An Association between Air Pollution and Mortality in Six U.S. Cities

Dockery, Douglas W.; Pope, C. Arden; Xu, Xiping; Spengler, John D.; Ware, James H.; Fay, Michael; Ferris, Benjamin G.; Speizer, Frank E.

doi:10.1056/nejm199312093292401

Cited by 7,043 publications

(4,289 citation statements)

References 33 publications

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“…In a recent study examining ozone and asthma ED visits in New York City, a strong association was found for heavy smokers (defined as !13 pack years ), whereas none was found for light or never smokers (Cassino et al, 1999 ) . A somewhat higher risk of airpollution-related mortality was also observed in a longitudinal study in relation to tobacco smoke exposure (Dockery et al, 1993 ) .…”

Section: Discussionsupporting

confidence: 55%

“…The strong negative association between hydrogen ion and ED visits was surprising given that relatively high peak levels were observed, although results from epidemiologic studies of the effects of hydrogen ion have been mixed. Significant positive associations with various adverse health outcomes have been reported by some investigators (Burnett et al, 1997a;Delfino et al, 1997;Dockery et al, 1996a;Lippmann and Ito, 1995;Neas et al, 1995;Raizenne et al, 1996;Thurston et al, 1994 ), whereas in other studies, no effect was apparent (Dockery et al, 1996b;Schwartz et al, 1996) , or the effect of hydrogen ion was weaker than that of other measures of particulate matter (Dockery et al, 1993 ). This could be partially mediated by a very weak correlation between levels measured at centrally located monitors and personal exposure, which we have observed in Saint John (Stieb et al, 1998b) , and which has been reported elsewhere (Brauer et al, 1989;Suh et al, 1992 ).…”

Section: Discussionmentioning

confidence: 91%

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Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada

Stieb

Beveridge

Brook

et al. 2000

J Expo Sci Environ Epidemiol

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Existing studies of the association between air pollution, aeroallergens and emergency department ( ED ) visits have generally examined the effects of a few pollutants or aeroallergens on individual conditions such as asthma or chronic obstructive pulmonary disease. In this study, we considered a wide variety of respiratory and cardiac conditions and an extensive set of pollutants and aeroallergens, and utilized prospectively collected information on possible effect modifiers which would not normally be available from purely administrative data. The association between air pollution, aeroallergens and cardiorespiratory ED visits ( n = 19,821 ) was examined for the period 1992 to 1996 using generalized additive models. ED visit, air pollution and aeroallergen time series were prefiltered using LOESS smoothers to minimize temporal confounding, and a parsimonious model was constructed to control for confounding by weather and day of week. Multipollutant and multi -aeroallergen models were constructed using stepwise procedures and sensitivity analyses were conducted by season, diagnosis, and selected individual characteristics or effect modifiers. In single -pollutant models, positive effects of all pollutants but NO 2 and COH were observed on asthma visits, and positive effects on all respiratory diagnosis groups were observed for O 3 , SO 2 , PM 10 , PM 2.5 , and SO 4 2 À . Among cardiac conditions, only dysrhythmia visits were positively associated with all measures of particulate matter. In the final year -round multipollutant models, a 20.9% increase in cardiac ED visits was attributed to the combination of O 3 ( 16.0%, 95% CI 2.8 ± 30.9 ) and SO 2 ( 4.9%, 95%CI 1.7 ± 8.2 ) at the mean concentration of each pollutant. In the final multipollutant model for respiratory visits, O 3 accounted for 3.9% of visits ( 95% CI 0.8 ± 7.2 ) , and SO 2 for 3.7% ( 95% CI 1.5 ± 6.0 ) , whereas a weak, negative association was observed with NO 2 . In multi -aeroallergen models of warm season asthma ED visits, Ascomycetes, Alternaria and small round fungal spores accounted for 4.5% ( 95% CI 1.8 ± 7.4 ) , 4.7% ( 95% CI 1.0 ± 8.6 ) and 3.0% ( 95% CI 0.8 ± 5.1 ) , respectively, of visits at their mean concentrations, and these effects were not sensitive to adjustment for air pollution effects. In conclusion, we observed a significant influence of the air pollution mix on cardiac and respiratory ED visits. Although in single -pollutant models, positive associations were noted between ED visits and some measures of particulate matter, in multipollutant models, pollutant gases, particularly ozone, exhibited more consistent effects. Aeroallergens were also significantly associated with warm season asthma ED visits.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 91%

Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada

Stieb

Beveridge

Brook

et al. 2000

J Expo Sci Environ Epidemiol

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“…Two recent cohort studies have suggested that long -term exposure to low levels of particulate matter (PM ) air pollution is associated with increased mortality due to, especially, respiratory and cardiovascular disease ( Dockery et al, 1993;Pope et al, 1995 ) . A more recent study has partly, but not completely, supported these findings ( Abbey et al, 1999 ) .…”

Section: Introductionmentioning

confidence: 99%

Estimation of long-term average exposure to outdoor air pollution for a cohort study on mortality

Hoek

Fischer

Brandt

et al. 2001

J Expo Sci Environ Epidemiol

137

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Recent prospective cohort studies have suggested that long -term exposure to low levels of particulate matter ( PM ) air pollution is associated with increased mortality due to, especially, cardio -pulmonary disease. Exposure to ambient air pollution was estimated mostly as city average concentrations, assuming homogenous exposure within the city. We used an ongoing cohort study -The Netherlands Cohort Study ( NLCS ) on diet and cancer -to investigate the relationship between traffic -related air pollution and mortality. The baseline data collection took place in 1986. A study was conducted to develop methods for exposure assessment and evaluate the contrast in exposure to air pollution within the cohort. Assessment of long -term exposure to two traffic -related air pollutants, Black Smoke ( BS ) and Nitrogen Dioxide ( NO 2 ) , consisted of separate estimation of regional background, urban background, and local traffic contributions at the home address. Interpolation of concentration data from a routine monitoring network was used to estimate the regional background concentration. A regression model relating degree of urbanization to air pollution was used to allow for differences between different towns / neighborhoods of cities. Distance to major roads was calculated to characterize local traffic contributions, using a Geographic Information System ( GIS ) . Interpolation resulted in reasonably precise regional background estimation when distant sites were not used and distance squared was used as the weight. Cross -validation showed that prediction errors were about 15% of the range in regional background concentration. Urban and local scales contributed significantly to the contrast within the cohort. Prediction errors for estimating the urban background were about 25% of the range in background concentrations. When the developed model was applied to the study cohort, there was substantial contrast in estimated exposure to BS and NO 2 . About 90% of the study population lived 10 years or more at its 1986 home address -supporting the use of the estimated concentration at the 1986 address as a relevant exposure variable.

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“…American Heart Association and the Environmental Protection Agency have officially acknowledged the detrimental effects of PM 2.5 on cardiovascular system and related morbidity outcome 2. The Harvard Six Cities study showed that the cardiopulmonary mortality was increased up to 37% in the population exposed to high levels of ambient PM 2.5 over a period of 14–16 years 22. The analysis from a population of 50 million living in the major U.S. cities (The National Morbidity, Mortality and Air Pollution Study) indicated that an increase of 10 μg/m 3 in PM 10 was related to an increase in 0.68% in cardiopulmonary mortality 23, 24, 25.…”

Section: Pm and Cardiovascular Diseasesmentioning

confidence: 99%

Ambient particulate matter exposure and cardiovascular diseases: a focus on progenitor and stem cells

Cui

Sun

Liu

2016

J Cellular Molecular Medi

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Air pollution is a major challenge to public health. Ambient fine particulate matter (PM) is the key component for air pollution, and associated with significant mortality. The majority of the mortality following PM exposure is related to cardiovascular diseases. However, the mechanisms for the adverse effects of PM exposure on cardiovascular system remain largely unknown and under active investigation. Endothelial dysfunction or injury is considered one of the major factors that contribute to the development of cardiovascular diseases such as atherosclerosis and coronary heart disease. Endothelial progenitor cells (EPCs) play a critical role in maintaining the structural and functional integrity of vasculature. Particulate matter exposure significantly suppressed the number and function of EPCs in animals and humans. However, the mechanisms for the detrimental effects of PM on EPCs remain to be fully defined. One of the important mechanisms might be related to increased level of reactive oxygen species (ROS) and inflammation. Bone marrow (BM) is a major source of EPCs. Thus, the number and function of EPCs could be intimately associated with the population and functional status of stem cells (SCs) in the BM. Bone marrow stem cells and other SCs have the potential for cardiovascular regeneration and repair. The present review is focused on summarizing the detrimental effects of PM exposure on EPCs and SCs, and potential mechanisms including ROS formation as well as clinical implications.

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An Association between Air Pollution and Mortality in Six U.S. Cities

Abstract: Although the effects of other, unmeasured risk factors cannot be excluded with certainty, these results suggest that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.

Cited by 7,043 publications

References 33 publications

Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada

Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada

Estimation of long-term average exposure to outdoor air pollution for a cohort study on mortality

Ambient particulate matter exposure and cardiovascular diseases: a focus on progenitor and stem cells

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