Presentation on theme: "Air Pollution and Public Health Limited time, we will discuss: Asthma Ischemic Stroke Otitis Media Myocardial Infarction."— Presentation transcript:
Air Pollution and Public Health Limited time, we will discuss: Asthma Ischemic Stroke Otitis Media Myocardial Infarction
Co-Authors for many projects Leonard Bielory, MD Van Dunn, MD MPH Susan Meehan RPh William Gauff, EMT Yu-Feng Chan, MD Hosseinali Shahidi, MD MPH Ronald B. Low MD
Most Data from New York City Hospital data available to me now from NYC Health and Hospitals Corporation (HHC) Pollution data from EPA Weather data from NWS Pollen data from Dr. Bielory NJ, NYC Issues pretty much the same Inferred NJ calculations
Similar atmospheric Conditions: NJ & NYC Weather Pollution Pollens: Only measured in NJ
NO x : NY and NJ Not as close as temperature, but clearly related (p<.0001) The closer to NYC, the tighter the relationship Generally, NJ levels only slightly lower than NYC levels: both ppm
Asthma One of the most studied diseases related to air pollution Our model is conservative, ascribing changes in asthma rates to: Time (seasons) Then weather and airborne allergens Last pollution effects
Basic Statistics NJ: 16,390 admissions in 2003 HHC: 15,914 admission in 2003 HHC: 59,865 ED Visits for asthma in 2003
Other effects Confounded with temperature, hard to show graphically in 3 or more dimensions
Model Time modeled first: Autoregressive effects of 1,2 and 7 days earlier; moving average effects of 6 and 365 days earlier 4 visits/day increase with weed pollen count increase of more URI visits 1 more asthma 10μg/m 3 particles<10μ, 2 more visits
Rough estimate of the effect small particles on NJ asthma Assuming causality Conservative Model 900 additional admissions in additional ED Visits in 2003
Ischemic Stroke Not as seasonal/time dependent as asthma Weekly effect and holiday effects. Conservatively, we adjust for them before looking for a pollution effect.
Ischemic Stroke NJ 2003: – 21,899 Admissions for all ischemic events NYC study average 9.34 strokes/day*2556 days. In 2003: –2615 Admissions for all ischemic events –1338 Ischemic Strokes Entire 8 year NYC: 23,888 ischemic strokes
Weekend, Holiday Effects Holiday=New Years, Martin Luther King, Presidents Day, Easter, Memorial Day, July 4, Labor Day, Thanksgiving, Christmas Average 0.9 fewer strokes ( ) on weekends (p<0.0001) Average 1.1 fewer strokes ( ) on holidays, p=.0002
White Stroke and Pollution Probably a real NO x effect, p= Best modeled as a logarithmic effect (Normality) Average effect 0.47 strokes/day, 2118 strokes during study, adjusted for weekends, holidays and temperature Assuming causality, ESTIMATED 2003 NJ effect: 1,900 strokes; 95 th % 112 strokes
Otitis Media Like asthma, seasonal and weekly effects We looked at clinic visits as well as ED visits Again, we model conservatively
Otitis visits: Basic Statistics HHC: – 809,252 visits during study –Average 181/day (lots of seasonal variability) –2003: 55,533 visits NJ: We do not have outpatient data
Otitis Model Except for NO x, I will not discuss coefficients: Log transform makes interpretation difficult –Temperature: lower is worse, p= –Weekends better than weekdays, p<.0001 –Holidays better than workdays, p<.0001 –365 day seasonal pattern, p<.0001 –URIs make otitis worse, p<.0001
Effect of NOx on NJ Otitis The log*log effect means that high levels are more problematic than low levels Assuming Causality: Lowering NOx to low levels should reduce OMV visits by between 2% to 8%, depending on starting levels and other assumptions.
Model Works Prospectively
Myocardial Infarction NJ in 2003: 22,464 HHC: –in 2003: 2,623 –Entire study: 22,371 (very close to NJ 2003)
MI Model No significant seasonal effect Worse on weekdays (p<.0001) Worse as temperature drops, p<.0001 No significant snow effect Curvilinear exacerbating effect of NO x, worse at highest levels, p= The effect is statistically small except until around the top 5 th % (>.14ppm). Difficult to accurately estimate effect.
Reservations Observational Studies –Limited to temperature and pollutant ranges we observed –Diagnostic accuracy dependent upon clinicians and coders –Pollutants co-correlated with each other, with weather, seasons, ?weekday traffic –These studies do not prove causality –Pollutant effects may be underestimated, they were always added last to model
Overall Conclusions Air pollution, at current levels, has some measurable relationship to asthma, otitis media, ischemic strokes and MI. NO x and suspended particles have the most widespread associations. If you assume causality, the health effects are significant