Acute Health Effects from Changes in Air Pollution and Weather in Heart Failure

1
Acute Health Effects from Changes in Air
Pollution and Weather in Heart Failure

• Mark Goldberg, PhD
• Department of Medicine
• McGill University

1
2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
Findings for Postmenopauasal Breast Cancer
6
Total Cardiovascular Mortality (ICD9 400-440)

• PM2.5 12 (95CI 1.09-1.15) increase in
  mortality rate for an increase of 10 µg/m3
• other pollutants no strong evidence of
  association

6
7
Research Questions for Acute Effects

• Does the number of adverse health events on a
  particular day increase if environmental
  conditions change on that day or on previous
  days?
• How far back in time (lag) do these changes
  affect health?
• If yes, are there certain populations
  particularly susceptible to these conditions?

8
Air Pollution Episodes
Donora, Pennsylvania (Oct 26-31, 1948) 14,000
residents 20 people died and over 7,000 were
hospitalized
London, UK (Dec 5-9, 1952) 3,000 more deaths
9
Aug 14 2002 PM2.537µg/m3
72 times lower than the 1952 London episode
9
10
Aug 27 2002 PM2.53µg/m3
10
11
Air Pollution Episode London, 1958-1959
NB Mortality after removing 15-day running
average
Flu epidemic Feb 18-20
Excess mortality200-250
12
(No Transcript)
13
Estimated attributable number of deaths in
various smog episodes occurring in London,
England, 1948-1962
14
Studies in Montreal

• Daily nonaccidental mortality in Montreal, from
  Quebec death certificates, 1984-2002
• Daily weather conditions recorded at Dorval
  International Airport, 1984-2002
• Daily average concentrations of air pollutants
  (e.g., NO2, O3) from the various monitoring
  stations in Montreal

14
15
Principal Air Pollution Monitors in Montreal
15
16
Time Series for Ozone, 1984-2002, Montreal.
The solid line represents the long-term trend in
the data.
17
Time Series for NO2, 1984-2002, Montreal.
The solid line represents the long-term trend in
the data.
18
Daily Nonaccidental Mortality, 1984-2002, Montreal
The solid line represents the long-term trend in
the data.
19
Temporal Cycles in Mortality
20
Filtered Mortality Time Series Nonaccidental
Causes
21
Montreal 1984-1993
22
(No Transcript)
23
Daily Maximum Temperature, 1984-2002, Montreal.
The solid line represents the long-term trend in
the data.
24
Air Pollution is a Complex Mixture
24
25
Nonaccidental Mortality and Ozone

25
26
Pooled Estimates of the Percent Increase in Daily
Mortality
From Stieb et al. J Air Waste Manag.Assoc.
200353258-61
27
Susceptible Populations Time Series Study of
Non-accidental Mortality Among Persons With
Specific Health Conditions
27
28
Congestive Heart Failure
29
Diabetes and Cardiovascular Disease
30
Possible Mechanisms
31
Particle Retention in Human Lungs
Data from Michael Brauer, U. of British Columbia.
31
32
Controlled Human Exposure Studies
Direct controlled human exposure studies to
determine dose-response relationships
of individual pollutants (if any) and uncover
biological mechanisms. Findings Inflammatory
response after exposure Thickening of arterial
walls
Human Exposure Facility at the Gage Occupational
and Environmental Health Unit of the University
of Toronto
.
32
33
Possible Mechanisms
Source Brook et al 2004 Circulation
33
34
Effects of Temperature
35
35
36
Myocardial Infarction Hospitalizations and
Maximum Temperature
36
37
Climate Change
37
38
Changes in the Distribution of Weather
38
39
Mortality from the 2003 Heat Wave
39
40
Montreal Recent Trends (April to September,
inclusive)
Red Maximum temperature Blue No. of days gt25C
40
41
Distribution of Maximum Daily Temperature,
Montreal, 2003
41
42
Sometime in the Future when Mean Global
Temperatures have Increased by 3C
42
43
Excess Mortality from Climate Change, Montreal,
Spring-Summer

• 2001 (57 days gt25C)
• Excess no. of deaths on days gt25C 212
• Projected to 2100 (97 days gt25C)
• Excess no. of deaths on days gt25C 454
• Attributable to Global Warming (3C) 454 - 212
  242 deaths 1.3 deaths/day during the warm
  season

44
Daily Diary Study of Congestive Heart Failure

• Nadia Giannetti, McGill
• Rick Burnett, Health Canada
• Nancy Mayo, McGill
• Marie-France Valois, McGill
• Jay Brophy, McGill

45
Objective

• To determine whether daily exacerbations in
  essential signs, symptoms, and physiologic
  indicators are associated with daily variations
  in concentrations of ambient air pollution and
  changing weather patterns

45
46
Design

• Daily diary of signs and symptoms
• Daily measurements of
• oxygen saturation, pulse rate
• weight
• blood pressure
• Daily measurements of air pollutants and weather
  conditions from fixed-site stations

46
47
Design

• 2 months duration per subject
• Very poor pumping of heart (ventricular ejection
  fraction lt35)
• Published Occupational and Environmental
  Medicine 200865659-6 and Environ Res
  2009109166-174

47
48
Page 2
48
49
Go Back
49
50
Pulse Oximeter
51
Results
51
52
52
53
53
54
54
55
55
56
New Panel Study
56
57
Modifications

• Increased sample size
• Expanded daily diary
• Environmental measurements inside and outside of
  the home
• Temperature, RH
• CO, PM2.5, NOX
• Air infiltration rates
• GPS device to estimate exposures outside of home

57
58
58
59
59
60
GPS Outdoor

Indoor
60