Air pollution and disease: are we asking the right questions? Dr Alex G Stewart CHaMPs July 2011

Local authority level 1998 to 2004 Levels of PM 10 & 0 3 associated with mortality Effect estimate considerably higher than previous estimates CO NO 2 PM 10 O 3 All cause mortality (2007) CASEpaper, 128. Centre for Analysis of Social Exclusion, London School of Economics and Political Science, London

VOC – greater variety PM 10 as mass masks increase in fines (<1µm) – numbers matter MASS

Increase in fines Decrease in S, Pb and SCPs [spheriodal carbon particles] Daresbury Delph, east of Runcorn Magnetic concentrations = accumulation / flux Fines may travel some distance ALSO – fines generated downwind of PM 10 sources Worsley & Powell unpublished work shows an increase in fine particles at Daresbury Delph

AIRPORT POLLUTION SIGNAL Post-1975 national airport activity and Oglet Pb flux Worsley & Powell also showed an increase in lead flux at Oglet near Liverpool airport Which they related to the increase in air travel.

Passenger transport by mode in Great Britain in billion passenger kilometre 1952–2007. Douglas M J et al. J Public Health 2011;33: © The Author 2011, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved Data Source: Transport Statistics Great Britain, 2009.

Chris Crosby, working with Prof Worsley of Edge Hill university Has been able to measure concentrations of road dust Every 5m along main roads. Magnentic concentration – metals in PM – rapid, simple, cheap

Mersey Basin cross-regional signal Lower Mersey Regional cross-section shows, in pond sediments, the ability to look at temporal and spatial magnetic records, thus allowing a profile of metal deposition to be developed. Worsley & Powell

Ormskirk Liverpool Industrial sites C&M COMAH

Deprivation NWPHO

Particles (estimated) & Deprivation PM 10 IMD

Classic diseases of air pollution Ayres et al. Environmental Medicine 2010 Asthma exacerbation Chronic Obstructive Pulmonary Disease (COPD) exacerbation & death Cardiovascular deaths, admissions, arrythmias PM 2.5 SO 2 NO 2 O 3 PM 10 SO 2 NO 2 PM 10 SO 2 O 3 PM 10 (not O 3 ) PM 10 PM 2.5 NO 2

Other recorded diseases Lung cancer (small amount) All cause mortality Intra-uterine death Birth defects Pre-eclampsia Diabetes mellitus Predisposition to asthma? Ear infections? Lower respiratory infections <5y olds

Polycyclic Aromatic Hydrocarbons PAHs carcinogenic, mutagenic, teratogenic Neurological development Predispose to asthma Preterm delivery (Af-Am) Small for gestational age Head/weight ratio

What about transgenerational effects?

Most disease is multi-factorial Stone? Sponge? What about lifestyle diseases?

Canada (Jerrett et al. JECH, 2004) Less Social StressMore Social Stress Lower air pollution-Health effect Higher air pollutionHealth effectIncreased effect Stress RATS (Clougherty et al. EHP, 2010) No Social StressSocial Stress No PM-Respiration effects PMRespiration effectsInflammatory Response Social Stress = deprivation (measured by low education & high manufacturing employment) (1) Addition: workplace exposures + ambient exposures (2) Lower educated less mobile => less measurement error => less bias (3) Manufacturing & education = proxy for material deprivation => susceptibility

Increases risk of lung cancer X2 - X9 fold Radon Could other pollutants?

Map 6: Renal disease in north Cheshire: age-sex standardised admission ratio 1996 to 2002 [1991 census wards] – this study Warrington Halton Source: Hospital Admission Statistics; ONS

NW England Poor health 100 years Pollution? Poverty? Lifestyle? Generational effect? A mixture of all?

Acknowledgements Apologies Public Health Environmental Scientists Epidemiologists Clinicians Geographers ……..