Air pollution and disease:
are we asking the right questions?
Dr Alex G Stewart
CHaMPs July 2011
CO
NO2
PM10
Local authority level
1998 to 2004
O3
All cause
mortality
Levels of PM10 & 03
associated with mortality
Effect estimate considerably
higher than previous
estimates
(2007) CASEpaper, 128. Centre for Analysis of Social Exclusion, London School of Economics and Political Science, London
MASS
VOC – greater variety
PM10 as mass masks increase in fines (<1µm) – numbers matter
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 airport
Which they related to the increase in air travel.
Passenger transport by mode in Great Britain in billion passenger kilometre
1952–2007.
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.
Magnentic concentration – metals in PM – rapid, simple, cheap
Chris Crosby, working with Prof Worsley of Edge Hill university
Has been able to measure concentrations of road dust
Every 5m along main roads.
Mersey Basin
cross-regional signal
Worsley & Powell
Lower Mersey Regional cross-section shows, in pond sediments, the ability to look
at temporal and spatial magnetic records, thus allowing a profile of metal deposition
to be developed.
Industrial sites
C&M
COMAH
Ormskirk
Liverpool
Deprivation
NWPHO
Particles (estimated) & Deprivation
PM10
IMD
Classic diseases of air pollution
Ayres et al. “Environmental Medicine” 2010
• Asthma exacerbation
• PM2.5 SO2 NO2 O3
• Chronic Obstructive
Pulmonary Disease
(COPD) exacerbation &
death
• PM10 SO2 NO2
• Cardiovascular deaths,
admissions,
arrythmias
• 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 Hydrocarbons
PAHs
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?
Stress
Canada (Jerrett et al. JECH, 2004) Less Social Stress
More Social Stress
Lower air pollution
-
Health effect
Higher air pollution
Health effect
Increased effect
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
RATS
(Clougherty et al. EHP, 2010)
No PM
PM
No Social Stress
Social Stress
-
Respiration effects
Respiration effects
Inflammatory Response
Radon
Increases risk of lung
cancer X2 - X9 fold
Could other
pollutants?
Map 6: Renal disease in north Cheshire: age-sex standardised admission ratio 1996 to 2002 [1991 census wards] – this study
1991 ward boundaries
Culcheth
& Glazebury
Warrington
Renal Admission Ratio
150 to 204
125 to 150
100 to 125
75 to 100
0 to 75
Croft
Winwick
Burtonwood
Hulme
Longford
Poulton South
Fairfield
Great Sankey
North
Great Sankey South
Farnworth
Appleton
Broadheath
Halton
Kingsway
Halton
Howley
Whitecross
Latchford
Hough Green
Rixton and Woolston
Orford
Bewsey
Westy
Statham
Grappenhall and Thelwall
Booths Hill
Heatley
Lymm
Stockton Heath
& Walton
Riverside
Ditton
Appleton and Stretton
Castlefields
Daresbury
Hale
Halton Brook
Grange
Heath
Clough
Murdishaw
Brookfields
Source: Hospital Admission Statistics; ONS
http://www.apho.org.uk/resource/view
NW England
Poor health 100 years
Pollution?
Poverty?
Lifestyle?
Generational effect?
A mixture of all?
Acknowledgements
Apologies
Public Health
Environmental Scientists
Epidemiologists
Clinicians
Geographers
……..