Health (DASH) study.We measured PM2.5 constituents, including elemental carbon, organic carbon, sulfate, and nitrate, at a central residential site from 2003 through 2007 and linked these daily pollution data to daily hospital admission counts in the five-county Denver metropolitan area. Total hospital admissions and subcategories of respiratory and cardiovascular admissions were examined. We assessed the lag structure of relative risks (RRs) of hospital admissions for PM2.5 and four constituents on the same day and from 1 to 14 previous days from a constrained distributed lag model; we adjusted for temperature, humidity, longer-term temporal trends, and day of week using a generalized additive model.RRs were generally larger at shorter lags for total cardiovascular admissions but at longer lags for total respiratory admissions. The delayed lag pattern was particularly prominent for asthma. Elemental and organic carbon generally showed more immediate patterns, whereas sulfate and nitrate showed delayed patterns.In general, PM2.5 chemical constituents were found to have more immediate estimated effects on cardiovascular diseases and more delayed estimated effects on respiratory diseases, depending somewhat on the constituent.
Project description:Ambient air pollution poses a significant risk for a group of common and often debilitating respiratory diseases, but its direct impact on cause-specific respiratory diseases using emergency room visit (ERV) as an indicator remains to be fully explored. In this study, we conducted a time-series study of ambient PM2.5, NO2, SO2 and their association with ERV for asthma, COPD and pneumonia in a four-year time span. Relative risks for ERV as per log increase in the level of ambient pollutants with time lags of up to 10 days were calculated, using a generalized additive model of Poisson regression. Daily 24-h average concentrations of PM2.5 and pollutant gases were obtained from a local Gutting air quality monitoring station. Results showed that the ERVs for pneumonia and asthma were associated with the level of PM2.5. The effects of PM2.5 on the risk of ERV for asthma were found to be significant at lag days 1 and 2 with increasing risk of 4.34% [RR: 1.091; CI: 1.020-1.166 (95%)] and 3.58% [RR: 1.074; CI: 1.007-1.146 (95%)], respectively. The ERV for pneumonia was associated with the level of PM2.5 at lag days 5, 6 and 7, with increasing risk of 1.92% [RR: 1.039; CI: 1.009-1.070 (95%)], 2.03% [RR: 1.041; CI: 1.009-1.075 (95%)], and 1.82% [RR: 1.037; CI: 1.001-1.075 (95%)], respectively. Further, PM2.5, but not NO2 and SO2, posed a significant risk of ERV for asthma during spring at lag days 0, 1 and 2 (17.12%, RR: 1.408, CI: 1.075-1.238; 15.30%, RR: 1.358 CI: 1.158-1.166; 11.94%, RR: 1.165, CI: 1.004-1.121), which was particularly evident for those who were younger than 75 years of age. In contrast, only PM2.5 was a significant risk of ERV for COPD, which was primarily for those who were younger than 75 years of age during summer season at lag days 3, 4 and 5. (26.66%, RR: 1.704, CI: 1.104-2.632; 26.99%; RR: 1.716, CI: 1.151-2.557; 24.09%; RR: 1.619, CI: 1.111-2.360). Collectively, these results suggested significant seasonal variation and differential time lag effects of PM2.5 on ERV for asthma, COPD and pneumonia.
Project description:BACKGROUND AND PURPOSE:Acute exposure to particulate matter with aerodynamic diameter <2.5 ?m (PM2.5) is associated with acute cardiovascular and cerebrovascular mortality. The aim of this study was to evaluate these associations with specific causes of cardiovascular and cerebrovascular mortality in Mexico City. METHODS:We obtained daily mortality records for Mexico City from 2004 to 2013 for cardiovascular and cerebrovascular causes in people ?25 and ?65 years old. Exposure to PM2.5 was assessed with daily estimates from a new hybrid spatiotemporal model using satellite measurements of aerosol optical depth PM2.5 and compared to ground level PM2.5 measurements with missing data estimated with generalized additive models PM2.5. We fitted Poisson regression models with distributed lags for all mortality outcomes. RESULTS:An increase of 10 µg/m3 in aerosol optical depth PM2.5 was associated with increased cardiovascular (1.22%; 95% confidence interval, 0.17-2.28) and cerebrovascular mortality (3.43%; 95% confidence interval, 0.10-6.28) for lag days 0 to 1 (lag 0-1). Stronger effects were identified for hemorrhagic stroke and people ?65 years. Associations were slightly smaller using generalized additive models PM2.5. CONCLUSIONS:These results support the evidence that acute exposure to PM2.5 is associated with increased risk of specific cardiovascular and cerebrovascular mortality causes.
Project description:BACKGROUND: Few studies have investigated the independent health effects of different size fractions of particulate matter (PM) in multiple locations, especially in Europe. OBJECTIVES: We estimated the short-term effects of PM with aerodynamic diameter ? 10 ?m (PM10), ? 2.5 ?m (PM2.5), and between 2.5 and 10 ?m (PM2.5-10) on all-cause, cardiovascular, and respiratory mortality in 10 European Mediterranean metropolitan areas within the MED-PARTICLES project. METHODS: We analyzed data from each city using Poisson regression models, and combined city-specific estimates to derive overall effect estimates. We evaluated the sensitivity of our estimates to co-pollutant exposures and city-specific model choice, and investigated effect modification by age, sex, and season. We applied distributed lag and threshold models to investigate temporal patterns of associations. RESULTS: A 10-?g/m3 increase in PM2.5 was associated with a 0.55% (95% CI: 0.27, 0.84%) increase in all-cause mortality (0-1 day cumulative lag), and a 1.91% increase (95% CI: 0.71, 3.12%) in respiratory mortality (0-5 day lag). In general, associations were stronger for cardiovascular and respiratory mortality than all-cause mortality, during warm versus cold months, and among those ? 75 versus < 75 years of age. Associations with PM2.5-10 were positive but not statistically significant in most analyses, whereas associations with PM10 seemed to be driven by PM2.5. CONCLUSIONS: We found evidence of adverse effects of PM2.5 on mortality outcomes in the European Mediterranean region. Associations with PM2.5-10 were positive but smaller in magnitude. Associations were stronger for respiratory mortality when cumulative exposures were lagged over 0-5 days, and were modified by season and age.
Project description:BACKGROUND:Exposure to fine particulate matter (PM2.5) during wildfire seasons has been associated with adverse health outcomes. Previous studies have focused on daily exposure, but PM2.5 levels in smoke events can vary considerably within 1 d. OBJECTIVES:We aimed to assess the immediate and lagged relationship between sub-daily exposure to PM2.5 and acute health outcomes during wildfire seasons in British Columbia. METHODS:We used a time-stratified case-crossover study design to evaluate the association between modeled hourly PM2.5 and ambulance dispatches during wildfire seasons from 2010 to 2015. Distributed lag nonlinear models were used to estimate the lag-specific and cumulative odds ratios (ORs) at lags from 1 to 48 h. We examined the relationship for all dispatches and dispatches related to respiratory, circulatory, and diabetic conditions, identified by codes for ambulance dispatch (AD), paramedic assessment (PA) or hospital diagnosis (HD). RESULTS:Increased respiratory health outcomes were observed within 1 h of exposure to a 10-?g/m3 increase in PM2.5. The 48-h cumulative OR [95% confidence interval (CI)] was 1.038 (1.009, 1.067) for the AD code Breathing Problems and 1.098 (1.013, 1.189) for PA code Asthma/COPD. The point estimates were elevated within 1 h for the PA code for Myocardial Infarction and HD codes for Ischemic Heart Disease, which had 24-h cumulative ORs of 1.104 (0.915, 1.331) and 1.069 (0.983, 1.162), respectively. The odds of Diabetic AD and PA codes increased over time to a cumulative 24-h OR of 1.075 (1.001, 1.153) and 1.104 (1.015, 1.202) respectively. CONCLUSIONS:We found increased PM2.5 during wildfire seasons was associated with some respiratory and cardiovascular outcomes within 1 h following exposure, and its association with diabetic outcomes increased over time. Cumulative effects were consistent with those reported elsewhere in the literature. These results warrant further investigation and may have implications for the appropriate time scale of public health actions. https://doi.org/10.1289/EHP5792.
Project description:Evaluation of short-term mortality displacement is essential to accurately estimate the impact of short-term air pollution exposure on public health.We quantified mortality displacement by estimating single-day lag effects and cumulative effects of air pollutants on mortality using distributed lag models.We performed a daily time series of nonaccidental and cause-specific mortality among elderly residents of São Paulo, Brazil, between 2000 and 2011. Effects of particulate matter smaller than 10 ?m (PM10), nitrogen dioxide (NO2) and carbon monoxide (CO) were estimated in Poisson generalized additive models. Single-day lag effects of air pollutant exposure were estimated for 0-, 1- and 2-day lags. Distributed lag models with lags of 0-10, 0-20 and 0-30 days were used to assess mortality displacement and potential cumulative exposure effects.PM10, NO2 and CO were significantly associated with nonaccidental and cause-specific deaths in both single-day lag and cumulative lag models. Cumulative effect estimates for 0-10 days were larger than estimates for single-day lags. Cumulative effect estimates for 0-30 days were essentially zero for nonaccidental and circulatory deaths but remained elevated for respiratory and cancer deaths.We found evidence of mortality displacement within 30 days for nonaccidental and circulatory deaths in elderly residents of São Paulo. We did not find evidence of mortality displacement within 30 days for respiratory or cancer deaths. Citation: Costa AF, Hoek G, Brunekreef B, Ponce de Leon AC. 2017. Air pollution and deaths among elderly residents of São Paulo, Brazil: an analysis of mortality displacement. Environ Health Perspect 125:349-354;?http://dx.doi.org/10.1289/EHP98.
Project description:BACKGROUND:Despite abruption's elusive etiology, knowledge of triggers that precede it by just a few days prior to delivery may help to understand the underpinnings of this acute obstetrical complication. We examine whether air pollution exposures immediately preceding delivery are associated with acute-onset abruptions. METHODS:We applied a bidirectional, time-stratified, case-crossover design to births with an abruption diagnosis in New York City, 2008-2014. We measured ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2). We fit distributed lag nonlinear models based on conditional logistic regression to evaluate individual exposure and cumulative exposures over lags 0-7 days before abruption, adjusted for temperature and relative humidity (similar lags to the main exposures). RESULTS:We identified 1,190 abruption cases. We observed increased odds of abruption for exposure to PM2.5 (per 10 ?g/m) on lag day 3 (odds ratio [OR] 1.19, 95% confidence interval [CI] = 0.98, 1.43), lag day 4 (OR 1.21, 95% CI = 1.01, 1.46), and lag day 5 (OR 1.17, 95% CI = 1.03, 1.33). Similarly, the odds of abruption increased with exposure to NO2 (per 5 ppb) on lag day 3 (OR 1.16, 95% CI = 0.98, 1.37), lag day 4 (OR 1.19, 95% CI = 1.02, 1.39), and lag day 5 (OR 1.16, 95% CI = 1.05, 1.27). Exposures to PM2.5 and NO2 at other lags, or cumulative exposures, were not associated with abruption of acute onset. CONCLUSIONS:This case-crossover study showed evidence of an association between short-term ambient air pollution exposures and increased abruption risk of acute onset.
Project description:Short term changes in exposure to outdoor fine particulate matter (PM2.5) concentrations are associated with an increased risk of mortality. However, less is known about how oxidant gases may modify the acute health effects of PM2.5. Our objective was to investigate whether associations between acute exposure to PM2.5 and mortality were modified by the oxidant gases O3 and NO2 using their redox-weighted average (Ox). We conducted a multi-city case-crossover study in 24 cities across Canada between 1998-2011 including 1,179,491 nonaccidental mortality events. Interquartile increases in lag-0 and 3-day mean PM2.5 and Ox concentrations were each associated with small increases in nonaccidental and cardiovascular mortality. In stratified analyses, associations between PM2.5 and nonaccidental and cardiovascular mortality tended to be greatest in the highest tertile of Ox with a significant interaction observed between lag 0 PM2.5 and 3-day mean Ox (interaction p-value?=?0.04). There was no evidence of effect modification by Ox in the relationship between PM2.5 and respiratory mortality. Overall, the relationship between short-term changes in outdoor PM2.5 and nonaccidental mortality may be greater when oxidant gas concentrations are also elevated. In some regions, reductions in oxidant gas concentrations may also reduce the acute health impacts of PM2.5.
Project description:Introduction: This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM10) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS). Methods: This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM10 were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM10. The latent effects of PM10 were estimated in single and cumulative lags, up to 14 days. Results: In the adjusted model, for each IQR increase in the average daily PM10 concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM10 in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions. Conclusion: Increase in daily PM10 concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.
Project description:Associations between ambient particulate matter <?2.5 ?m (PM2.5) and asthma morbidity have been suggested in previous epidemiologic studies but results are inconsistent for areas with lower PM2.5 levels. We estimated the associations between early-life short-term PM2.5 exposure and the risk of asthma or wheeze clinical encounters among Massachusetts children in the innovative Pregnancy to Early Life Longitudinal (PELL) cohort data linkage system.We used a semi-bidirectional case-crossover study design with short-term exposure lags for asthma exacerbation using data from the PELL system. Cases included children up to 9 years of age who had a hospitalization, observational stay, or emergency department visit for asthma or wheeze between January 2001 and September 2009 (n?=?33,387). Daily PM2.5 concentrations were estimated at a 4-km resolution using satellite remote sensing, land use, and meteorological data. We applied conditional logistic regression models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CI). We also stratified by potential effect modifiers.The median PM2.5 concentration among participants was 7.8 ?g/m3 with an interquartile range of 5.9 ?g/m3. Overall, associations between PM2.5 exposure and asthma clinical encounters among children at lags 0, 1 and 2 were close to the null value of OR?=?1.0. Evidence of effect modification was observed by birthweight for lags 0, 1 and 2 (p?<?0.05), and season of clinical encounter for lags 0 and 1 (p?<?0.05). Children with low birthweight (LBW) (<?2500 g) had increased odds of having an asthma clinical encounter due to higher PM2.5 exposure for lag 1 (OR: 1.08 per interquartile range (IQR) increase in PM2.5; 95% CI: 1.01, 1.15).Asthma or wheeze exacerbations among LBW children were associated with short-term increases in PM2.5 concentrations at low levels in Massachusetts.