Long term exposure to air pollution

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1 SCARP hälsostudier i Stockholm SCARP Hälsostudier Epidemiologisk och experimentell design Effekter relaterade till kort- och långtidsexponering studier från Göteborg, Stockholm och Umeå Exponering för trafikrelaterade luftföroreningar, lungfunktion, astma och allergi hos barn Korttidseffekter av luftföroreningar hos känsliga grupper i relation till källspecifik exponering Kohortstudie rörande hälsoeffekter av långtidsexponering för luftföroreningar Långtidsexponering för luftföroreningar och genetisk känslighet i relation till hjärtinfarkt Göran Pershagen 9 november 007 Long term exposure to air pollution Residential history for study subjects SO from heating (µg/m 3 ) NO from traffic (µg/m 3 ) Year 5 0 Mean (area) Mean (population) 0th to 90th percentile (population) Mean (area) 5 Mean (population) PM 0th to 90th percentile (population) Year Geocoding and linking coordinates to dispersion models Linearinterpolation for yearsbetween EDBs Emission databases (EDB) 960, 970, 980, 990, 000 NO CO SO Göran Pershagen 9 november

2 Göran Pershagen 9 november Göran Pershagen november Göran Pershagen 9 november Göran Pershagen november 007 8

3 Air pollution and airway disease in preschool children Wheeze in relation to air pollution exposure Exposure questionnaire and dust % year symptom questionnaire % year follow up Questionnaire % Dust % PEF % Blood 6 6 % and spec IgE Peak Expiratory Flow Odds Ratio (95% CI) Transient wheeze year symptom questionnaire 383 9% Late onset wheeze Exposure :st year of life. Outcome up to yrs of age.6 any wheeze - PM0 any wheeze - persistent wheeze - PM0 persistent wheeze - Persistent wheeze Sensitisation to specific IgE s Adjusted for municipality, socioeconomic status, heredity, mother s smoking during pregnancy and in infancy, year that house was built, damp or mould in the home at birth and sex of the child Göran Pershagen 9 november Göran Pershagen 9 november Peak Expiratory Flow in relation to air pollution exposure Sensitization in relation to air pollution exposure Mean PEF: 69 l/min, SD 9 l/min Effect on PEF (l/m) Point estimate (95%CI)* Traffic-PM (-0.67, -0.05) *Adjusted for sex, age, height and municipality Traffic-NO x (-6.8, 0.68) Göran Pershagen 9 november 007 Exposure :st year of life. Outcome up to yrs of age any sens - PM0Odds Ratio (95% CI).6 any sens - Nox sens to inhalant all. - PM0 sens to inhalant all. - sens to pollen - PM0 sens to pollen - Adjusted for municipality, socioeconomic status, heredity, mother s smoking during pregnancy and in infancy, year that house was built, damp or mould in the home at birth and sex of the child Göran Pershagen 9 november 007 3

4 Cohort study on total public health burden related to long-term air pollution exposure A total of,000,000 subjects from 3 existing cohorts in Stockholm county Assessment of long-term exposure to air pollution using residential history, emission data bases and dispersion modelling Detailed follow-up of cardiovascular events, cancer, cause of death etc Prospective longitudinal information available on various risk factors based on interviews, questionnaires etc Long-term exposure to air pollution and cardiac effects is based on SHEEP Population-based case-control study in Stockholm County All first-time MI-cases 5-70 years old. Controls matched on age, sex, and catchment area. Risk factors for MI from questionnaire, telephone interview and health examination (n=,067). Source-specific air pollution exposure during each year between Biologic material stored for all study subjects Göran Pershagen 9 november Göran Pershagen 9 november 007 Air pollution exposure, blood marker levels, genetics and myocardial infarction Suggested associations between short-term exposure to traffic related air pollution exposure and several blood markers (IL-6, TNF-α, fibrinogen, PAI-) Strong association between long-term exposure to air pollution and IL-6 Analyses ongoing on gene-environment interactions Göran Pershagen 9 november 007 5

5 Diskussionspunkter SCARP Workshop. Hur kan exponeringsdata utvecklas för att i epidemiologiska undersökningar belysa hälsoeffekter av vedeldning?. Vilken exponeringsinformation är önskvärd vid epidemiologiska studier baserad på trajektorier? 3. Föreslå hur exponeringsdata med stor geografisk upplösning kan utvecklas för att belysa hälsoeffekter av trafikgenererade luftföroreningar, ssk partiklar?. Vad och hur ska vi mäta luftföroreningar för att ge bättre stöd för epidemiologiska undersökningar? Relative risk for MI and air pollution exposure Risk of non-fatal MI, fatal MI in or outside in relation to air pollution exposure Source-specific air pollution exposure NO from traffic CO from traffic PM 0 from traffic SO from heating All cases OR (95% CI) 0.99 ( ).0 (0.89-.).00 ( ).03 ( ) OR Fatal cases (95% CI).5 ( ). ( ).39 ( ). ( ) ORs calculated for a change in pollution level from the 5th-95th percentile. Adjusted for age, sex,, smoking, physical inactivity, diabetes, socioeconomic status. PM 0 assessed only for the year 000, ie assuming constant levels Göran Pershagen 9 november OR (95% CI) NO from traffic CO from traffic Nonfatal Fatal in Fatal outside PM 0 from traffic SO from heating Göran Pershagen 9 november Nonfatal Fatal in Fatal outside *Adjusted for age, sex,, smoking, socioeconomic status, physical inactivity, diabetes 5

6 Air pollution guidelines in relation to exposure-response relationships in epidemiological studies MKN for PM0, WHO 006 Long-term exposure and death WHO 006 EP 05 US-EPA 00 EC Fine particles (PM.5) Dockery et al, NEJM Short-term exposure and death in cardiovascular disease US-EPA PM.5 Fine and coarse particles (PM0) Daniels et al, Am J Epidemiology 000 Conclusions Air pollution exposure assessment Complex mixtures, exposure characterisation difficult Short-term effects Mortality, previous cardiac disease marks increased susceptibility, inflammation, arrythmia Long-term effects on lung cancer Long induction-latency period Long-term cardiac effects Cardiac death, myocardial infarction Long-term respiratory effects in adults and children Lung function, symptoms, sensitisation Guidelines and limit values WHO, US-EPA, EU Göran Pershagen 9 november 007 6

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