SCARP Hälsostudier. Epidemiologisk och experimentell design. Effekter relaterade till kort- och långtidsexponering

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1 SCARP Hälsostudier Epidemiologisk och experimentell design Effekter relaterade till kort- och långtidsexponering 12 studier från Göteborg, Stockholm och Umeå

2 SCARP hälsostudier i Stockholm 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 15 november

3 Long term exposure to air pollution Residential history for study subjects Geocoding and linking coordinates to dispersion models SO 2 from heating (µg/m 3 ) NO 2 from traffic (µg/m 3 ) Mean (area) Mean (population) 10th to 90th percentile (population) Year PM Mean (area) 5 Mean (population) 10th to 90th percentile (population) Year Linearinterpolation for yearsbetween EDBs Emission databases (EDB) 1960, 1970, 1980, 1990, 2000 NO 2 CO SO 2 10

4 NOx Göran Pershagen 15 november

5 NOx Göran Pershagen 15 november

6 NOx Göran Pershagen 15 november

7 NOx Göran Pershagen 15 november

8 NOx Göran Pershagen 15 november

9 Air pollution and airway disease in preschool children Exposure questionnaire and dust % 1 year symptom questionnaire % 4 year follow up Questionnaire % Dust % PEF % Blood % and spec IgE Peak Expiratory Flow 2 year symptom questionnaire % Transient wheeze Late onset wheeze Persistent wheeze Sensitisation to specific IgE s Göran Pershagen 15 november Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet

10 Wheeze in relation to air pollution exposure Odds Ratio (95% CI) Exposure 1:st year of life. Outcome up to 4 yrs of age.6 any wheeze - PM10 any wheeze - NOx persistent wheeze - PM10 persistent wheeze - NOx 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 15 november Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet

11 Peak Expiratory Flow in relation to air pollution exposure Mean PEF: 169 l/min, SD 29 l/min Effect on PEF (l/m) Traffic-PM 10 Traffic-NO x Point estimate (95%CI)* (-10.67, -0.05) (-6.84, 0.68) *Adjusted for sex, age, height and municipality Göran Pershagen 15 november Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet

12 Sensitization in relation to air pollution exposure Exposure 1:st year of life. Outcome up to 4 yrs of age any sens - PM10Odds Ratio (95% CI) any sens - Nox sens to inhalant all. - PM10 sens to inhalant all. - NOx sens to pollen - PM10 sens to pollen - NOx 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 15 november Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet

13 Cohort study on total public health burden related to long-term air pollution exposure A total of 11,000 12,000 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 Biologic material stored for all study subjects Göran Pershagen 15 november

14 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 years old. Controls matched on age, sex, and hospital catchment area. Risk factors for MI from questionnaire, telephone interview and health examination (n=4,067). Source-specific air pollution exposure during each year between Göran Pershagen 15 november

15 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-1) Strong association between long-term exposure to air pollution and IL-6 Analyses ongoing on gene-environment interactions Göran Pershagen 15 november

16 Relative risk for MI and air pollution exposure Source-specific air pollution exposure NO 2 from traffic CO from traffic PM 10 from traffic SO 2 from heating All cases OR (95% CI) 0.99 ( ) 1.04 ( ) 1.00 ( ) 1.03 ( ) Fatal cases OR (95% CI) 1.51 ( ) 1.22 ( ) 1.39 ( ) 1.24 ( ) ORs calculated for a change in pollution level from the 5th-95th percentile. Adjusted for age, sex, hospital, smoking, physical inactivity, diabetes, socioeconomic status. PM 10 assessed only for the year 2000, ie assuming constant levels Göran Pershagen 15 november

17 Risk of non-fatal MI, fatal MI in or outside hospital in relation to air pollution exposure 4 NO 2 from traffic 4 CO from traffic OR (95% CI) 2 1 Nonfatal Fatal in hospital Fatal outside hospital PM 10 from traffic Nonfatal Fatal in hospital Fatal outside hospital SO 2 from heating *Adjusted for age, sex, hospital, smoking, socioeconomic status, physical inactivity, diabetes Göran Pershagen 15 november

18 Air pollution guidelines in relation to exposure-response relationships in epidemiological studies MKN for PM10, WHO 2006 Long-term exposure and death WHO 2006 EP 2015 US-EPA 2010 EC 2010 Short-term exposure and death in cardiovascular disease US-EPA PM2.5 Fine particles (PM2.5) Dockery et al, NEJM 1993 Fine and coarse particles (PM10) Daniels et al, Am J Epidemiology 2000

19 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 15 november

Long term exposure to air pollution

Long term exposure to air pollution SCARP hälsostudier i Stockholm SCARP Hälsostudier Epidemiologisk och experimentell design Effekter relaterade till kort- och långtidsexponering studier från Göteborg, Stockholm och Umeå Exponering för