Health Effects of Particulate
Matter Air Pollution

C. Arden Pope III
Mary Lou Fulton Professor of Economics Presented at
EPA Wood Smoke Health Effects Webinar
July 28, 2011 What we breath impacts our health
 Pure Air nitrogen (78%),Oxygen (21%), Argon, CO
2
. . .
+
 Various gaseous pollutants including:
– SO
2
, NO
2

2.5
(2.5 mm)

Magnified ambient particles (www.nasa.gov/vision/earth/environment)

This presentation not organized
chronologically, but methodologically
Studies of short-term exposure (hours-days)
 Episode
 Population-based daily time-series
 Panel-based acute exposure
 Case-crossover

Studies of long-term exposure (years-decades)
 Population-based cross-sectional
 Cohort-based mortality
 Cohort- and panel-based morbidity
 Case-control studies

Intervention/natural experiment (months-years)

Controlled experimental human and animal

This presentation not organized
chronologically, but methodologically
Studies of short-term exposure (hours-days)
 Episode
 Population-based daily time-series
 Panel-based acute exposure
 Case-crossover

Controlled experimental human and animal

Early “Killer smog” episodes demonstrated that air pollution at extreme
levels can contribute to respiratory and cardiovascular disease and death
Dec. 5-9, 1952: London 1000’s of excess deaths
Dec. 1-5, 1930: Meuse Valley, Belgium
60 deaths (10x expected)
Oct. 27-31, 1948: Donora, PA
20 deaths, ½ the town’s population fell ill
Respiratory and cardiovascular
disease and death
London Fog Episode, Dec. 1952
From: Brimblecombe P. The Big Smoke, Methuen 1987
Utah Valley, 1980s
• Winter inversions trap local pollution
• Natural test chamber
• Local Steel mill contributed ~50% PM
2.5
• Shut down July 1986-August 1987
• Natural Experiment
Large difference in air quality
when inversions trap air pollution in valley
Utah Valley: Clean day
Utah Valley: Dirty day
(PM
10
= 220 mg/m
3
)
m

Asthma
Total
Children's Respiratory Hospital Admissions
Fall and Winter Months, Utah Valley
Sources: Pope. Am J Pub Health.1989; Pope. Arch Environ Health. 1991
When the steel mill was open, total children’s hospital
admissions for respiratory conditions approx. doubled.
m
g/m
3
/Numbers of Admissions
0
50
100
150
200
250
300
PM
10
concentrations
Children's respiratory hospital admissions
Mean PM
10
levels for
Months
Included
Mean High
PM
10


Intervention/natural experiment (months-years)

Controlled experimental human and animal

Health studies take advantage of highly variable air
pollution levels that result from inversions.
98 99 00 01 02 03 04 05 06 07 08 09 10
0
10
20
30
40
50
60
70
80
90
100
98 99 00 01 02 03 04 05 06 07 08 09 10
0
10
20
30
40
50
60
70
80
90
Note: λ = mean and variance. If λ is constant across time, we have a
stationary Poisson process. If λ changes over time due to changes in
pollution (P), time trends, temperature, etc., this non-stationary Poisson
process can model as:

ln λ
t
= α + β(w
0
P
t
+ w
1
P
t-1
+ w
2
P
t-2
+ . . .) + s
1
(t) + s
2
(temp
t
) + . . .
Unadjusted
(Anderson et al. 2005)
6 U.S. cities
(Klemm and Mason 2003)
8 Canadian cities
(Burnett and Goldberg 2003)
9 Californian cities
(Ostro et al. 2006)
10 U.S cities
(Schwartz 2000, 2003)
14 U.S cities, case-crossover
(Schwartz 2004)
NMMAPS, 20-100 U.S. cities
(Dominici et al. 2003)
APHEA-2, 15-29 European cities
(Katsouyanni et al. 2003)
9 French cities
(Le Tertre et al. 2002)
13 Japanese cities
(Omori et al. 2003)
Non GAM-based studies
(Stieb et al. 2002, 2003)
Publication bias adjusted
(Anderson et al. 2005)
7 Korean cities
(Lee et al. 2000)
20 g/m
3
PM
10

PM
2.5
20 g/m
3
PM
10
20 g/m
3
PM
10
20 g/m
3
PM
10
20 g/m
3
BS
40 g/m
3
TSP
20 g/m
3
SPM
Review of Asian Lit 8 studies
(HEI Report, Table TS2)
20 g/m
3
PM
10
20 g/m

remarkably consistent across meta-analyses and multi-city studies.
Daily time-series studies ***of over 200 cities***
This presentation not organized
chronologically, but methodologically
Studies of short-term exposure (hours-days)
 Episode
 Population-based daily time-series
 Panel-based acute exposure
 Case-crossover

Studies of long-term exposure (years-decades)
 Population-based cross-sectional
 Cohort-based mortality
 Cohort- and panel-based morbidity
 Case-control studies

Intervention/natural experiment (months-years)

Controlled experimental human and animal
Panel studies of asthmatics and non-asthmatics

Summary of early Utah Valley epidemiological studies
Health effects


Pope, Hill, Villegas (1999)
Environ. Health Perspect.
This presentation not organized
chronologically, but methodologically
Studies of short-term exposure (hours-days)
 Episode
 Population-based daily time-series
 Panel-based acute exposure
 Case-crossover

Studies of long-term exposure (years-decades)
 Population-based cross-sectional
 Cohort-based mortality
 Cohort- and panel-based morbidity
 Case-control studies

Intervention/natural experiment (months-years)

Controlled experimental human and animal Methods:
Case-crossover study of acute
ischemic coronary events (heart
attacks and unstable angina) in
12,865 well-defined and followed up
cardiac patients who lived on Utah’s
Wasatch Front
…and who underwent coronary
angiography