MODELLING OF AIR POLLUTION AND HEALTH EFFECTS in INDIA

THE NEXUS OF CLIMATE AND HEALTHCentre for Global Health Delivery & Harvard Global Health Institute

23rd February, 2021

Poornima Prabhakaran MBBS MSc PhD

Head-Environmental Health & Additional Professor

Deputy Director, Centre for Environmental Health

Public Health Foundation of India

Consultant, Centre for Chronic Disease Control

Ambient PM2.5 Variation Over Time

99% of districts above WHO annual exposure guidelines60% above National Ambient Air Quality Standards

Source: Urbanemissions.info 2

Air Pollution: Headline for 2017• Annual population-weighted mean exposure to ambient particulate matter

PM2·5 in India was 90 μg/m3 (more than twice the recommended values by the National Ambient Air Quality Standards in India)

• Indo Gangetic plain has the highest exposure

• Proportion of population using solid fuels in India: 55·5%: exceeds 75% in the low SDI states of Bihar, Jharkhand, and Odisha

• 1·24 million deaths ( 1 in 8 total deaths) attributable to air pollution: 0·67 million from ambient particulate matter pollution and 0·48 million from household air pollution.

• >50% 0f deaths premature ( <70 years of age)

• Average of 1.7 years loss in life expectancy The Lancet Planetary Health 2019 3, e26-e39DOI: (10.1016/S2542-5196(18)30261-4)

Balakrishnan et al The Lancet Planetary Health 2019 3, e26-e39DOI: (10.1016/S2542-5196(18)30261-4)

Chronic Diseases linked to Air Pollution…………what is known?

?? Hypertension , Diabetes and Obesity

Indians have one of the highest risk for CVD and diabetes in the world

Others: Heart Failure; Dementia; cognitive impairment

Mechanisms of increased risk for CVD from air pollution : A summary

• Endothelial dysfunction

• Inflammation/ Lipid peroxidation

• Increased BP

• Abnormalities of Heart rhythm

• Metabolic abnormalities

• Atherosclerosis

• Hypertension

• Arrhythmias

• LV dysfunction

• Ischemic Heart D

• Peripheral Vasc. D

• Congestive HF

• Arrhythmias/Sudden death

PM2.5 & others

Do we have evidence in India for health effects of air pollution?

• Studies linking maternal exposure and birth outcomes

• Studies linking adult exposure and respiratory health

• Cross-sectional studies linking acute air pollution episodes and rise in emergency room footfall for acute respiratory infections

• Studies from global burden of disease estimates and exposure –response functions using data from developed countries

Contextualized local studies based on exposure assessments-

modelled/ measured and longitudinal datasets of health outcomes in India ???

What can be done ? What have we done so far??

What more can we do---and together?

The CArdiometabolic Risk Reduction in South Asia CARRS Study - Sampling

Wards

Census Enumeration Blocks (CEBs)

Households

Individuals : 1 M and 1 F

Two metropolitan cities- Delhi and Chennai

8000 Adults aged ≥ 20 years , 2010

Sampling: Multi-stage cluster random sampling, stratified for gender

Primary sampling units

Delhi and Chennai: Ward

Collaboration between CCDC, PHFI , AIIMS, MDRF in India and Emory University, USA

Example: Delhi

1st Follow-up Survey

2nd Follow-up Survey

(B)

Cohort 1

2011

3rd Follow-up Survey

The CARRS Study - Design

Community Population

Community Population

Random Sample Cross-

Sectional Survey (B)

Random Sample Cross-

Sectional Survey (B)

4th Follow -up Survey (B)

2012 2013 2014 2015

Cohort 2

1st Follow-up Survey

2016

2018

Robust exposure assessment ( PM2.5) at fine resolution

Link exposure to CV Risk factors and outcomes

Capacity building in the science of air pollution

10

Main

Objectives

10

Air Pollution and Cardiometabolic health: The Geo-Health Program

Goal: A fully integrated research and training program on air pollution and cardiometabolic diseases with policy relevance to improve health of Indians

Develop an exposure model to predict daily PM2.5 concentrations at a 1 km2 spatial resolution for Delhi

A total of 1635 grids, 7 years (2010-16), 2557 days

4180695 observations

Main Objective : Link PM 2.5 levels to incident CVD risk factors and outcomes in Delhi and Chennai

Air Pollution and Cardiometabolic health: The Geo-Health Program

Area: 1484 km2

Air Pollution and Cardiometabolic health: The Geo-Health Program

Data from multiple sources

Monitoring data

AOD Land Use Variables

Chemical Transport

Model

Adjusted for meteorological

variables

Air Pollution and Cardiometabolic health: The Geo-Health Program Structure of Model : “Ensemble modelling”

+ +

Mandal S, Madhipatla KK, Guttikunda S, Kloog I, Prabhakaran D, Schwartz JD. Ensemble averaging based assessment of spatiotemporal variations in

ambient PM2.5 concentrations over Delhi, India, during 2010-2016. Atmos Environ (1994). 2020 Mar 1;224.

Air Pollution and Cardiometabolic health: The Geo-Health Program Some interesting results

Initial estimates of PM2.5 exposures over Delhi

• 3296 individuals from 2248 households with 3 BP measures over 7 years

• Long- & short-term exposure to ↑ particulate matter concentrations associated with ↑ BP & risk of developing HTN in urban India

• Every +25 µ/ m3 of PM2.5 : ↑ BP by 3.5-5mmHg depending on BMI

• Achieving national ambient air quality standards can potentially ↓ prevalence of HTN by 15% in urban Delhi

• Implications for health care access and delivery

• Treating Sick populations: Non-Personal policy interventions can have major benefits

Air Pollution and Cardiometabolic health: The Geo-Health Program Summary

Prabhakaran D, Mandal S, Krishna B, Magsumbol M, Singh K, Tandon N, Venkat NarayanKM, Shivashankar R, Kondal D, Ali MK, Srinath Reddy K,

Schwartz JD. Exposure to Particulate Matter Is Associated With Elevated Blood Pressure and Incident Hypertension in Urban India.Hypertension.

2020 Oct;76(4):1289-1298. doi: 10.1161/HYPERTENSIONAHA.120.15373. Epub2020 Aug 17.

Average increase in SBP and DBP per interquartile increase in PM2.5

Interaction with Central adiposity

PM2.5 Fasting Plasma Glucose and HbA1c

Delhi Chennai

Unpublished results-please don’t share

Personal Exposure Monitoring Study – PI Kishore Madhipatla

Aim: To characterize personal exposure of PM2.5 , Black Carbon, and heavy metals among

100 adults belonging to various age and socio-economic groups residing in Delhi

Air Pollution

monitor

GPS pouch

Specifications 1. Personal air pollution Monitor

Model: pDR 1500, Thermo Scientific.,

Waltham, MA

Sampling frequency: 1 min

Sampling time: 24h (once in summer and

once in winter)

Sampling Technique: Photometry (Real-

time) and Gravimetry (Federal

Reference Method)

Tubing. Tygon (anti-static)

Filter material: Teflon

2. GPS enabled with a tri-axial

accelerometer

Model: eTrex 30, Garmin., Olathe, KS

Sampling frequency: 1 min

Participants profile

43 57

Total Participants: 100

Nested in CARRS

longitudinal cohort in

Delhi

Age group: 30-60

Non- smokers

Non-pregnant women

Occupation >40 different professions

List of occupations of few participants

Type of

neighbourhood

Total

Participants

Slum 18

JJ colony 25

Non-Slum 57

Location Total

Participants

Urban-Delhi 90

Rural-Delhi 10

Driver

Paratha-wala

Carpenter

Property dealer

Electronics

technician

Flour mill worker

Metal Smith

Farmer

Travel agent

Shop Keeper

Vegetable seller

Textile industry

worker

Teacher

Water supplier

Delivery executive

Tailor

IT employee

Housewife

Flower seller

Household

industry worker

Domestic maid

Brick Kiln Owner

Government peon

Marketing

Executive

PM2.5 exposure profile

Fig: Left hand side image shows PM2.5 exposure profile of one of the participants (who works as an office-assistant in an office in New

Delhi) during summer-2019. The right hand side graph represents her activity based exposures over the day of measurement.

Travel Occupational Cooking SleepingExposures:

Personal PM2.5 exposures variability across occupations

Capacity Building Initiatives

1. Short Term• 1-2 week training programmes for faculty and health system professionals• Establishing linkages with national and international institutions for exchange

programmes -Emory, Michigan, HSPH, Columbia, Israel, Queensland, UK, Europe

3. Long Term• Development of an integrated MPH/PhD programme in Environmental Health• Establish systematic evidence base for multiple exposures and health impacts

2. Medium Term• Pilot grants for young researchers/faculty at PHFI & TISS• Short-term exchange programs • Career development workshops with national and international experts• Aid in the development of evidence informed policy

Establish a critical mass of environmental

health researchers and policymakers in

India

24

Completed Courses:• Introduction to Environmental Health (September 2016)• Air pollution, Climate and Health – Methods & Modelling (January 2017)• Research Ethics for Environmental Health (February 2017)• Workshop on Remediation of Polluted Sites (August 2017) • Principles of Toxicology (September 2017)• Introduction to Environmental Health (September 2017)• Air pollution, Climate and Health – Methods & Modelling (January 2018)• Occupational and Environmental Medicine (March 2018)• Risk Assessment (May 2018)• Food and the Environment, 23-27 July 2018• Environmental Exposure Assessment, 22-27 October 2018, • A short course was organised in Delhi with Prof. Petros Koutrakis and his post-doctoral fellow Dr. Annelise

Bloomberg (Harvard T.H. Chan School of Public Health), Prof. Tarun Gupta (IIT-Kanpur) from 10-14, December 2018

• A three-day ethics course , 17-19, December 2018 • Environmental and occupation health , 7-11th January, 2019• System science approaches for clean cooking (with Boston College and Indian and Bangladesh GEO-Health Hubs),

11-13, February 2019• Occupation medicine, 18-22, February, 2019 • Satellite –based exposure assessments with NASA scientists- Feb 2020

Short-term training

25

Short courses: Participants profile

26

• Beneficiaries represent a number of National institutions including medical colleges, universities, research organizations, government institutions, and think tanks

• Most from public health or medical background with master’s level or higher training

• Participants from the Bangladesh and Ghana GEOHealth Hubs have also attended courses, joint courses are planned for coming years

Over 300

beneficiaries till

date

27

Future directions: Expansion of the PM2.5 model nationwideConsortium for Health effects of AIR

Pollution in India (CHAIR-India)*-May 2019

NATIONWIDE EXPOSURE MODEL for PM2.5

• Daily 1x1 km predictions

• 2008-2020

• Covering rural and urban areas

Health association studies Useful in existing cohorts of:

• Maternal and child health• Cardiovascular health• Pulmonary health• Diabetes and metabolic health• Cognitive function

Prabhakaran, P., et al. (2020). "Building capacity for air pollution epidemiology in India.

" Environmental Epidemiology 4(5): e117

• To develop a nation-wide exposure model for daily ambient PM2.5 and ambient temperature from 2008-2020 at a spatial resolution of 1x1km and locally at 200x200m in India; interactions with heat and flooding

• Link our national estimates of PM2.5 and temperature to health data to quantify the associations between PM2.5 and ambient temperature, independently and jointly on the following major public health endpoints:

Total Mortality

Cardiometabolic outcomes

Lung function outcomes

Other health outcomes- multiple studies and research groups in the CHAIR consortium

• Create a public website with environmental data on a 1x1km grid that can be used by planners, policy makers and general public to increase awareness and aid decision-making

• Specifically engage with key stakeholders using a dedicated communications strategy that will increase the efficiency of the project, disseminate results well beyond the scientific community and facilitate translation of project deliverables into policy action

Climate, Health and AIr pollution Research in India (CHAIR-India) Addressing Gaps in Achieving the Sustainable Development Goals(3,11 and 13)

New Frontiers

Significance of CHAIR consortium model

Results will be highly relevant to Indian environmental health policy

Open-sourcing PM2.5 model

Access to PM2.5 predictions

Temperature

Greenspace

Population and land-use data

Accelerate research activity

Facilitate public health planning and interventions

Increase public awareness

Capacity building through training programs

Areas of concern

• Access to data

• Funding

• Sustainability

• Capacity building – Placement(demand vs supply), job creation strategies for both public health and environmental sciences -?Integration

THANK YOU FOR YOUR ATTENTION

With sincere thank you and appreciation to all my colleagues at Centre for Environmental Health, Public

Health Foundation of India &

Centre for Chronic Disease Control, New Delhi