Multiple Pollutants and Risk of Emergency Department Visits for Cardiorespiratory Outcomes in Atlanta

EPA Grant Number: R829213
Title: Multiple Pollutants and Risk of Emergency Department Visits for Cardiorespiratory Outcomes in Atlanta
Investigators: Tolbert, Paige , Flanders, Dana , Klein, Mitchel , Lyles, Robert , Mulholland, James , Russell, Armistead G. , Ryan, P. Barry , Todd, Knox , Waller, Lance
Current Investigators: Tolbert, Paige , Flanders, Dana , Klein, Mitchel , Lyles, Robert , Metzger, Kristina , Mulholland, James , Peel, Jennifer , Russell, Armistead G. , Ryan, P. Barry , Sarnat, Stefanie Ebelt , Sarnat, Jeremy , Todd, Knox , Waller, Lance
Institution: Emory University
EPA Project Officer: Chung, Serena
Project Period: January 1, 2002 through December 31, 2004 (Extended to December 31, 2006)
Project Amount: $1,238,940
RFA: Health Effects of Particulate Matter (2001) RFA Text |  Recipients Lists
Research Category: Air Quality and Air Toxics , Particulate Matter , Health Effects , Air


In this project, we will investigate roles of specific air contaminants, and inter-relationships among them, in producing acute exacerbations of certain cardiac and respiratory conditions. To do this, we plan to double the study period of an ongoing epidemiologic study and address multi-pollutant questions in the resulting unique and powerful database.


The study is a time-series investigation of cardiac and respiratory emergency department (ED) visits in relation to daily measures of air quality, including detailed measurements of particulate matter (PM) components being conducted at the station being operated for the Aerosol Research and Inhalation Epidemiology Study (ARIES) in downtown Atlanta. The study period for our previous epidemiologic study, part of the Study of Particulates and Health in Atlanta (SOPHIA) done in conjunction with ARIES, was August 1, 1998 through August 31, 2000. Operation of the ARIES station is being extended an additional two years, through August 31, 2002, and in the proposed work we will extend outcome data collection for this period and conduct analyses that directly address questions of interest described in the RFA. Outcome data will be obtained from the 31 hospitals in the 20-county metropolitan Atlanta area participating in the SOPHIA study. The hospitals will be asked to download patient data on all visits to the ED during the extended study period, including date of visit, diagnostic codes, demographic information, and residential zip code, and these data will be merged with the outcome database for the first two years. Using the diagnostic codes for the visits, the following case groups will be formed: asthma, chronic obstructive pulmonary disease, upper respiratory illness, lower respiratory illness, all respiratory disease combined, dysrhythmia, congestive heart failure, ischemic heart disease, myocardial infarction, cardiac arrest, peripheral and cerebrovascular disease, and all cardiovascular disease combined. For each of these case groupings, time series analysis will be performed to examine the relationship of pollutant levels to daily counts of the outcome. Pollutants of a priori interest being measured at the ARIES station include: the criteria gaseous pollutants, polar VOCs, multiple size fractions of particulate matter -- including PM10, coarse PM (PM between 2.5 and 10 microns), PM2.5, ultrafine particles (10-100 nm) mass, number and surface area -- and the following components of PM2.5: sulfates, nitrates, acidity, water-soluble metals, elemental carbon, and organic matter. Generalized linear models, generalized estimating equations and generalized additive models will be fit to the data, controlling for meteorologic variables and time trends. Control for co-pollutants will be achieved through standard modeling approaches as well as an innovative application of factor analysis. Interaction among pollutants will be assessed. Examination of age groups, and other subanalyses, will be performed. In addition, an assessment of the role of measurement error, including spatial variability, will be conducted.

Expected Results:

With over one million ED visits per year, this study may be the largest study of its type (i.e., single-city ED study with speciated PM data). While it is resource-intensive, this undertaking will contribute substantially more to our understanding of the complex relationships of interest than a number of small-scale efforts would be able to provide. This investigation will make advances in disentangling effects of PM from the effects of other pollutants and will contribute to our understanding of the effects of exposure to PM in the presence of other pollutants. Moreover, the detailed air quality data available to the proposers will allow assessment of the role of components of PM (e.g., sulfates, water-soluble metals) and size fractions in the multi-pollutant analysis. This study will therefore be uniquely well-positioned to address research issues outlined in the RFA.

Publications and Presentations:

Publications have been submitted on this project: View all 92 publications for this project

Journal Articles:

Journal Articles have been submitted on this project: View all 14 journal articles for this project

Supplemental Keywords:

ambient air, exposure, risk, health effects, human health, population, sensitive populations, children, elderly, dose-response, chemicals, particulates, VOC, metals, nitrogen oxides, sulfates, organics, public policy, socioeconomic, epidemiology, modeling, Georgia, GA., RFA, Health, Scientific Discipline, PHYSICAL ASPECTS, Air, Geographic Area, particulate matter, air toxics, Health Risk Assessment, State, Epidemiology, Susceptibility/Sensitive Population/Genetic Susceptibility, Risk Assessments, Environmental Monitoring, Southeast, Disease & Cumulative Effects, Physical Processes, genetic susceptability, tropospheric ozone, asthma, sensitive populations, Nitrogen Oxides, risk, ambient air quality, health effects, elderly adults, particulates, PM10, health risks, stratospheric ozone, air pollutants, exposure and effects, PM 2.5, effects assessment, acute cardiovascular effects, multiple acute exposure, airway disease, COPD, exposure, ambient air, ambient measurement methods, Atlanta, Georgia, Georgia (GA), pulmonary disease, VOCs, air pollution, modeling, children, cardiopulmonary response, pulmonary, human exposure, inhalation, clinical studies, public health, inhaled, elderly, Acute health effects, sensitive subgroups, ambient particulates, ecological risk, Aerosol Research and Inhalation Epidemiology Study (ARIES), inhaled particles, nitrogen oxides (Nox), Volatile Organic Compounds (VOCs), aerosol, cardiopulmonary, human health, Study of Particulates and Health in Atlanta (SOPHIA), measurement methods , cardiotoxicity, air contaminant exposure, environmental hazard exposures, toxics, metals, cardiopulmonery responses

Progress and Final Reports:

  • 2002 Progress Report
  • 2003 Progress Report
  • 2004
  • 2005 Progress Report
  • Final Report