health impacts of diesel
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Health
Impacts
of
Diesel,
Based
on
DatafromtheNational-ScaleAir
ToxicsAssessment(NATA)
October2009
Preparedby:
DonaldMcCubbin,Ph.D.
Preparedfor:
CleanAirTaskForce
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TableofContentsTableofContents.................................................................................................................................11. Introduction....................................................................................................................................22. Methods.........................................................................................................................................3
2.1 AnnualAverageAmbientDieselConcentrations............................................................................... 3
2.2 EstimatingCasesofDieselRelatedHumanHealthImpacts.............................................................. 3
2.3 ValuingEstimatedHealthImpacts..................................................................................................... 4
3. Results............................................................................................................................................8AppendixA. HumanHealthImpactFunctionDetails...........................................................................9
A.1 DerivingHealthImpactFunctions...................................................................................................... 9
A.2 PM2.5HealthImpactFunctions........................................................................................................ 12
References.........................................................................................................................................29
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1. Introduction
Dieselparticlescausewidespreaddamagetohumanhealth. Thisreportestimatestheimpactofonroad
andoffroadsourcesofdieselparticles.
Thecontributionofdieselparticlestoambientparticlelevelslessthanorequalto2.5microns(PM2.5)in
aerodynamicdiameterarefromtheNationalScaleAirToxicsAssessment(NATA)program. The
epidemiologicalstudiesandmethodsusedtoestimatethehealthimpactsofdieselarethesameas
thoseusedbytheU.S.EnvironmentalProtectionAgency(EPA)inrecentregulatoryimpactassessments
(e.g.,U.S.EPA2008a;2008b;2009).
InSection2,IbrieflydescribethestudiesandmethodsthatIusedtoestimatethehealthimpactsof
diesel. AdditionaldetailsonthestudiesareprovidedinAppendixA. AndinSection3,Ibriefly
summarizethenationallevelhealthimpacts.
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2.Methods
ToestimatethedieselPM2.5relatedhumanhealthimpactsandvaluetheseimpacts,Iuseversion4.0oftheEnvironmentalBenefitsMappingandAnalysisProgram(BenMAP).1 ThefirststepinusingBenMAPis
tochangeinambientairquality,inthiscasethecontributionofdirectdieselparticlestoannualaverage
ambientPM2.5levels. (NoimpactsofdieselrelatedNOxandVOCemissionsonambientPM2.5are
considered.) GiventheannualchangeindieselPM2.5concentrations,BenMAPcalculatestheassociated
changeinadversehealtheffects,suchasprematuremortality. Toestimatetheeconomicvalueofthese
healtheffects,IusedEPAunitvaluesandperformedthecalculationswithSAS(version9.2).
2.1AnnualAverageAmbientDieselConcentrations
TheNATAprogramestimatedtractleveldirectdieselparticlecontributionstoambientPM2.5concentrationsforonroadandoffroadsources. AtractlevelfilewasaccessedfromtheNATAwebsite
(http://www.epa.gov/ttn/atw/nata2002/tables.html)andthenformattedforuseinBenMAP.
2.2 EstimatingCasesofDiesel-RelatedHumanHealthImpacts
Thefirststepinestimatinghealthimpactsinvolvesthespecificationofhealthimpactfunctions,which
quantifytherelationshipbetweenchangesinairpollutionandadversehealthimpacts. Atypicalhealth
impactfunctionforPM2.5hasfourcomponents:
Effectestimate. Aneffectestimate(beta)quantifiesthechangeinhealtheffectsperunitofchangeinPM2.5,andisderivedfromanepidemiologicalstudy.
PM2.5change. TheestimatedchangeintheconcentrationofambientPM2.5. Incidencerate. Thebaselineincidencerateforthehealtheffectduetoallcauses. Population. Theaffectedpopulation;theagerangeincludeddependsontheagesincludedin
theepidemiologicalstudy.
Thetypicalloglinearhealthimpactfunctionlooksasfollows:
Anothercommonformforhealthimpactfunctionsisthelogistic,whichappearsasfollows:
1ThekeydifferencebetweenBenMAPversions3.0and4.0isthatversion4.0hasupdatedmortalityincidence
ratesbasedonratesfortheperiod20042006(asopposedto19961998).
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AllofthehealthimpactfunctionsIuseareinoneofthesetwomainforms. Bothtypeshavethesame
fourelements. AppendixAderivesthesetwoformsandprovidesadditionaldetailsonindividual
studies. Table1presentsthePM2.5relatedhealthendpointsincludedinthisanalysis.
Table1. EpidemiologicalStudiesUsedtoEstimateAdverseHealthImpactsofDieselParticles
Endpoint Author AgeMortality,AllCause Ladenetal 2599
Mortality,AllCause Popeetal(2002) 3099
Mortality,AllCause Woodruffetal(1997) Infant
ChronicBronchitis Abbeyetal(1995c) 2799
HeartAttack,Nonfatal Petersetal(2001) 1899
HA,AllCardiovascular(lessMyocardialInfarctions) Moolgavkar(2000b) 1864
HA,AllCardiovascular(lessMyocardialInfarctions) Moolgavkar(2003) 6599
HA,CongestiveHeartFailure Ito(2003) 6599
HA,Dysrhythmia Ito(2003) 6599
HA,IschemicHeartDisease(lessMyocardialInfarctions) Ito(2003) 6599
HA,Pneumonia Ito(2003) 6599HA,ChronicLungDisease(lessAsthma) Moolgavkar(2000a) 1864
HA,ChronicLungDisease Ito(2003) 6599
HA,ChronicLungDisease Moolgavkar(2003) 6599
HA,Asthma Sheppard(2003) 064
EmergencyRoomVisits,Asthma Norrisetal(1999) 017
AcuteBronchitis Dockeryetal(1996) 812
LowerRespiratorySymptoms SchwartzandNeas(2000) 714
UpperRespiratorySymptoms Popeetal(1991) 911
AsthmaExacerbation,Cough Ostroetal(2001) 618
AsthmaExacerbation,ShortnessofBreath Ostroetal(2001) 618
AsthmaExacerbation,Wheeze Ostroetal(2001) 618
AsthmaExacerbation,Cough Vedaletal(1998) 618WorkLossDays(WLD) Ostro(1987) 1864
MinorRestrictedActivityDays(MRAD) Ostroand Rothschild(1989) 1864
Note:HA=hospitaladmissions.
2.3 ValuingEstimatedHealthImpacts
Estimatingtheeconomicbenefitoftheestimatedchangeinhealthincidence,Imultipliedthenumberof
adversecasesofaspecifictypeofeffect(e.g.,mortality)byitsassociatedunitvalueandthenadjusted
fortheestimatedchangeinincomebetween1990and2002:
Table2presentsthemeanestimateoftheunitvaluesusedinthisanalysis. Asdescribedinthenext
subsection,theapproachIusetoadjustforincomefollowstheapproachusedbyEPAinrecent
regulatoryanalyses. Inadditiontoadjustingforincome,Ialsoadjustthemortalityestimatetoaccount
foranassumeddistributionofdeathsovertime. Thismortalityadjustment(describedbelow)isalsoan
approachusedbyEPAinrecentregulatoryanalyses.
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Table2. UnitValuesforEconomicValuationofHealthEndpoints(basedon2002 incomeand2008$)
HealthEndpoint AgeRange UnitValueMortality* 0 99 $8,300,000
ChronicBronchitis 27 99 $450,000
AcuteMyocardialInfarction,Nonfatal** 0 24 $92,000
AcuteMyocardialInfarction,Nonfatal 25 44 $103,000
AcuteMyocardialInfarction,Nonfatal 45 54 $109,000
AcuteMyocardialInfarction,Nonfatal 55 64 $190,000
AcuteMyocardialInfarction,Nonfatal 65 99 $92,000
HA,AllCardiovascular(lessAMI) 18 64 $31,700
HA,AllCardiovascular(lessAMI) 65 99 $29,500
HA,CongestiveHeartFailure 65 99 $21,200
HA,Dysrhythmia 65 99 $21,200
HA,IschemicHeartDisease(lessAMI) 65 99 $36,100
HA,Pneumonia 65 99 $24,800
HA,ChronicLungDisease(lessAsthma) 1864 $17,200
HA,ChronicLungDisease 65 99 $18,700
HA,Asthma 0 64 $10,800
AsthmaERVisits*** 0 17 $399AcuteBronchitis 8 12 $470
LowerResp.Symptoms 7 14 $20
UpperResp.Symptoms 9 11 $31
AsthmaExacerbation,Cough 6 18 $54
AsthmaExacerbation,ShortnessofBreath 6 18 $54
AsthmaExacerbation,Wheeze 6 18 $54
WorkLossDays(WLD) 18 64 $161
MinorRestrictedActivityDays(MRAD) 18 64 $67
NOTE:Numbersroundedtothreesignificantdigits. HA=hospitaladmissions. *Mortalityvalueafteradjustment
for20yearlag.**Theagespecificacutemyocardialinfarctionunitvaluesarebasedonanaverageoftwo
estimates:onebasedonRussell(1998)andonebasedonWittels(1990). **TheasthmaERvisitvalueisan
averageoftwoestimates:onebasedonSmithetal(1997)andtheotherbasedonStanfordetal(1999).****
Countyspecificmediandailywage.
IncomeAdjustment
Thereisevidencethataspeoplesincomeincreases,theirwillingnesstopay(WTP)toavoidadverse
healthimpactsalsoincreases. EconomistsestimateelasticitiestodescribebywhatpercentWTPgoes
upforagivenpercentageincreaseinincome. Asitturnsout,theseestimatedelasticitiesaremuchless
thanone,however,thereisconsiderableuncertaintyovertheprecisevalue. Ifollowtheapproachused
byEPAinrecentregulatoryanalyses(U.S.EPA2008b),whichusedelasticityestimatesthatvarybytype
ofhealtheffect,withrelativelyminoreffectshavingasmallerelasticitythanmoresevereeffects.
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Table3. ElasticityofWTPbyTypeofHealthEffectHealthEffect CentralElasticityEstimateMinorHealthEffect 0.14
Severe&ChronicHealthEffects 0.45
PrematureMortality 0.4
Source:EPA(2005,p.418).
Multiplyingtheseelasticitiesbyhistoricalandforecastedincomedata,EPAdevelopedincome
adjustmentfactorswhichIuseinthisreport. Table4presentstheyear2002incomeadjustmentfactors
thatIuse,alongwiththeinterveningyearsbetween1990(theassumedincomeyearforthevaluation
estimates)and2002(theyearofinterest).
Table4. IncomeAdjustmentFactorsbyTypeofHealthEffect
Year Mortality Severe Minor1990 1.000 1.000 1.000
1991 0.992 0.991 0.997
1992 0.998 0.998 0.999
1993 1.003 1.003 1.001
1994 1.013 1.014 1.004
1995 1.017 1.019 1.006
1996 1.024 1.027 1.008
1997 1.034 1.039 1.012
1998 1.039 1.044 1.013
1999 1.043 1.048 1.015
2000 1.039 1.043 1.013
2001 1.044 1.049 1.015
2002 1.050 1.056 1.017
NotethatbecauseofalackofdataonthedependenceofCOIonincome,andalackofdataon
projectedgrowthinaveragewages,noadjustmentsaremadetobenefitsestimatesbasedontheCOI
approachortoworklossdaysandworkerproductivitybenefitsestimates.Thislackofadjustmentwould
tendtoresultinanunderpredictionofbenefitsinfutureyears,becauseitislikelythatincreasesinreal
U.S.incomewouldalsoresultinincreasedCOI(due,forexample,toincreasesinwagespaidtomedical
workers)andincreasedcostofworklossdaysandlostworkerproductivity(reflectingthatifworker
incomesarehigher,thelossesresultingfromreducedworkerproductionwouldalsobehigher).
MortalityAdjustment
Thedelay,orlag,betweenchangesinPMexposuresandchangesinmortalityratesisnotprecisely
known. Thecurrentscientificliteratureonadversehealtheffects,suchasthoseassociatedwithPM
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(e.g.,smokingrelateddisease),andthedifferenceintheestimatedeffectofchronicexposurestudies
versusdailymortalitystudies,suggeststhatitislikelythatnotallcasesofavoidedprematuremortality
associatedwithagivenincrementalreductioninPMexposurewouldoccurinthesameyearasthe
exposurereduction.
FollowingrecentEPAanalyses(U.S.EPA2006,p.521),Iassumea20yearlagstructure,with30percentofprematuredeathsoccurringinthefirstyear,50percentoccurringevenlyoveryears2to5afterthe
reductioninPM2.5,and20percentoccurringevenlyoveryears6to20afterthereductioninPM2.5.It
shouldbenotedthattheselectionofa20yearlagstructureisnotdirectlysupportedbyanyPMspecific
literature. Rather,itisintendedtobeareasonableestimateoftheappropriatetimedistributionof
avoidedcasesofPMrelatedmortality. AsnotedbyEPA,thedistributionofdeathsoverthelatency
periodisintendedtoreflectthecontributionofshorttermexposuresinthefirstyear,cardiopulmonary
deathsinthe2 to5yearperiod,andlongtermlungdiseaseandlungcancerinthe6 to20yearperiod.
Finally,itisimportanttokeepinmindthatchangesinthelagassumptionsdonotchangethetotal
numberofestimateddeathsbutratherthetimingofthosedeaths.
Specifyingthelagisimportantbecausepeoplearegenerallywillingtopaymoreforsomethingnowthan
forthesamethinglater. Theywould,forexample,bewillingtopaymoreforareductionintheriskof
prematuredeathinthesameyearasexposureisreducedthanforthatsameriskreductiontobe
receivedthefollowingyear. Thistimepreferenceforreceivingbenefitsnowratherthanlateris
expressedbydiscountingbenefitsreceivedlater. Theexactdiscountratethatisappropriate(i.e.,that
representspeoplestimepreference)isatopicofmuchdebate. EPAhasoftenusedadiscountrateof
threepercent,andIuseathreepercentrateforthisanalysisinconjunctionwiththe20yearlag
structuredescribedabove.
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3. Results
Table5summarizestheonroadandoffroaddieselimpacts. Detailsonthecalculationsareprovidedin
Chapter2andAppendixA.
Table5. Onroad&OffroadDieselHealthImpactsin2002
OnRoadDiesel OffRoad DieselHealthImpact Cases Value(million
2008$) Cases Value(million2008$)Mortality,Adult(Ladenetal,2006) 11,200 $84,200 23,900 $180,000
Mortality,Adult(Popeetal,2002) 4,360 $32,800 9,350 $70,300
Mortality,Infant 39 $324 86 $710
ChronicBronchitis 2,880 $1,300 6,250 $2,810HeartAttack,Nonfatal 6,330 $727 13,500 $1,550
HA,AllCardiovascular 2,020 $58 4,360 $126
HA,Respiratory 1,470 $27 3,180 $58
ERVisits,Asthma 3,920 $2 8,500 $3
AcuteBronchitis 7,870 $4 16,900 $8
LowerResp.Symptoms 93,800 $2 202,000 $4
UpperResp.Symptoms 71,300 $2 156,000 $5
AsthmaExacerbation 154,000 $8 336,000 $18
WLD 616,000 $99 1,350,000 $217
MRAD 3,590,000 $240 7,850,000 $526
Note:HA=hospitaladmissions. ER=emergencyroom.WLD=worklossdays. MRAD=minorrestrictedactivity
days. Resultsroundedtothreedigits.
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AppendixA. HumanHealthImpactFunction
Details
Thisappendixpresentsthederivationofthetwomainhealthimpactfunctionsusedinthisanalysis(log
linearandlogistic),aswellasdetailsoneachfunctionused.
A.1 DerivingHealthImpactFunctions
Below,Ipresentaderivationofthemeancoefficientestimatesforloglinearandlogistichealthimpact
functions.
Log-Linear
Derivation
PM
c
c
c
c
Bey
PMy
PMPMPM
conditionscontrolunderlevelsPMPM
conditionsbaselineunderlevelsPMPM
yyy
conditionscontrolunderIncidencey
conditionsbaselineunderIncidencey
=
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)ln(
0
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=
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PMPM
PM
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BeBeBey
BeBey
Bey
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( )
( )( )
=
=
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=
PM
PM
PMPM
PMPMPM
eyy
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eBey
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11
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00
LogisticDerivation
riablevaPMtheoftcoefficien
tscoefficienofvector
riablesvaplanatoryexofvectorX
PMPMPM
conditionscontrolunderlevelsPMPM
conditionsbaselineunderlevelsPMPM
yyy
conditionscontrolunderIncidencey
conditionsbaselineunderIncidencey
c
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=
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=
=
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eee
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c
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A.2 PM2.5HealthImpactFunctions
Thisanalysisusesarangeofhealthimpactfunctions,includingthosetoestimateprematuremortality,
chronicbronchitis,andhospitaladmissions.Thesehealthimpactfunctionsarethesameonesusedin
recentEPAregulatoryimpactanalyses(e.g.,U.S.EPA2008b).
NotethattheinputtoBenMAPistheannualaveragecontributionofdieselparticlestopopulation
exposureofPM2.5. ToestimatethechangeinhealtheffectsassociatedwithdailychangesinPM2.5,
BenMAPassumesthattheannualchangeisareasonableproxyandmultipliestheresultby365. Since
thehealthimpactfunctionsarereasonablylinear,theeffectofthisassumptionissmall,generallywithin
afewpercent,evenforfairlyextremeassumptions.
Below,IpresentatablewiththehealthimpactfunctionsusedtoestimatePM2.5relatedadversehealth
effects. Followingthistable,Ipresentabriefsummaryofeachofthestudiesalongwithdetailsnotin
thesummarytable.
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Table6. DetailsofPM2.5HumanHealthImpactFunctions
EndpointName Study Location Age Beta StdErrorAdultmortality Ladenetal(2002) 6cities 2599 0.014842 0.004170Adultmortality Popeetal(2002) 51cities 3099 0.005827 0.002157Infantmortality
Woodruff
et
al(1997) 86
cities 0
0
0.003922 0.001221ChronicBronchitis Abbeyetal(1995c) California 2799 0.013185 0.006796
HeartAttack,Nonfatal Petersetal(2001) Boston,MA 1899 0.024121 0.009285
CongestiveHeartFailure Ito(2003) Detroit,MI 6599 0.003074 0.001292
Dysrhythmia Ito(2003) Detroit,MI 6599 0.001249 0.002033
IschemicHeartDisease(lessAMI) Ito(2003) Detroit,MI 6599 0.001435 0.001156
ChronicLungDisease Ito(2003) Detroit,MI 6599 0.001169 0.002064
Pneumonia Ito(2003) Detroit,MI 6599 0.003979 0.001659
AllCardiovascular(lessAMI) Moolgavkar(2000b) LosAngeles,CA 1864 0.001400 0.000341
ChronicLungDisease(lessAsthma) Moolgavkar(2000b) LosAngeles,CA 1864 0.002200 0.000733
AllCardiovascular(lessAMI) Moolgavkar(2003) LosAngeles,CA 6599 0.001580 0.000344
ChronicLungDisease Moolgavkar(2003) LosAngeles,CA 6599 0.001850 0.000524
Asthma Sheppard(2003) Seattle,WA 064 0.003324 0.001045
EmergencyRoomVisits,Asthma Norrisetal(1999) Seattle,WA 017 0.016527 0.004139MinorRestrictedActivityDays(MRAD) Ostro&Rothschild
(1989)
Nationwide 1864 0.007410 0.000700
AcuteBronchitis Dockeryetal(1996) 24communities 812 0.027212 0.017096
WorkLossDays(WLD) Ostro(1987) Nationwide 1864 0.004600 0.000360
LowerRespiratorySymptoms SchwartzandNeas
(2000)
6U.S.cities 714 0.019012 0.006005
AsthmaExacerbation,Cough Ostroetal(2001) LosAngeles,CA 618 0.000985 0.000747
AsthmaExacerbation,Shortnessof
Breath
Ostroetal LosAngeles,CA 618 0.002565 0.001335
AsthmaExacerbation,Wheeze Ostroetal LosAngeles,CA 618 0.001942 0.000803
AsthmaExacerbation,Cough Vedaletal(1998) Vancouver,CAN 618 0.007696 0.003786
UpperRespiratorySymptoms Popeetal(1991) UtahValley 911 0.0036 0.0015
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Mortality,AllCause(Ladenetal.2006)TheLadenetal(2002)analysisisalongitudinalcohorttrackingstudythatusesthesamesixcitycohort
astheoriginalDockeryetal(1993)study,andtheKrewskietal(2000)reanalysis. Akeydifferenceis
thattheLadenetalstudyusedalongerfollowupperiod.
ThecoefficientandstandarderrorforPM2.5areestimatedfromtherelativerisk(1.16)and
95%confidenceinterval(1.071.26)associatedwithachangeinannualmeanexposureof
10.0 g/m3(Ladenetal.2006,p.667).
FunctionalForm:LoglinearCoefficient:0.014842
StandardError:0.004170IncidenceRate:countyspecificannualallcausemortalityrateperpersonages25andolderPopulation:populationofages25andolder.
Mortality,AllCause(Popeetal.2002)
ThePopeetal(2002)analysisisalongitudinalcohorttrackingstudythatusesthesameAmerican
CancerSocietycohortastheoriginalPopeetal(1995)study,andtheKrewskietal(2000)reanalysis.
Popeetal(2002)analyzedsurvivaldataforthecohortfrom1982through1998,9yearslongerthanthe
originalPopestudy. Popeetal(2002)followedKrewskietal(2000)andPopeetal(1995,Table2)and
reportedresultsforallcausedeaths,lungcancer(ICD9code:162),cardiopulmonarydeaths(ICD9
codes:401440and460519),andallotherdeaths.2Liketheearlierstudies,Popeetal(2002)found
thatmeanPM2.5issignificantlyrelatedtoallcauseandcardiopulmonarymortality. Inaddition,Popeet
al(2002)foundasignificantrelationshipwithlungcancermortality,whichwasnotfoundintheearlier
studies. Noneofthethreestudiesfoundasignificantrelationshipwithallotherdeaths.
ThecoefficientandstandarderrorforPM2.5usingtheaverageof7983and9900PMdataare
estimatedfromtherelativerisk(1.06)and95%confidenceinterval(1.021.11)associatedwithachange
inannualmeanexposureof10 g/m3.Popeetal(2002,Table2).
FunctionalForm:LoglinearCoefficient:0.005827
StandardError:0.002157IncidenceRate:countyspecificannualallcausemortalityrateperpersonages30andolderPopulation:populationofages30andolder.
InfantMortality(Woodruffetal.1997)
Inastudyoffourmillioninfantsin86U.S.metropolitanareasconductedfrom1989to1991,Woodruff
etal(1997)foundasignificantlinkbetweenPM10exposureinthefirsttwomonthsofaninfantslife
withtheprobabilityofdyingbetweentheagesof28daysand364days. PM10exposurewassignificant
forallcausemortality. PM10wasalsosignificantforrespiratorymortalityinaveragebirthweight
infants,butnotlowbirthweightinfants.
2 Allcausemortalityincludesaccidents,suicides,homicidesandlegalinterventions. Thecategoryallotherdeathsis
allcausemortalitylesslungcancerandcardiopulmonarydeaths.
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Thecoefficientandstandarderrorarebasedontheoddsratio(1.04)and95%confidenceinterval(1.02
1.07)associatedwitha10 g/m3changeinPM10(Woodruffetal.1997,Table3).
FunctionalForm:LogisticCoefficient:0.003922StandardError:0.001221IncidenceRate:countyspecificannualpostneonatal3infantdeathsperinfantundertheageofonePopulation:populationofinfantsunderoneyearold.ChronicBronchitis (Abbeyetal.1995b)Abbeyetal(1995b)examinedtherelationshipbetweenestimatedPM2.5(annualmeanfrom1966to
1977),PM10(annualmeanfrom1973to1977)andTSP (annualmeanfrom1973to1977)andthesame
chronicrespiratorysymptomsinasamplepopulationof1,868CalifornianSeventhDayAdventists. The
initialsurveywasconductedin1977andthefinalsurveyin1987. Toensureabetterestimateof
exposure,thestudyparticipantshadtohavebeenlivinginthesameareaforanextendedperiodof
time. Insinglepollutantmodels,therewasastatisticallysignificantPM2.5relationshipwithdevelopmentofchronicbronchitis,butnotforAODorasthma;PM10wassignificantlyassociatedwith
chronicbronchitisandAOD;andTSPwassignificantlyassociatedwithallcasesofallthreechronic
symptoms. Otherpollutantswerenotexamined.
Theestimatedcoefficient(0.0137)ispresentedforaoneg/m3changeinPM2.5(Abbeyetal.1995b,
Table2). Thestandarderroriscalculatedfromthereportedrelativerisk(1.81)and95%confidence
interval(0.983.25)fora45g/m3changeinPM2.5(Abbeyetal.1995b,Table2).
FunctionalForm:LogisticCoefficient:0.0137
StandardError:0.00680IncidenceRate:annualbronchitisincidencerateperperson(Abbeyetal.1993,Table3)=0.00378Population:populationofages27andolder4withoutchronicbronchitis=95.57%ofpopulation27+.5
AcuteMyocardialInfarction(HeartAttacks),Nonfatal(Petersetal.2001)
Petersetal(2001)studiedtherelationshipbetweenincreasedparticulateairpollutionandonsetof
heartattacksintheBostonareafrom1995to1996. TheauthorsusedairqualitydataforPM10,PM102.5,
PM2.5,blackcarbon,O3,CO,NO2,andSO2inacasecrossoveranalysis. Foreachsubject,thecase
periodwasmatchedtothreecontrolperiods,each24hoursapart. Inunivariateanalyses,theauthors
observedapositiveassociationbetweenheartattackoccurrenceandPM2.5levelshoursbeforeanddays
beforeonset. Theauthorsestimatedmultivariateconditionallogisticmodelsincludingtwohourand
twentyfourhourpollutantconcentrationsforeachpollutant. Theyfoundsignificantandindependent
associationsbetweenheartattackoccurrenceandbothtwohourandtwentyfourhourPM2.5
concentrationsbeforeonset. SignificantassociationswereobservedforPM10aswell. Noneoftheother
3Postneonatalreferstoinfantsthatare28daysto364daysold.
4Usingthesamedataset,Abbeyetal(1995a,p.140)reportedtherespondentsin1977rangedinagefrom27to95.
5TheAmericanLungAssociation (2002b,Table4) reportsachronicbronchitisprevalencerateforages18andoverof
4.43%(AmericanLungAssociation2002b).
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particlemeasuresorgaseouspollutantsweresignificantlyassociatedwithacutemyocardialinfarction
forthetwohourortwentyfourhourperiodbeforeonset.
Themeanageofparticipantswas62yearsold,with21%ofthestudypopulationundertheageof50. In
ordertocapturethefullmagnitudeofheartattackoccurrencepotentiallyassociatedwithairpollution
andbecauseagewasnotlistedasaninclusioncriteriaforsampleselection,BenMAPassumesanagerangeof18andoverinthehealthimpactfunction. AccordingtotheNationalHospitalDischargeSurvey,
therewerenohospitalizationsforheartattacksamongchildren
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FunctionalForm:LoglinearCoefficient:0.003324
StandardError:0.001045IncidenceRate:regionspecificdailyhospitaladmissionrateforasthmaadmissionsperperson
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Ages65andolder(Moolgavkar2003)Thecoefficientandstandarderrorarecalculatedfromanestimatedpercentagechangeof1.85
andt
statisticof3.53fora10 g/m3increaseinPM2.5inthe2daylagGAM30dfstringent(108)model
(Moolgavkar2003,Table17).
FunctionalForm:LoglinearCoefficient:0.001833
StandardError:0.000519IncidenceRate:regionspecificdailyhospitaladmissionrateforchroniclungdiseaseadmissionsperperson65+(ICDcodes490496)
Population:populationofages65andolder.HospitalAdmissionsforAllCardiovascular(Moolgavkar2000b;2003)
Moolgavkar(2000b)examinedtheassociationbetweenairpollutionandcardiovascularhospital
admissions(ICD390448)intheChicago,LosAngeles,andPhoenixmetropolitanareas. Hecollecteddailyairpollutiondataforozone,SO2,NO2,CO,andPM10inallthreeareas. PM2.5datawasavailable
onlyinLosAngeles. ThedatawereanalyzedusingaPoissonregressionmodelwithgeneralizedadditive
modelstoadjustfortemporaltrends. Separatemodelswererunfor0to5daylagsineachlocation.
Amongthe65+agegroup,thegaseouspollutantsgenerallyexhibitedstrongereffectsthanPM10or
PM2.5. ThestrongestoveralleffectswereobservedforSO2andCO. Inasinglepollutantmodel,PM2.5
wasstatisticallysignificantforlag0andlag1. IncopollutantmodelswithCO,thePM2.5effectdropped
outandCOremainedsignificant. Forages2064,SO2andCOexhibitedthestrongesteffectandany
PM2.5effectdroppedoutincopollutantmodelswithCO.
InresponsetoconcernswiththeSplusissue,Moolgavkar(2003)reanalyzedhisearlierstudy. Inthereanalysis,hereportedthatmoregeneralizedadditivemodelswithstringentconvergencecriteriaand
generalizedlinearmodelsresultedinsmallerrelativeriskestimates. Notalloftheoriginalresultswere
replicated,soBenMAPusesamixofhealthimpactfunctionsfromthereanalysisandfromtheoriginal
study(whenthereanalyzedresultswerenotavailable). ThePM2.5CRfunctionsarebasedonsingle
pollutantandcopollutant(PM2.5andCO)models.
NotethatMoolgavkar(2000b)reportedresultsthatincludeICDcode410(heartattack). Iestimate
avoidednonfatalheartattacksusingtheresultsreportedbyPetersetal(2001). Inordertoavoid
doublecountingheartattackhospitalizations,ICDcode410wasexcludedfromthebaselineincidence
rateusedinthisfunction.
8AlthoughMoolgavkar(2000a)reportsresultsforthe2064yearoldagerange,forcomparabilitytootherstudies,we
applytheresultstothepopulationofages18to64.
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Ages18to64(Moolgavkar2000a)Thesinglepollutantcoefficientandstandarderrorarecalculatedfromanestimatedpercentchangeof
1.4andtstatisticof4.1fora10 g/m3increaseinPM2.5inthezerolagmodel(Moolgavkar2000b,Table
4).
FunctionalForm:LoglinearCoefficient:0.0014
StandardError:0.000341IncidenceRate:regionspecificdailyhospitaladmissionrateforallcardiovascularadmissionsperpersonages18to64(ICDcodes390409,411429)
Population:populationofages18to64.9Ages65andolder(Moolgavkar2003)Thesinglepollutantcoefficientandstandarderrorarecalculatedfromanestimatedpercentchangeof
1.58andtstatisticof4.59fora10 g/m3increaseinPM2.5inthe0daylagGAM30dfstringent(108)
model(Moolgavkar2003,Table12).
FunctionalForm:LoglinearCoefficient:0.001568
StandardError:0.000342IncidenceRate:regionspecificdailyhospitaladmissionrateforallcardiovascularadmissionsperperson65+(ICDcodes390409,411429)
Population:populationofages65andolder.HospitalAdmissionsforRespiratory&CardiovascularCauses(Ito2003)
Lippmannetal(2000)studiedtheassociationbetweenparticulatematteranddailymortalityand
hospitalizationsamongtheelderlyinDetroit,MI. Datawereanalyzedfortwoseparatestudyperiods,
19851990and19921994. The19921994studyperiodhadagreatervarietyofdataonPMsizeand
wasthemainfocusofthereport. Theauthorscollectedhospitalizationdataforavarietyof
cardiovascularandrespiratoryendpoints. TheyuseddailyairqualitydataforPM10,PM2.5,andPM102.5in
aPoissonregressionmodelwithgeneralizedadditivemodels(GAM)toadjustfornonlinearrelationships
andtemporaltrends. Insinglepollutantmodels,allPMmetricswerestatisticallysignificantfor
pneumonia(ICDcodes480486),PM102.5andPM10weresignificantforischemicheartdisease(ICDcode
410414),andPM2.5andPM10weresignificantforheartfailure(ICDcode428). Therewerepositive,but
notstatisticallysignificantassociations,betweenthePMmetricsandCOPD(ICDcodes490496)anddysrhythmia(ICDcode427). InseparatecopollutantmodelswithPMandeitherozone,SO2,NO2,or
CO,theresultsweregenerallycomparable. ThePM2.5CRfunctionsarebasedonresultsofthesingle
pollutantmodelandcopollutantmodelwithozone.
9AlthoughMoolgavkar(2000a)reportsresultsforthe2064yearoldagerange,forcomparabilitytootherstudies,we
applytheresultstothepopulationofages18to64.
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InresponsetoconcernswiththeSplusissue,Ito(2003) reanalyzedthestudybyLippmannetal(2000).
ThereanalysisbyItoreportedthatmoregeneralizedadditivemodelswithstringentconvergencecriteria
andgeneralizedlinearmodelsresultedinsmallerrelativeriskestimates.
ChronicLungDiseaseThecoefficientandstandarderrorarebasedontherelativerisk(1.043)and95%confidenceinterval
(0.9021.207)fora36 g/m3increaseinPM2.5inthe3daylagGAMstringentmodel(Ito2003,Table8).
FunctionalForm:LoglinearCoefficient:0.001169
StandardError:0.002064IncidenceRate:regionspecificdailyhospitaladmissionrateforchroniclungdiseaseadmissionsperperson65+(ICDcodes490496)
Population:populationofages65andolder.PneumoniaTheestimatedPM2.5coefficientandstandarderrorarebasedonarelativeriskof1.154(95%CI 1.027,
1.298)duetoaPM2.5changeof36 g/m3inthe1daylagGAMstringentmodel(Ito2003,Table7).
FunctionalForm:LoglinearCoefficient:0.003979
StandardError:0.001659IncidenceRate:regionspecificdailyhospitaladmissionrateforpneumoniaadmissionsperperson65+(ICDcodes480487)
Population:populationofages65andolder.DysrhythmiaThecopollutantcoefficientandstandarderrorarecalculatedfromarelativeriskof1.046(95%CI0.906
1.207)fora36 g/m3increaseinPM2.5inthe1daylagGAMstringentmodel(Ito2003,Table10).
FunctionalForm:LoglinearCoefficient:0.001249
StandardError:0.002033IncidenceRate:regionspecificdailyhospitaladmissionratefordysrhythmiaadmissionsperperson65+(ICDcode427)
Population:populationofages65andolder.CongestiveHeartFailureThecopollutantcoefficientandstandarderrorarecalculatedfromarelativeriskof1.117(95%CI1.020
1.224)fora36 g/m3increaseinPM2.5inthe1daylagGAMstringentmodel(Ito2003,Table11).
FunctionalForm:LoglinearCoefficient:0.003074
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StandardError:0.001292IncidenceRate:regionspecificdailyhospitaladmissionrateforcongestiveheartfailureadmissionsperperson65+(ICDcode428)
Population:populationofages65andolder.IschemicHeartDiseaseThecopollutantcoefficientandstandarderrorarecalculatedfromarelativeriskof1.053(95%CI0.971
1.143)fora36 g/m3increaseinPM2.5inthe1daylagGAMstringentmodel(Ito2003,Table9).
FunctionalForm:LoglinearCoefficient:0.001435
StandardError:0.001156IncidenceRate:regionspecificdailyhospitaladmissionrateforischemicheartdiseaseadmissionsperperson65+(ICDcodes411414)10
Population:populationofages65andolder.EmergencyRoomVisitsforAsthma(Norrisetal.1999)
Norrisetal(1999)examinedtherelationbetweenairpollutioninSeattleandchildhood(
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livingin24communitiesinU.S.andCanada. Healthdatawerecollectedin19881991,andsingle
pollutantmodelswereusedintheanalysistotestanumberofmeasuresofparticulateairpollution.
Dockeryetalfoundthatannuallevelofsulfatesandparticleacidityweresignificantlyrelated to
bronchitis,andPM2.1andPM10weremarginallysignificantlyrelatedtobronchitis.11Theyalsofound
nitrateswerelinkedtoasthma,andsulfateslinkedtochronicphlegm. Itisimportanttonotethatthe
studyexaminedannualpollutionexposures,andtheauthorsdidnotruleoutthatacute(daily)
exposurescouldberelatedtoasthmaattacksandotheracuteepisodes.
Bronchitiswascountedinthestudyonlyiftherewerereportsofsymptomsinthepast12
months(Dockeryetal.1996,p.501). Itisunclear,however,ifthecasesofbronchitisareacuteand
temporary,orifthebronchitisisachroniccondition. DockeryetalfoundnorelationshipbetweenPM
andchroniccoughandchronicphlegm,whichareimportantindicatorsofchronicbronchitis. Iassume
thatthehealthimpactfunctionbasedonDockeryetalismeasuringacutebronchitis.
Theestimatedlogisticcoefficientandstandarderrorarebasedontheoddsratio(1.50)and95%
confidenceinterval(0.912.47)associatedwithbeinginthemostpollutedcity(PM2.1
=20.7 g/m3)
versustheleastpollutedcity(PM2.1=5.8 g/m3)(Dockeryetal.1996,Tables1and4).Theoriginalstudy
usedPM2.1,however,BenMAPusesthePM2.1coefficientandapplyittoPM2.5data.
FunctionalForm:LogisticCoefficient:0.027212
StandardError:0.017096IncidenceRate:annualbronchitisincidencerateperperson=0.043(AmericanLungAssociation2002c,Table11)
Population:populationofages812.LowerRespiratorySymptoms(SchwartzandNeas2000)
SchwartzandNeas(2000)usedlogisticregressiontolinklowerrespiratorysymptomsandcoughin
childrenwithcoarsePM10,PM2.5,sulfateandH+(hydrogenion). Childrenwereselectedforthestudyif
theywereexposedtoindoorsourcesofairpollution:gasstovesandparentalsmoking. Thestudy
enrolled1,844childrenintoayearlongstudythatwasconductedindifferentyears(1984to1988)insix
cities. Thestudentswereingradestwothroughfiveatthetimeofenrollmentin1984. Bythe
completionofthefinalstudy,thecohortwouldthenbeintheeighthgrade(ages1314);thissuggests
anagerangeof7to14.
Thecoefficientandstandarderrorarecalculatedfromthereportedoddsratio(1.33)and95%confidenceinterval(1.111.58)associatedwitha15g/m3changeinPM2.5(SchwartzandNeas2000,
Table2).
FunctionalForm:Logistic11TheoriginalstudymeasuredPM2.1,howeverwhenusingthestudy'sresultsweusePM2.5. Thismakesonlyanegligible
difference,assumingthattheadverseeffectsofPM2.1andPM2.5arecomparable.
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Coefficient:0.01901
StandardError:0.006005IncidenceRate:dailylowerrespiratorysymptomincidencerateperperson=0.0012(Schwartzetal.1994,Table2).
Population:populationofages7to14.
MinorRestrictedActivityDays(Ostro1989)
OstroandRothschild(1989)estimatedtheimpactofPM2.5andozoneontheincidenceofminor
restrictedactivitydays(MRADs)andrespiratoryrelatedrestrictedactivitydays(RRADs)inanational
sampleoftheadultworkingpopulation,ages18to65,livinginmetropolitanareas. Theannualnational
surveyresultsusedinthisanalysiswereconductedin19761981. ControllingforPM2.5,twoweek
averageozonehashighlyvariableassociationwithRRADsandMRADs. Controllingforozone,twoweek
averagePM2.5wassignificantlylinkedtobothhealthendpointsinmostyears.12 TheCRfunctionforPM
isbasedonthiscopollutantmodel.
Usingtheresultsofthetwopollutantmodel,separatecoefficientsweredevelopedforeachyearinthe
analysis,whichwerethencombinedforuseinthisanalysis. Thecoefficientisaweightedaverageofthe
coefficientsinOstroandRothschild(1989,Table4)usingtheinverseofthevarianceastheweight. The
standarderrorofthecoefficientiscalculatedasfollows,assumingthattheestimatedyearspecific
coefficientsareindependent.
FunctionalForm:LoglinearCoefficient:0.00741
StandardError:0.00070IncidenceRate:dailyincidencerateforminorrestrictedactivitydays(MRAD)=0.02137(OstroandRothschild1989,p.243)
Population:adultpopulationages18to64.13WorkLossDays(Ostro1987)
Ostro(1987)estimatedtheimpactofPM2.5ontheincidenceofworklossdays(WLDs),restrictedactivity
days(RADs),andrespiratoryrelatedRADs(RRADs)inanationalsampleoftheadultworkingpopulation,
ages18to65,livinginmetropolitanareas. Theannualnationalsurveyresultsusedinthisanalysiswere
conductedin19761981. OstroreportedthattwoweekaveragePM2.5levelsweresignificantlylinkedto
worklossdays,RADs,andRRADs,howevertherewassomeyeartoyearvariabilityintheresults.14
12Thestudyusedatwoweekaveragepollutionconcentration;theCRfunctionusesadailyaverage,whichisassumed
tobeareasonableapproximation.13Thestudyisbasedonaconveniencesampleofnonelderlyindividuals. ApplyingtheCRfunctiontothisage
groupislikelyaslightunderestimate,asitseemslikelythatelderlyareatleastassusceptibletoPMasindividuals
under65.14Thestudyusedatwoweekaveragepollutionconcentration;theCRfunctionusesadailyaverage,whichisassumed
tobeareasonableapproximation.
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Separatecoefficientsweredevelopedforeachyearintheanalysis(19761981);thesecoefficientswere
pooled. Thecoefficientusedintheconcentrationresponsefunctionpresentedhereisaweighted
averageofthecoefficientsinOstro(1987,Table3)usingtheinverseofthevarianceastheweight.
ThecoefficientusedintheCRfunctionisaweightedaverageofthecoefficientsinOstro(1987,Table3)
usingtheinverseofthevarianceastheweight. Thestandarderrorofthecoefficientiscalculatedasfollows,assumingthattheestimatedyearspecificcoefficientsareindependent.
FunctionalForm:LoglinearCoefficient:0.0046
StandardError:0.00036IncidenceRate:dailyworklossdayincidencerateperpersonages18to64=0.00595(U.S.BureauoftheCensus1997,No.22;Adamsetal.1999,Table41)
Population:adultpopulationages18to64.15
AsthmaExacerbation:
Pooling
Ostro
et
al.
(2001)
and
Vedal
et
al.
(1998)
IpooltheresultsofstudiesbyOstroetal(2001)andVedaletal(1998)togetanestimateoflower
respiratorysymptomsinasthmatics. IuseasimpleaverageoftheresultswhenIpoolunlikethe
analysisperformedforCleanAirInterstateRule(U.S.EPA2005,Table47). Inadditiontothelower
respiratoryestimate,IincludeanupperrespiratoryestimatebasedonastudybyPopeetal(1991).
Tocharacterizeasthmaexacerbationsinchildren,EPAusestwostudiesthatfollowedpanelsof
asthmaticchildren.Ostroetal(2001)followedagroupof138AfricanAmericanchildreninLosAngeles
for13weeks,recordingdailyoccurrencesofrespiratorysymptomsassociatedwithasthma
exacerbations(e.g.,shortnessofbreath,wheeze,andcough).Thisstudyfoundastatisticallysignificant
associationbetweenPM2.5,measuredasa12houraverage,andthedailyprevalenceofshortnessof
breathandwheezeendpoints.Althoughtheassociationwasnotstatisticallysignificantforcough,the
resultswerestillpositiveandclosetosignificance;consequently,EPAincludesthisendpoint,alongwith
shortnessofbreathandwheeze,ingeneratingincidenceestimates.
Vedaletal(1998)followedagroupofelementaryschoolchildren,including74asthmatics,locatedon
thewestcoastofVancouverIslandfor18monthsincludingmeasurementsofdailypeakexpiratoryflow
(PEF)andthetrackingofrespiratorysymptoms(e.g.,cough,phlegm,wheeze,chesttightness)through
theuseofdailydiaries.AssociationbetweenPM10andrespiratorysymptomsfortheasthmatic
populationwasonlyreportedfortwoendpoints:coughandPEF.BecauseitisdifficulttotranslatePEF
measuresintoclearlydefinedhealthendpointsthatcanbemonetized,EPAonlyincludedthecoughrelatedeffectestimatefromthisstudyinquantifyingasthmaexacerbations.
15Thestudyisbasedonaconveniencesampleofnonelderlyindividuals. ApplyingtheCRfunctiontothisage
groupislikelyaslightunderestimate,asitseemslikelythatelderlyareatleastassusceptibletoPMasindividuals
under65.
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EPAemployedthefollowingpoolingapproachincombiningestimatesgeneratedusingeffectestimates
fromthetwostudiestoproduceasingleasthmaexacerbationincidenceestimate. First,EPApooledthe
separateincidenceestimatesforshortnessofbreath,wheeze,andcoughgeneratedusingeffect
estimatesfromtheOstroetal(2001)study,becauseeachoftheseendpointsisaimedatcapturingthe
sameoverallendpoint(asthmaexacerbations)andtherecouldbeoverlapintheirpredictions.The
pooledestimatefromtheOstroetal.studyisthenpooledwiththecoughrelatedestimategenerated
usingtheVedaletalstudy.Therationaleforthissecondpoolingstepissimilartothefirst;bothstudies
areattemptingtoquantifythesameoverallendpoint(asthmaexacerbations).
Topreventdoublecounting,EPA(2005,p.438)focusedtheestimationonasthmaexacerbations
occurringinchildrenandexcludedadultsfromthecalculation. Asthmaexacerbationsoccurringin
adultsareassumedtobecapturedinthegeneralpopulationendpointssuchasworklossdaysand
MRADs.Consequently,ifEPAhadincludedanadultspecificasthmaexacerbationestimate,thiswould
likelyhavedoublecountedincidenceforthisendpoint.However,becausethegeneralpopulation
endpointsdonotcoverchildren(withregardtoasthmaticeffects),ananalysisfocusedspecificallyon
asthmaexacerbationsforchildren(6to18yearsofage)couldbeconductedwithoutconcernfor
doublecounting.
AsthmaExacerbation:Cough,Wheeze,andShortnessofBreath(Ostroetal.2001)
Ostroetal.(2001)studiedtherelationbetweenairpollutioninLosAngelesandasthmaexacerbationin
AfricanAmericanchildren(8to13yearsold)fromAugusttoNovember1993. Theyusedairqualitydata
forPM10,PM2.5,NO2,andO3inalogisticregressionmodelwithcontrolforage,income,timetrends,and
temperaturerelatedweathereffects.1 Asthmasymptomendpointsweredefinedintwoways:
probabilityofadaywithsymptomsandonsetofsymptomepisodes. Newonsetofasymptom
episodewasdefinedasadaywithsymptomsfollowedbyasymptomfreeday. TheauthorsfoundcoughprevalenceassociatedwithPM10andPM2.5andcoughincidenceassociatedwithPM2.5,PM10,and
NO2. Ozonewasnotsignificantlyassociatedwithcoughamongasthmatics.
NotethatthestudyfocusedonAfricanAmericanchildrenages8to13yearsold. EPAappliesthe
functionbasedonthisstudytothegeneralpopulationages6to18yearsold.
AsthmaExacerbation,CoughThecoefficientandstandarderrorarebasedonanoddsratioof1.03(95%CI0.981.07)fora30 g/m3
increasein12houraveragePM2.5concentration(Ostroetal.2001,Table4,p.204).
FunctionalForm:LogisticCoefficient:0.000985
StandardError:0.0007471Theauthorsnotethattherewere26daysinwhichPM2.5concentrationswerereportedhigherthanPM10
concentrations. Themajorityofresultstheauthorsreportedwerebasedonthefulldataset. Theseresultswereusedfor
thebasisfortheCRfunctions.
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IncidenceRate:dailycoughrateperperson(Ostroetal.2001,p.202) =0.145Population:asthmaticpopulationages6to18=5.67%.2AsthmaExacerbation,ShortnessofBreathThecoefficientandstandarderrorarebasedonanoddsratioof1.08(95%CI1.001.17)fora30 g/m3
increasein12houraveragePM2.5concentration(Ostroetal.2001,Table4,p.204).
FunctionalForm:LogisticCoefficient:0.002565
StandardError:0.001335IncidenceRate:dailyshortnessofbreathrateperperson(Ostroetal.2001,p.202)=0.074Population:asthmaticpopulationages6to18=5.67%.AsthmaExacerbation,WheezeThecoefficientandstandarderrorarebasedonanoddsratioof1.06(95%CI1.011.11)fora30 g/m3
increasein12houraveragePM2.5concentration(Ostroetal.2001,Table4,p.204).
FunctionalForm:LogisticCoefficient:0.001942
StandardError:0.000803IncidenceRate:dailywheezerateperperson(Ostroetal.2001,p.202) =0.173Population:asthmaticpopulationages6to18=5.67%.AsthmaExacerbation,Cough(Vedaletal.1998)
Vedaletal.(1998)studiedtherelationshipbetweenairpollutionandrespiratorysymptomsamong
asthmaticsandnonasthmaticchildren(ages6to13)inPortAlberni,BritishColumbia,Canada. Four
groupsofelementaryschoolchildrenweresampledfromapriorcrosssectionalstudy:(1)allchildren
withcurrentasthma,(2)childrenwithoutdoctordiagnosedasthmawhoexperiencedadropinFEVafter
exercise,(3)childrennotingroups1or2whohadevidenceofairwayobstruction,and(4)acontrol
groupofchildrenwithmatchedbyclassroom.
Theauthorsusedlogisticregressionandgeneralizedestimatingequationstoexaminetheassociation
betweendailyPM10levelsanddailyincreasesinvariousrespiratorysymptomsamongthesegroups. In
theentiresampleofchildren,PM10wassignificantlyassociatedwithcough,phlegm,nosesymptoms,andthroatsoreness. Amongchildrenwithdiagnosedasthma,theauthorsreportasignificant
associationbetweenPM10andcoughsymptoms,whilenoconsistenteffectswereobservedintheother
groups. Sincethestudypopulationhasanoverrepresentationofasthmatics,duetothesampling
2TheAmericanLungAssociation(2002a,Table7)estimatesasthmaprevalenceforchildren517at5.67%(basedondata
fromthe1999NationalHealthInterviewSurvey).
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strategy,theresultsfromthefullsampleofchildrenarenotgeneralizeabletotheentirepopulation.
TheCRfunctionpresentedbelowisbasedonresultsamongasthmaticsages6to18.
ThePM10coefficientandstandarderrorarebasedonanincreaseinoddsof8%(95%CI016%)reported
intheabstractfora10 g/m3increaseindailyaveragePM10.
FunctionalForm:LogisticCoefficient:0.007696
StandardError:0.003786IncidenceRate:dailycoughrateperperson(Vedaletal.1998,Table1,p.1038) =0.086Population:asthmaticpopulationages6to18=5.67%.3UpperRespiratorySymptoms(Pope1991)
Usinglogisticregression,Popeetal.(1991)estimatedtheimpactofPM10ontheincidenceofavarietyof
minorsymptomsin55subjects(34schoolbasedand21patientbased)livingintheUtahValley
fromDecember1989throughMarch1990. ThechildreninthePopeetal.studywereaskedtorecord
respiratorysymptomsinadailydiary. Withthisinformation,thedailyoccurrencesofupperrespiratory
symptoms(URS)andlowerrespiratorysymptoms(LRS)wererelatedtodailyPM10concentrations. Pope
etal.describeURSasconsistingofoneormoreofthefollowingsymptoms: runnyorstuffynose;wet
cough;andburning,aching,orredeyes. Levelsofozone,NO2,andSO2werereportedlowduringthis
period,andwerenotincludedintheanalysis.
Thesampleinthisstudyisrelativelysmallandismostrepresentativeoftheasthmaticpopulation,
ratherthanthegeneralpopulation. Theschoolbasedsubjects(ranginginagefrom9to11)were
chosenbasedonapositiveresponsetooneormoreofthreequestions:everwheezedwithoutacold,
wheezedfor3daysormoreoutoftheweekforamonthorlonger,and/orhadadoctorsaythechild
hasasthma(Popeetal.1991,p.669). Thepatientbasedsubjects(ranginginagefrom8to72)were
receivingtreatmentforasthmaandwerereferredbylocalphysicians. Regressionresultsfortheschool
basedsample(Popeetal.1991,Table5)showPM10significantlyassociatedwithbothupperandlower
respiratorysymptoms. ThepatientbasedsampledidnotfindasignificantPM10effect. Theresultsfrom
theschoolbasedsampleareusedhere.
Thecoefficientandstandarderrorforaoneg/m3changeinPM10isreportedinPopeetal(1991,Table
5).
FunctionalForm:LogisticCoefficient:0.0036
StandardError:0.0015
3TheAmericanLungAssociation(AmericanLungAssociation2002a)estimatesasthmaprevalenceforchildren517at
5.67%(basedondatafromthe1999NationalHealthInterviewSurvey).
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IncidenceRate:dailyupperrespiratorysymptomincidencerateperperson=0.3419(Popeetal.1991,Table2)
Population:asthmaticpopulationages9to11=5.67%ofpopulationages9to11.4
4 TheAmericanLungAssociation(2002a,Table7)estimatesasthmaprevalenceforchildrenages5to17at5.67%(based
ondatafromthe1999NationalHealthInterviewSurvey).
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