1. Scaling factors that relate human health costs to PM 2.5 exposures using available data David R. Brown Sc.D. Environment and Human Health NESCAUM

2. PROBABILITY OF A LOSS COST IN $

3. PROBABILITY OF A LOSS COST IN $

4. PROBABILITY OF A LOSS TOTAL COST IN $ A B C

5. PROBABILITY OF ASTHMA HOSPITALIZATION in CONNECTICUT COST IN $ Of ASTHMA hospitalization 1 2

6. Available scaling information plausible link between the exposures and disease. characterization of PM 2.5 exposures the incidence and prevalence of the diseases related to PM 2.5 Size of population at risk

7. Results from the Harvard Six-cities study: All Cause Mortality Rates most exposed to least exposed City Fine Particles All cause death 1.26 (1.08-1.47) Lung Cancer 1.37 (0.81-2.31) Cardio pulmonary 1.37 (1.11-1.68) Other causes 1.01 (0.79-1.30) Range of exposure 11-29.6 ug/m3 Dockery, NEJM 1993; 329: 1753-1759

8. Health actions from exposures of 2 hours or less. Peters etal. pm 2.5 & myocardial infarction –1.48 odds ratio 2 hr after 25ug/m3 increase –1.69 odds ratio 1 day after 20ug/m3 increase Gent etal. Severe asthma & O3, pm 2.5 –35% increase wheeze 1 hr after 50ppb O 3 inc. –47% increase in chest tightness 1 hr after. –1.24 odds ratio Chest tightness 12-18ug/m3 pm

9. PM 2.5 New Haven, Hartford and Waterbury (ug/m3)

10. This 3-month long series of hourly observations would be collapsed to a single value… 9.2 ug/m 3 … Totally obscuring any structure or other content within the data set (Carmine Dibattista, CT DEP). (22% of days each year exceed 30 ug/m3 for 6 hours)

11. Hospitalizations and costs for Connecticut 1998 8,264 heart attacks 9,835 Congestive heart failures 3,715 Asthma 8,352 Chronic obstructive pulmonary diseases $ 15,858 per heart attack $9,256 per Congestive heart failure admission $ 5,138 per asthma admission $ 6,876 per Chronic obstructive pulmonary disease

12. Adult diesel soot impacts Bridgeport, Stamford Norwalk 69 premature deaths 121 non fatal heart attacks 1,503 Asthma attacks 8,820 workdays lost 46 cases of chronic bronchitis www.cat.us/projects/diersel

13. O3 and PM2.5 Non-attainment Ozone and PM 2.5 non-attainment

14. Draft NESCAUM material submitted to EHP/JAWMA

17. PROBABILITY OF A LOSS TOTAL COST IN $ A B C Scale Y axis. $ 10s MM Scale X axis; Number of 6 hour episodes that exceed 30 ug/m3

18. PROBABILITY OF A LOSS TOTAL COST IN $ A B C Scale Y axis. $ 10s MM Scale X axis; Number of 6 hour episodes that exceed 30 ug/m3 25%10%20% $30 MM Savings Program costs RISK 5%

19. Summary Four things needed are available, 1)characterization of PM 2.5 exposures, 2)the incidence and prevalence of the diseases related to PM 2.5, 3) plausible link between the exposures and disease and, 4) a systematic tool to evaluate practical policy decisions