A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework
New York University1, Rutgers University2, University of Paris3, University of California, Berkeley4, University of California, San Francisco5, University of Michigan6, National Institutes of Health7, Umeå University8, University of Rochester Medical Center9, Queen Mary University of London10, Utrecht University11, National Institute for Health Research12, University of Basel13, Swiss Tropical and Public Health Institute14, University of Maryland, Baltimore15, University of California, Los Angeles16, University of Southern California17, Aarhus University18, Pompeu Fabra University19
TL;DR: A set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health are proposed.
Abstract: The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.
Citations
More filters
••
Icahn School of Medicine at Mount Sinai1, Pure Earth2, World Bank3, University of Arizona4, McGill University5, Indian Ministry of Environment and Forests6, Qatar Airways7, University of Health Sciences Antigua8, Ludwig Maximilian University of Munich9, Johns Hopkins University10, Boston College11, Chulabhorn Research Institute12, University of Maryland, College Park13, University of Ghana14, Centro Nacional de Investigaciones Cardiovasculares15, University of Chicago16, University of London17, University of Oxford18, Indian Institute of Technology Delhi19, Simon Fraser University20, Consortium of Universities for Global Health21, University of Ottawa22, Columbia University23, Stockholm Resilience Centre24, Massachusetts Institute of Technology25, University of Queensland26, University of California, Berkeley27, New York University28, National Institutes of Health29, Public Health Research Institute30, United Nations Industrial Development Organization31, Renmin University of China32
TL;DR: This book is dedicated to the memory of those who have served in the armed forces and their families during the conflicts of the twentieth century.
2,628 citations
••
Health Canada1, United States Environmental Protection Agency2, Brigham Young University3, University of Texas at Austin4, University of British Columbia5, Health Effects Institute6, McGill University7, University of Minnesota8, Harvard University9, Utrecht University10, University of Washington11, Fudan University12, New York University13, University of California, Los Angeles14, University of Ottawa15, American Cancer Society16, University of California, Davis17, Cancer Prevention Institute of California18, University of New Brunswick19, Dalhousie University20, Carleton University21, Statistics Canada22, University of Toronto23, Chinese Center for Disease Control and Prevention24, St George's, University of London25, University of Hong Kong26, University of Ulm27, SERC Reliability Corporation28
TL;DR: PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.
Abstract: Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.
1,283 citations
••
University of Illinois at Chicago1, University of California, San Francisco2, Mayo Clinic3, National Institutes of Health4, Yonsei University5, Liverpool School of Tropical Medicine6, Beth Israel Deaconess Medical Center7, University of New Mexico8, New York University9, University of Toronto10, University of Cape Town11, University of Illinois at Urbana–Champaign12
TL;DR: Air pollution affects the immune system and is associated with allergic rhinitis, allergic sensitization, and autoimmunity, and it is also associated with osteoporosis and bone fractures, conjunctivitis, dry eye disease, blepharitis, inflammatory bowel disease, increased intravascular coagulation, and decreased glomerular filtration rate.
460 citations
••
University of Illinois at Chicago1, University of California, San Francisco2, Mayo Clinic3, National Institutes of Health4, Yonsei University5, Liverpool School of Tropical Medicine6, Beth Israel Deaconess Medical Center7, University of New Mexico8, New York University9, University of Toronto10, University of Cape Town11, University of Illinois at Urbana–Champaign12
TL;DR: Although air pollution affects people of all regions, ages, and social groups, it is likely to cause greater illness in those with heavy exposure and greater susceptibility, and Persons are more vulnerable to air pollution if they have other illnesses or less social support.
317 citations
••
TL;DR: Although the overall mortality attributable to air pollution decreased in China between 1990 and 2017, 12 provinces showed an increasing trend during the past 27 years, and air pollution remains an important risk factor.
247 citations
References
More filters
••
TL;DR: In this paper, the authors estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010.
9,324 citations
••
TL;DR: Fine particulate and sulfur oxide--related pollution were associated with all-cause, lung cancer, and cardiopulmonary mortality and long-term exposure to combustion-related fine particulate air pollution is an important environmental risk factor for cardiopULmonary and lung cancer mortality.
Abstract: ContextAssociations have been found between day-to-day particulate air pollution
and increased risk of various adverse health outcomes, including cardiopulmonary
mortality. However, studies of health effects of long-term particulate air
pollution have been less conclusive.ObjectiveTo assess the relationship between long-term exposure to fine particulate
air pollution and all-cause, lung cancer, and cardiopulmonary mortality.Design, Setting, and ParticipantsVital status and cause of death data were collected by the American
Cancer Society as part of the Cancer Prevention II study, an ongoing prospective
mortality study, which enrolled approximately 1.2 million adults in 1982.
Participants completed a questionnaire detailing individual risk factor data
(age, sex, race, weight, height, smoking history, education, marital status,
diet, alcohol consumption, and occupational exposures). The risk factor data
for approximately 500 000 adults were linked with air pollution data
for metropolitan areas throughout the United States and combined with vital
status and cause of death data through December 31, 1998.Main Outcome MeasureAll-cause, lung cancer, and cardiopulmonary mortality.ResultsFine particulate and sulfur oxide–related pollution were associated
with all-cause, lung cancer, and cardiopulmonary mortality. Each 10-µg/m3 elevation in fine particulate air pollution was associated with approximately
a 4%, 6%, and 8% increased risk of all-cause, cardiopulmonary, and lung cancer
mortality, respectively. Measures of coarse particle fraction and total suspended
particles were not consistently associated with mortality.ConclusionLong-term exposure to combustion-related fine particulate air pollution
is an important environmental risk factor for cardiopulmonary and lung cancer
mortality.
7,803 citations
••
TL;DR: The overall prevalence and absolute burden of hypertension in 2000 and the global burden in 2025 were estimated to be about 1.56 billion (1.54-1.58 billion) and the number of adults with hypertension in 2025 was predicted to increase by about 60% respectively.
7,633 citations
"A joint ERS/ATS policy statement: w..." refers background in this paper
...High blood pressure is the leading risk factor for morbidity and mortality worldwide, accounting for nearly half of all myocardial infarctions and strokes [1, 82]....
[...]
••
TL;DR: The criteria outlined in "The Environment and Disease: Association or Causation?" help identify the causes of many diseases, including cancers of the reproductive system.
Abstract: In 1965, Austin Bradford Hill published the article "The Environment and Disease: Association or Causation?" in the Proceedings of the Royal Society of Medicine. In the article, Hill describes nine criteria to determine if an environmental factor, especially a condition or hazard in a work environment, causes an illness. The article arose from an inaugural presidential address Hill gave at the 1965 meeting of the Section of Occupational Medicine of the Royal Society of Medicine in London, England. The criteria he established in the article became known as the Bradford Hill criteria and the medical community refers to them when determining whether an environmental condition causes an illness. The criteria outlined in "The Environment and Disease: Association or Causation?" help identify the causes of many diseases, including cancers of the reproductive system.
6,992 citations
••
Mohammad H. Forouzanfar1, Lily Alexander, H. Ross Anderson, Victoria F Bachman1 +733 more•Institutions (289)
TL;DR: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) as discussed by the authors provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
5,668 citations