Elsevier

Annals of Epidemiology

Volume 19, Issue 4, April 2009, Pages 257-263
Annals of Epidemiology

Health Effects of Particulate Air Pollution

https://doi.org/10.1016/j.annepidem.2009.01.018Get rights and content

In the 1980's it was generally felt that particulate air pollution concentrations in the United States were not a hazard to the public health. However, in the early 1990's the application of econometric time-series studies and prospective cohort studies suggested increased mortality associated with acute (daily) and chronic (decades) exposures to particulate air pollution commonly observed in the developed world. The epidemiologic evidence was not supported by evidence of causal associations from other disciplines. Nevertheless, the EPA moved to tighten controls on fine particulate air pollution. The debate over the science was played out in public hearings and the courts. The experience provides lessons on the use of epidemiologic data in setting public policy.

Section snippets

What is Particulate Air Pollution?

In the simplest terms, particulate air pollution is anything solid or liquid suspended in the air. It includes smoke, fumes, soot, and other combustion by-products, but also natural particles such as windblown dust, sea salt, pollen, and spores. It includes primary particles coming directly out of exhaust stacks and tailpipes, but also can include secondary particles, such as sulfates and nitrates, which form from condensation of vaporized materials or from the by-products of the oxidation of

Early Epidemiology and Regulation

The goals of early air pollution legislation in the United States were broad and general, but called for a science-based approach to control. The 1970 Clean Air Act required identification of pollutants which “may reasonably be anticipated to endanger public health and welfare”. The Act required the government to establish criteria which “accurately reflect the latest scientific knowledge useful in indicating the kind and extent of all identifiable effects on public health and welfare” (section

Review of the EPA Particle Standard

The Clean Air Act requires the EPA to periodically review the ambient air quality standard based on the latest scientific knowledge of health effects, but the epidemiology evidence remained limited. Nevertheless, in 1987 the EPA replaced the TSP standard with a standard for particles smaller than 10 μm (PM10) (9). This standard was based on dosimetric studies that had shown that particles larger than PM10 did not penetrate the body's defenses in the nose, mouth, and upper airways and were

Time Series Studies

In the 1980′s, analyses of counts of daily mortality in London had found inconsistent associations with concurrent particle (Black Smoke) measurements (14). Drs. Joel Schwartz and Allan Marcus of the EPA Reanalyzed the London daily mortality data using a time series approach (15). These new analyses showed increased daily deaths associated with daily Black Smoke concentrations down to the lowest observed concentrations. However, because of the uniqueness of this approach, the different

Studies of Effects of Long-Term Particle Exposures

While the epidemiologic evidence was strong for a causal link between episodically elevated particulate air pollution and daily mortality, the question remained whether these associations represented substantial life-shortening and whether repeated or chronic exposures to elevated PM were associated with additional risks.

The prospective follow-up of the sample of adults in the Harvard Six Cities study provided an opportunity to examine survival associated with city-specific mean air pollution

EPA Forced to Act

The Clean Air Act requires that the standards be reviewed every 5 years to reflect the latest scientific knowledge. The EPA last had reviewed the particle standard in 1987. Based on the epidemiologic evidence from the time-series and prospective cohort studies that appeared in the early 1990′s, the American Lung Association sued EPA in federal court in 1994 to force the agency to review the PM10 standard (39). The court ordered the EPA Administrator to review the particle air quality standard

1997 Decision and Subsequent Research

In the meantime, the review of the particle standard required by the court continued, and in 1997 the EPA promulgated a new standard for PM2.5(48). The decision to regulate PM2.5 was still based largely on the epidemiologic evidence. As part of that decision, the EPA asked the National Research Council to convene a panel to evaluate the research needs in other fields of science, such as toxicology, to more fully understand particulate air pollution exposures and health effects. As a result

Lessons

Epidemiology played a key role in identifying a major threat to public health and provided key information that led to standards for particulate pollution that are having a substantial beneficial effect on public well being. Vested interests fought those standards by attacking the epidemiologic evidence in general and specific key studies. Ultimately those attacks failed, but they delayed regulations that would have provided greater health protection for the public. Many public health issues

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