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Acrolein and Neurocognitive Loss in a Nationally Representative Sample of United States Adults 55 and Over


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Acrolein is an air toxic that laboratory studies suggest may adversely affect neurocognitive function. Although there is strikingly little epidemiology available, US EPA estimates that acrolein is responsible for about 75 percent of non-cancer respiratory health effects attributable to air toxics in the United States, based on the Agency's 2005 National-Scale Air Toxics Assessment (NATA). This data gap was addressed by geographically linking 2005 NATA acrolein exposure estimates at the census tract with residences of subjects in the National Health Interview Survey (NHIS) 2000-2009. The NHIS monitors the health of the civilian, non-institutionalized population of the United States through a comprehensive interview of a nationally representative sample of households. The health outcome was self-reported limitation of activity attributed to senility among adults 55 years and older (n = 21,040). Preliminary results indicate that in the two highest quintiles of acrolein exposure (0.034 - 0.055 and 0.055 - 0.46 ug/m3), there were statistically significant increases in the prevalence of neurocognitive loss (pOR [95% CI]= 1.42 [1.04:1.96] and 1.38 [1.02:1.86], respectively), relative to the lowest exposure quintile and controlling for potential confounders, including smoking status.

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Acrolein and Neurocognitive Loss in a Nationally Representative Sample of United States Adults 55 and Over

  1. 1. Acrolein and Neurocognitive Loss in aNationally Representative Sample of United States Adults 55 and Over B. Rey de Castro, Sc.D. Statistician before the International Society of Exposure Science Seattle, WA October 29, 2012 National Center for Health Statistics Office of Analysis & Epidemiology, Special Projects Branch
  2. 2. AcroleinAldehydeType 2 alkene Related to acrylamideHazardous Air Pollutant subject to Clean Air Act
  3. 3. UbiquitousCombustion Tobacco Mobile sources, especially diesel Airports Wood heating & forest fires Industrial boilersIndoor air pollutant Cooking Smoking
  4. 4. Industrial UsesSynthesis of acrylic acidBiocide
  5. 5. ExposureInhalation Combustion by-products Cigarette smoke Cooking smokeFood Heating carbohydrates, lipids, certain amino acidsFormed physiologically Oxidative stress Polyamine metabolism
  6. 6. Health EffectsAcute and chronic (non-cancer) effectsHighly potent irritant Oral, respiratoryMildly associated with asthma attack prevalenceSuspected role in neurologic damage Alzheimer’s disease Multiple sclerosis, myelin damageSuspected role in cardiorespiratory damage Acute lung injury, COPD Cardiomyopathy
  7. 7. Neurologic Risk
  8. 8. Neurologic Risk
  9. 9. Regulatory Ambient Exposure Levels 1000 LC50 (rats) 750 100 NIOSH IDLH 10 4.6Acrolein Concentration [mg/m3] LOAEL (rats) NIOSH STEL 0.9 0.8 1 NIOSH REL EPA AEGL-2 (8h) US 0.25 0.23 US EPA AEGL-1 (8h) 0.1 0.07 0.01 0.001 CA OEHHA REL 0.00035 0.0001 US EPA RfC 0.00002 0.00001
  10. 10. Alternative 1 Ambient MeasurementVery difficultHighly reactiveAmbient formation Even within samplersSensitive to Sampler preparation Sampler type Time elapsed from preparation to analysisInter-laboratory variability in analysis
  11. 11. Therefore, no epidemiologicresearch on acrolein
  12. 12. Alternative 2 Exposure BiomarkersUrineMercapturic acid metabolitesAnalytical methods recently developed at CDC Presentation here at ISES 2012: Abstract 1398914 Next session in this room. Presented by Benjamin C. Blount For details, Udeni Alwis ualwis@cdc.govNot the subject of this talk
  13. 13. Alternative 3 Modeled ExposureUS EPA National-Scale Air Toxics Assessment 2005Nationwide estimate of chronic inhalation exposure Census tract resolutionHazardous air pollutantsDiesel particulate matterCancer and non-cancer health effects
  14. 14. NATA 2005 Process National Emissions Inventory 2005 Nonpoint Sources Point & Mobile Sources Photochemical Pollutants ASPEN HEM3/AERMOD CMAQAmbient Monitoring Ambient Concentrations Exposure Concentrations HAPEM Risk Assessment Cancer & Non-Cancer
  15. 15. US EPA says… …Acrolein responsible for “about 75 percent ofthe nationwide average non-cancer hazard”Remarkable for air toxic with no epidemiologyDriven by inhalation RfC = 0.02 µg/m3
  16. 16. Now that we haveexposure estimates,what if we could gethealth effects data?
  17. 17. Nationwide Health EffectsNational Health Interview Survey 2000 — 2009 Health conditions and behaviors Access to health servicesRepresentative sample of United States , nationwide Non-institutionalized CivilianCross-sectional prevalence
  18. 18. NATA-NHIS Data Merge NHIS NATA AdultAcrolein CognitiveExposure Loss Merge by Census Tract Merged NATA- NHIS Data
  19. 19. NATA 2005 & NHIS 2000-2009NATA exposure concentration for residence census tractNHIS subjects 55 years-old and over 21,040 subjectsSelf-reported limitation in activities due to “senility” Prevalence: 5.13 percent
  20. 20. Loss of cognitive function Because of a physical, mental, or emotional problem, does subject need help with “activities of daily living?” Bathing, dressing, eating, getting to and using toilet, getting around inside the home, transferring to/from bed or chairs “Activity limitation”AND What condition or health problem causes subjects limitations? Answer: “senility”
  21. 21. Logistic Regression ModelBinary outcome: activity limitation from senility NHIS 2000 — 2009 Self-reportPredictor of interest: acrolein quintile NATA 2005 Inhalation exposure concentration at residence census tract
  22. 22. Potential ConfoundersRace/ethnicitySexAge: 55 – 64, 65 – 74, 75 – 84, and >=85 years-oldSmoking status: Never, former, currentEducationPoverty income ratioUrban/rural residenceNHIS survey yearAccess to healthcareInsurance coverage
  23. 23. Cognitive Loss 2.00 1.75 1.50pOR [95% CI] 1.25 1.00 0.75 1 2 3 4 5 Exposure Quintile
  24. 24. Primary ResultAt two highest quintiles of acrolein exposure ≥3.40E-2 µg/m338 – 42 percent increase in cognitive loss prevalenceAdults 55 years-old and older [µg/m3] Quintile [µg/m3] pOR [95% CI] 1st: 1.38E-4 – 1.09E-2 Ref. US EPA RfC: 2.00E-2 2nd: 1.09E-2 – 2.14E-2 1.21 [0.91:1.61] 3rd: 2.14E-2 – 3.40E-2 1.15 [0.85:1.57] CA REL: 3.50E-1 4th: 3.40E-2 – 5.51E-2 1.42 [1.04:1.96] 5th: 5.51E-2 – 4.57E-1 1.38 [1.02:1.86]
  25. 25. Strengths Large sample National geographic coverage Census tract resolution Generalizable to US population 55 years-old and over36
  26. 26. Limitations Uncertainty of NATA exposure estimates NATA appropriate for answering such questions as: Which pollutants or sources might be associated with higher risks than others But not for determining: How many people are exposed to certain levels of absolute risk Whats safe and whats not37
  27. 27. Limitations Merge bias Cross-sectional Acrolein from indoor air, food38
  28. 28. Feasible to conduct national epidemiologic analysis for air toxics using modeledchronic exposure estimates
  29. 29. Second demonstration ofacrolein’s adverse effect on general population
  30. 30. Asthma Attack 2.00 1.75 1.50pOR [95% CI] 1.25 1.00 0.75 1 2 3 4 5 Exposure Quintile
  31. 31. Approaches to Acrolein Exposure Assessment Modeling Exposure AssessmentMeasurement Biomarker
  32. 32. AcknowledgementsCDC Jenifer Parker, Ph.D. • Chief, NCHS OAE Special Projects Branch • Merged EPA air quality data with o NHIS 1986 — 2005 o NHANES 1986 — 1994 o National Hospital Discharge Survey 1999 — 2005 Lara Akinbami, NCHS Nataliya Kravets, NCHS Erik Olson, Geospatial Research, Analysis, & Services ProgramTed Palma, US EPAPhillip Kott, RTI International
  33. 33. B. Rey de Castro, Sc.D. Centers for Disease ControlNational Center for Environmental Health Atlanta, Georgia +1 770 488 0162 The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Health Statistics Office of Analysis & Epidemiology, Special Projects Branch