PRESENTATION NAME

Air Pollution and Built Environment: How Where You Live Affects Your Health Francine Laden, ScD

Mark and Catherine Winkler Associate Professor of Environmental EpidemiologyHarvard School of Public HealthBoston MA USA1OverviewThe Nurses Health Study

Air pollutionExposure modelingAssociations with health

The Built EnvironmentConceptual modelThe county sprawl indexIndividual level measures

Summary

The Nurses Health StudiesProspective cohort studies of US womenNHS: 121,700 nurses enrolled in 1976, aged 30-55NHSII: 118,000 nurses enrolled in 1989, aged 25-45

Followed every 2 years by mailed questionnaireDisease follow-upRisk factors and exposures

At BaselineNHS 1976

NHSII 19894And Now

NHS 1986-2010

NHSII 1989-20095

AIR pollution

Exposures

Spatio-temporal ModelsGIS techniquesComplex model including existing monitoring networks, weather, andGIS covariates including distance to road, elevation, land-use, county level emissions, population density, point source emissions

Monthly average models PM10, PM2.5, PM10-2.5Average Monthly PM2.5

Distance to Major RoadUS Census Road ClassificationsA1 (primary roads, typically interstates, with limited access)A2 (primary major, non-interstate roads)A3 (smaller, secondary roads, usually with more than two lanes)

Green = A1, purple =A2, red=A3Jaimes house=163 m fr closest A2, 645 m to the pikeLandmark=15 m fr closest A2, to nearest A3 340 m, to nearest 510 m to A1Brigham = 220 m fr closest A2Channing=85 m fr closest A2

10Hazardous Air Pollutants (HAPs)EPA National Air Toxics Assessments1990, 1996, 1999, 2002, 2006Includes metals, diesel particulate, methylene chloride, quinoline, styrene, trichlorethylene, vinyl chloride

Census tract level estimated concentrations of pollutants from outdoor sources based on dispersion models

associations with health

Adjusted for age, year, season and state of residence16% increase per 10 g/m3 in 12-month avg PM10Puett et al. AJE 2008: 168:116168All-cause Mortality and PM10Northeastern Region 1992-200413OutcomeHR (95% CI)PM2.5PM10-2.5All-cause mortality1.29 (1.03,1.62)0.96(0.82,1.12)First CHD1.10 (0.76,1.60)1.01 (0.78,1.31)Fatal CHD2.13 (1.07,4.26)0.91 (0.56,1.48)Non-fatal MI0.71 (0.44,1.13)1.06 (0.77,1.47)Adjusted for the other size fraction, age, state, year, season, smoking , BMI, risk factors for CHD, physical activity, neighborhood SES.Puett et al. EHP 2009: 117:16971701Mortality and Coronary Heart Disease 10 g/m3 Fine and Coarse PMAdd in Jens slides14Effect Modification BMI and SmokingFatal CHD and PM10

Puett et al. AJE 2008: 168:116168Add in Jens slides15Cognitive DeclinePM can access the brain viaCirculationIntranasal route direct translocation through olfactory bulb

where it may precipitate inflammatory response, injure BBB, increase amyloid beta

Associations with CVD, stroke, and vascular risk factorsCognitive DeclineNHS participants 70 yrs n= ~17,000Cognitive assessment by telephoneTests of working memory attention, global cognition, verbal memory/learning and verbal fluencyBaseline administered 1995-20012nd and 3rd approx 2 and 4 yrs laterPM10, PM2.5, PM10-2.5

Long-term exposure to PM10-2.5 in relation to decline in standardized cognitive scoreAdjusted for age, education, husband's education, smoking history, physical activity, and alcohol consumption.Median of PM10-2.5 quintile, g/m3refPtrend = 0.01Difference in global cognitive score change per 2 years, by increasing quintile of PM10-2.5

(ref: lowest quintile)1 year of ageWeuve et al. Arch Intern Med 2012: 172:219-2718May also damage bbbMay adversely affect cog reserve (e.g., early life exposures)Stronger association with measures of long-term exposure to PM10-2.5Adjusted for age, education, husband's education, smoking history, physical activity, and alcohol consumption.Past monthPast 2 yrsPast 5 yrsSince 1989Past yrDifference in global cognitive score change per 2 years,per 10 g/m3increase in PM10-2.51 year of age19Effect size is similar to what we see with people who are 1-2 years apart in age.Long-term exposure to PM2.5 in relation to decline in standardized cognitive scoreMedian of PM2.5 quintile, g/m3Ptrend = 0.11Difference in global cognitive score change per 2 years, by increasing quintile of PM2.5

(ref: lowest quintile)Adjusted for age, education, husband's education, smoking history, physical activity, and alcohol consumption.1 year of age20May also damage bbbMay adversely affect cog reserve (e.g., early life exposures)Stronger association with measures of long-term exposure to PM2.5 Adjusted for age, education, husband's education, smoking history, physical activity, and alcohol consumption.Past monthPast 2 yrsPast 5 yrsSince 1989Past yrDifference in global cognitive score change per 2 years,per 10 g/m3increase in PM2.51 year of age21Effect size is similar to what we see with people who are 1-2 years apart in age.Parkinsons DiseasePM10PM2.5Quartiles (g/m3)casesRR (95% CI)Quartiles (g/m3)casesRR (95% CI)4.3-18.8117Ref0-11.4120Ref18.8-21.61351.27 (0.98, 1.64)11.4-13.31241.08 (0.83, 1.40)21.6-24.91381.33(1.02, 1.72)13.3-`15.41361.17 (0.90-1.52)24.9-68.91251.28(0.96-1.70)15.4-49.81351.19 (0.90,1.56)P for trend0.08P for trend0.18Per 10 g/m35151.16 (0.96-1.40)Per 10 g/m35151.34 (0.95, 1.89)Adjusted for age, smoking, region population density, caffeine intake and ibuprofen use

Palacios et al. in preparationDiabetesParticulate Matter1 IQR HR (95% CI)PM2.50.99 (0.92,1.08)PM10-2.51.04 (0.98,1.11)Distance to Road metersHR (95% CI)