Clean Air – the Continuing Public Health Challenge. Health Benefits of Improving Air Quality - Douglas Dockery

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  • 1. Health Benefits of Improving Air QualityClean Air – the Continuing Public Health Challenge Dublin Institute of Technology June 27, 2012 Douglas W. Dockery Professor of Environmental Epidemiology Harvard School of Public Health
  • 2. Reform EnvironmentalRegulation As president, Mitt Romney will eliminate the regulations promulgated in pursuit of the Obama administration’s costly and ineffective anti-carbon agenda. Romney will also press Congress to reform our environmental laws to ensure that they allow for a proper assessment of their costs. http://www.mittromney.com/issues/regulation
  • 3. Benefits and Costs of Federal Regulations in US  Largest estimated benefits of ALL Federal Regulations attributable to the reduction in public exposure to a single air Other pollutant: fine particulate matter.  Clean Air Fine Particulate Implementation Mortality  Benefits ($ Millions/year)  $19,00 to $167,000  Costs ($ Millions/year)  $ 7,000
  • 4. What is Fine Particulate AirPollution? Anything collected on a filter  Solid particles or liquid droplets  Not gases BS - Black Smoke PM - Mass
  • 5. Size Matters
  • 6. Wiley Interdisciplinary Reviews
  • 7. What is evidence for effectsof fine combustion particles(BS and PM2.5) on mortality?
  • 8. Experience in Dublin Oil crisis in 1970’s led to programs to encourage use of solid fuels, primarily coal Dundalk 1980’s - switch from oil to coal Dominant source of air pollution in Dublin was smoke from domestic Wexford fires
  • 9. • Deterioration in air quality after switch to coal (Flanagan, 1986)• During winters of 1980’s, Dublin experienced number of severe air pollution episodes.
  • 10. Dublin Borough 800 40Black Smoke (ug/m3) Black 35 600 Smoke 30 Deaths 400 25 200 20 0 15 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 January 1982
  • 11. Dublin Borough 800 40Black Smoke (ug/m3) Black 35 600 Smoke 30 Deaths Deaths 400 25 200 20 0 15 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 January 1982
  • 12. Dublin County BurroughJanuary 1982 40 35Deaths 30 25 20 15 10 0 200 400 600 800 3 Day Mean Black Smoke (ug/m3)
  • 13. Dublin 1980-1990 17 16 15Deaths per Day 14 13 12 11 10 Mean of 20 consecutive points 9 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  • 14. Cardiovascular Deaths: Dublin 1980-1990 9 8Deaths per Day 7 6 5 Mean of 20 consecutive points 4 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  • 15. Respiratory Deaths: Dublin 1980-1990 4Deaths per Day 3 2 Mean of 20 consecutive points 1 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  • 16. Other Deaths: Dublin 1980-1990 Non-Cardiovascular, Non-Respiratory 6Deaths per Day 5 4 Mean of 20 consecutive points 3 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  • 17. Can we see effect of airpollution controls in Dublin?
  • 18. Dublin Coal Ban On September 1, 1990, the marketing, sale, and distribution of bituminous coals was banned within the city of Dublin (Air Pollution Act, 1987).
  • 19. Dublin Black Smoke 140 Ban on Coal Sales 120 100 80 -36 g/m3g/m3 60 (-71%) 40 20 0
  • 20. Dublin Total Mortality Ban on Coal Sales 12Deaths per 1000 Pyr 7% drop in Total Mortality 10 8 6
  • 21. Dublin Cardiovascular 6 Ban on Coal SalesDeaths per 1000 Pyr 5 4 3 13% drop in Cardiovascular Mortality 2
  • 22. Dublin Respiratory Deaths 3 Ban on Coal SalesDeaths per 1000 Pyr 2 1 16% drop in Respiratory Mortality 0
  • 23. Summary Air pollution is associated with acute increases in deaths at levels seen in Ireland in the 1980’s Effects on respiratory and cardiovascular system Reductions in air pollution in Dublin have produced measurable improvements in health
  • 24. Dublin 1990-1996 Cardio-Respiratory Deaths 11 10Deaths per Day 9 8 7 Mean of 20 consecutive points 6 0 10 20 30 40 50 3 Day Mean Black Smoke (ug/m3)
  • 25. Dublin 1980-1990 17 16 15Deaths per Day 14 13 12 11 10 Mean of 20 consecutive points 9 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  • 26. Dublin 1990-1996 Cardio-Respiratory Deaths 11 10Deaths per Day 9 8 7 Mean of 20 consecutive points 6 0 100 200 300 400 3 Day Mean Black Smoke (ug/m3)
  • 27. Bans onCoal SalesSeptember 1, 1990-DublinOctober 1, 1995-CorkOctober 1, 1998-Limerick-Dundalk-Drogheda-Wexford-Arklow
  • 28. 98th percentiles of Daily Black SmokeConcentrations in Major Urban Areas DUBLIN CORK 1990 Ban 1995 Ban 1998 Ban Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
  • 29. What are the effects ofrepeated, long termexposures to Fine Particles?
  • 30. Satellite-Derived PM2.5:2001–2006 Average Von Donkelaar et al Envir Hlth Pers 2010;118:847
  • 31. Six Cities Adult Mortality Study 8111 adults in 6 cities  Dirty: Steubenville & St. Louis  Moderate: Watertown & Kinston/Harriman  Clean: Topeka & Portage Enrolled starting in 1974 14-16 years of mortality follow-up Effect of 10 g/m3 PM2.5  +13% (95% CI 4% to 23%) increase in mortality rate Dockery et al, NEJM 1993;329:1753
  • 32. Six Cities Adult Mortality 1.4 EPA NAAQS 1.3 Steubenville Kingston Mortality Risk Ratio 1.2 St. Louis 1.1 Topeka Watertown 1.0 Portage 0.9 0.8 0.7 0 10 20 30 40 PM 2.5 ( g/m3)
  • 33. Six Cities Mortality Follow-up 1974 to 1989 follow-up  1990 to 1998 follow-up  Annual returned  National Death Index postcards and search National Death Index  1,368 deaths  1,364 deaths  54,735 person  104,243 person years years  PM2.5 measurements  PM2.5 estimated from 1979-1986 PM10 1990-1998Laden et al, AJRCCM 2006;54:709
  • 34. Six Cities Cohort Follow-up 1.4 1.3 Steubenville Mortality Risk Ratio 1.2 Kingston 1.1 Topeka 1.0 Portage 0.9 St. Louis Watertown Improved air quality 0.8 leads to reduced mortality 0.7 0 5 10 15 20 25 30 35 PM 2.5 (g/m3)Laden et al, AJRCCM 2006;54:709
  • 35. Can we see effect of airpollution controls in US?
  • 36. Age-adjusted death rates: United States, 1960-2005 1,400Rate per 100,000 population 1,200 Age-adjusted 1,000 800 600 0 1960 1970 1980 1990 2000 2005
  • 37. Trends in the Levels of the Six Criteria PollutantsRelative to U.S. National Standards: 1980 - 2006
  • 38. Estimated PM10
  • 39. County life expectancies at birth for white malesand females;1997–2001 CJL Murray et al, Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med. 2006 Sep;3(9):e260
  • 40. Cigarette Smoking – United StatesSOURCES: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey
  • 41. Fine Particulate Air Pollution andUS County Life ExpectanciesPope, Ezzati, Dockery (NEJM 2009) Standardized life expectancy for each US County by year 51 U.S. metropolitan areas (217 counties)  PM2.5 data for ~1980 and ~2000 Estimated association between reductions PM2.5 and change in life expectancy, controlling for  changes in socio-economic indicators  changes in demographic variables  proxy indicators of cigarette smoking (COPD and Lung Cancer mortality).
  • 42. 51 Metropolitan areas (dots); Study Counties (shaded gray)
  • 43. Life Expectancy vs PM2.51978-82 81 80 EPA NAAQS 79 78Life Expectancy 77 Boston 76 75 Topeka 74 73 72 Steubenville 71 5 10 15 20 25 30 35 PM2.5 (g/m3) Pope, Ezzati, Dockery. NEJM 2009; 360:376
  • 44. Life Expectancy vs PM2.51997-2001 EPA NAAQS 81 Boston 80 79 78Life Expectancy Steubenville 77 76 75 74 Topeka 73 72 71 5 10 15 20 25 30 35 PM 2.5 ( g/m3) Pope, Ezzati, Dockery. NEJM 2009; 360:376
  • 45. Life Expectancy vs PM2.51980-2000 81 80 79 78Life Expectancy 77 76 Topeka 75 74 73 72 71 5 10 15 20 25 30 3 PM2.5 (g/m ) Pope, Ezzati, Dockery. NEJM 2009; 360:376
  • 46. Life Expectancy vs PM2.51980-2000 81 0.61 ± 0.20 yr per 80 10g/m3 PM2.5 79 78Life Expectancy 77 76 75 74 73 72 71 5 10 15 20 25 30 3 PM 2.5 (g/m ) Pope, Ezzati, Dockery (NEJM 2009)
  • 47. Life Expectancy vs PM2.51980-2000 81 80 79 78Life Expectancy 77 76 75 74 73 2000 Boston 1980 72 3 11.3 g/m 3 18.1 g/m 71 5 10 15 20 25 30 PM 2.5 ( g/m ) 3 Pope, Ezzati, Dockery (NEJM 2009)
  • 48. PM2.5 obligations set out inCAFE Directive 2008/50/EC Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
  • 49. Life Expectancy vs PM2.51980-2000 81 EPA NAAQS CAFE CAFE 80 Stage II Stage I Limit Limit 79 Value Value 78Life Expectancy 77 76 75 74 73 72 Health benefits below current NAAQS 71 5 10 15 20 25 30 PM 2.5 ( g/m ) 3 Pope, Ezzati, Dockery (NEJM 2009)
  • 50. Summary statistics for PM2.5concentrations in 2010 DUBLIN CORK ENNIS Annual mean limit value 25 μg/m3. Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
  • 51. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  • 52. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  • 53. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  • 54. Life Expectancy vs PM2.51980-2000 Pope, Ezzati, Dockery (NEJM 2009)
  • 55. How big is 0.5 year increase in lifeexpectancy? 65 year old nonsmoking male  Additional life expectancy 17.5 years  Additional 0.5 years life expectancy  18.0 years
  • 56. How big is 0.5 year increase in lifeexpectancy in population of Ireland? Tobacco Smoking  6.8 years reduced life expectancy for average smoker (Streppel et al, Tob Cont 2007)  31% Current Smoking in Ireland(2009) (Special Eurobarometer 332)  6.8 yr among 31% of population  2.1 yr longer life expectancy in population Diabetes  7.8 years for men, 8.4 years for women (Fromer et al, Arch Int Med 2007)  4.7% Diabetes Mielitus in Ireland (2005) (Institute of Public Health in Ireland, 2006.)  8 yr among 4.7% of population  0.4 yr longer life expectancy in population Fine particle air pollution  0.5 years for 2 g/m3 reduction in PM2.5  100% of population affected  0.5 yr longer life expectancy in population
  • 57. Conclusions PM2.5 associated significant health effects  Life shortening (mortality) Improved air quality leads to measurably improved public health Benefits at all levels of air pollution  Even in clean communities
  • 58. Current U.S. Values for Health Effects Premature death $5.5 million Chronic bronchitis $340,000 Heart attacks $66,000 - $140,000 Hospital admissions $6,000 - $18,000 ER visits $300 Respiratory symptoms $15 - $60 Asthma attacks $40 Work loss days $100 School absences $75
  • 59. Counties with PM2.5 Monitoring 2000 and 2007Pop Density (Ppl/mi2) Correia, Pope, Ezzati, Dockery, Dominici
  • 60. Life Expectancy vs PM2.52000 (545 Counties) 84 EPA NAAQS 82 80Life Expectancy 78 Mean 76 76.7 years 74 72 70 Mean 13.2 g/m3 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  • 61. Life Expectancy vs PM2.52007 (545 Counties) 84 EPA NAAQS 82 80Life Expectancy 78 Mean 77.5 years 76 74 72 70 Mean 11.6 g/m3 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  • 62. Life Expectancy vs PM2.52000- 2007 (545 Counties) 84 EPA NAAQS 82 80Life Expectancy 78 76 74 72 70 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  • 63. Life Expectancy vs PM2.52000 - 2007 (545 Counties) 84 EPA NAAQS 0.35 ± 0.16 yr per 82 10g/m3 PM2.5 80Life Expectancy 78 76 74 72 70 68 0 5 10 15 20 25 3 PM2.5 (g/m ) Correia, Pope, Ezzati, Dockery, Dominici
  • 64. Summary statistics for black smokeconcentration April 2009-March 2010 DUBLIN Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality