SCARP Hälsostudier Epidemiologisk och experimentell design Effekter relaterade till kort- och långtidsexponering 12 studier från Göteborg, Stockholm och Umeå
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 2007 2
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 ) 160 140 120 100 80 60 40 20 NO 2 from traffic (µg/m 3 ) Mean (area) Mean (population) 10th to 90th percentile (population) 0 1955 1960 1965 1970 201975 1980 1985 1990 Year 15 40 35 30 25 10 PM Mean (area) 5 Mean (population) 10th to 90th percentile (population) 0 1955 1960 1965 1970 1975 1980 1985 1990 Year Linearinterpolation for yearsbetween EDBs Emission databases (EDB) 1960, 1970, 1980, 1990, 2000 NO 2 CO SO 2 10
NOx 1960 1970 1980 1990 1970 2000 Göran Pershagen 15 november 2007 4
NOx 1960 1970 1980 1990 2000 Göran Pershagen 15 november 2007 5
NOx 1960 1970 1980 1990 2000 Göran Pershagen 15 november 2007 6
NOx 1960 1970 1980 1990 2000 Göran Pershagen 15 november 2007 7
NOx 1960 1970 1980 1990 2000 Göran Pershagen 15 november 2007 8
Air pollution and airway disease in preschool children 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Exposure questionnaire and dust 4089 100% 1 year symptom questionnaire 3925 96% 4 year follow up Questionnaire 3720 91 % Dust 3610 88 % PEF 2966 73 % Blood 2614 64 % and spec IgE Peak Expiratory Flow 2 year symptom questionnaire 3843 94% Transient wheeze Late onset wheeze Persistent wheeze Sensitisation to specific IgE s Göran Pershagen 15 november 2007 9 Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet
Wheeze in relation to air pollution exposure Odds Ratio (95% CI) 4 2 1 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 2007 10 Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet
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)* -5.36 (-10.67, -0.05) -3.08 (-6.84, 0.68) *Adjusted for sex, age, height and municipality Göran Pershagen 15 november 2007 11 Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet
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) 4 2 1.6 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 2007 12 Stockholm Centre for Public Health and Institute of Environmental Medicine, Karolinska Institutet
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 2007 13
Long-term exposure to air pollution and cardiac effects is based on SHEEP Population-based case-control study in Stockholm County 1992-1994. All first-time MI-cases 45-70 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 1960-1994. Göran Pershagen 15 november 2007 14
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 2007 15
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 (0.76-1.30) 1.04 (0.89-1.21) 1.00 (0.79-1.27) 1.03 (0.78-1.36) Fatal cases OR (95% CI) 1.51 (0.96-2.37) 1.22 (0.98-1.52) 1.39 (0.94-2.07) 1.24 (0.77-2.02) 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 1960-2000. Göran Pershagen 15 november 2007 16
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 4 2 1 Fatal in hospital Fatal outside hospital PM 10 from traffic 2 1 4 2 1 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 2007 17
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
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 2007 19