2003 Progress Report: 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 , Metzger, Kristina , Mulholland, James , Peel, Jennifer , 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 , Rollins School of Public Health, Emory University
Current Institution: Emory University
EPA Project Officer: Chung, Serena
Project Period: January 1, 2002 through December 31, 2004 (Extended to December 31, 2006)
Project Period Covered by this Report: January 1, 2003 through December 31, 2004
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


The objective of this research project is to investigate the roles of specific air contaminants, and interrelationships among them, in producing acute exacerbations of certain cardiac and respiratory conditions.

Progress Summary:

To accomplish the objective, the study period of an ongoing epidemiologic study will be doubled, and multipollutant questions in the resulting unique and powerful database will be addressed. 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 that is operated for the Aerosol Research and Inhalation Epidemiology Study (ARIES) in downtown Atlanta. The study period for the previous epidemiologic study, part of the Study of Particulates and Health in Atlanta (SOPHIA) conducted in conjunction with ARIES, was August 1, 1998, through August 31, 2000. The operation of the ARIES station is being extended an additional 2 years, through August 31, 2002, and in the proposed research project we will extend outcome data collection for this period and conduct epidemiologic analysis of the combined data.

Outcome data will be obtained from the 31 hospitals in the metro-Atlanta area that are participating in the SOPHIA study. Using the diagnostic codes for the visits, multiple cardiac and respiratory case groups will be formed. For each group, 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, oxygenated hydrocarbons, multiple size fractions of PM—including PM10, coarse PM, PM2.5, and a number of ultrafine particles (10-100 nm)—and selected components of PM2.5 (sulfates, nitrates, acidity, water-soluble metals, elemental carbon, and organic matter). Control for copollutants and the assessment of interactions among them will be achieved through standard modeling approaches as well as innovative methods. In addition, the impact of spatial variability on the epidemiological results will be assessed.

With more than 1 million ED visits per year, this study may be the largest of its type (i.e., single-city ED study with speciated PM data). This investigation will make advances in disentangling the 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 an assessment of the role of the components of PM (e.g., sulfates, water-soluble metals) and size fractions in the multipollutant analysis.

In Year 2 of the project, we have focused on the following activities:

  • We continued to work with the 41 hospitals in metropolitan Atlanta to obtain data on ED visits (for 2000-2002) for use in our study. Data are now in-house for 23 hospitals. Four more hospitals have agreed to provide data, and they are working on the download. For another nine hospitals, the process of obtaining approval is midstream. One hospital has declined to participate, three have closed since 2000, and one does not have usable electronic data. The implementation of the Health Insurance Portability and Accountability Act has delayed the acquisition of data from some of the hospitals.
  • We edited new ED data. As batches of new data arrive from the participating hospitals, we have been reviewing and editing the data. This entails examination of the distributions of the various data elements and other descriptive analyses. Data are compared across hospitals and within hospitals for the earlier period and the current period.
  • We conducted descriptive analysis of new air quality data. We have assembled air quality data for 2000-2002 from the Air Quality System (AQS) and the Assessment of Spatial Aerosol Composition in Atlanta (ASACA) monitoring networks, and are conducting spatial and temporal analyses of these data. The data from the ARIES monitor for 2000-2002 now are available for most variables in preliminary form (i.e., not fully reviewed by the contractor performing the measurements yet). We are proceeding with preliminary descriptive analysis of these data.
  • We continued analysis of in-house data.As we collect new data for 2000-2002, we have continued to analyze the data we have in-house for the period through 2000. The additional analyses that we have been performing on these data will help to inform and expedite analyses of the data through 2002, when they are available. Analyses of the relationship of air quality to cardiovascular disease through 2000 have been published. Cardiovascular disease visits were associated with NO2, CO, PM2.5, elemental carbon, and organic carbon, which may be acting as markers of traffic exhaust. The effect of ambient pollution on cardiovascular conditions appeared to be rapid, as the strongest associations were observed with pollution levels on the same day as the ED visits. A second manuscript, presenting the results of the respiratory outcomes, currently is in review. Upper respiratory infection visits were associated with PM10, ozone, NO2, and CO; pneumonia visits were associated with PM2.5 organic carbon; and chronic obstructive pulmonary disease visits were associated with NO2 and CO. Distributed lag models indicated that positive associations persisted beyond 3 days for several of the outcomes, and for more than 1 week for asthma. In addition, we have been assessing the representativeness of pollutant measurements at the various monitors.
  • We worked on methodological issues. We also have been conducting extensive work on modeling issues relating to the time series air pollution analyses. This work will assist in optimizing the final modeling approach used in the analysis of the study data, and will have applications to other similar studies.

Future Activities:

In Year 3 of the project, we will perform the following activities:

  • We will complete assembly, editing, and descriptive analysis of hospital data for 2000-2002.
  • We will review new air quality data from the ARIES station for 2000-2002.
  • We will continue to analyze other monitoring data (Aerometric Information Retrieval System [AIRS] and ASACA) assembled for 2000-2002.
  • We will perform preliminary epidemiologic analysis of the new 2-year data for hospitals that have provided data as of May 2004, and we will compare the results with those for 1998-2000 (using ARIES and ASACA data) and 1993-2000 (using AQS data). Also, we will perform epidemiologic analysis of these periods and the combined periods (1998-2002 for ARIES and ASACA data and 1993-2002 for AIRS data), when all participating hospitals have provided data.
  • We will conduct multipollutant modeling and secondary analyses, and we will assess the impact of measurement error.

Journal Articles on this Report : 2 Displayed | Download in RIS Format

Other project views: All 107 publications 31 publications in selected types All 29 journal articles
Type Citation Project Document Sources
Journal Article Metzger KB, Tolbert PE, Klein M, Peel JL, Flanders WD, Todd K, Mulholland JA, Ryan PB, Frumkin H. Ambient air pollution and cardiovascular emergency department visits. Epidemiology 2004;15(1):46-56. R829213 (2003)
R829213 (Final)
  • Abstract from PubMed
  • Other: GATECH PDF
  • Journal Article Peel JL, Tolbert PE, Klein M, Metzger KB, Flanders WD, Todd K, Mulholland JA, Ryan PB, Frumkin H. Ambient air pollution and respiratory emergency department visits. Epidemiology 2005;16(2):164-174. R829213 (2003)
    R829213 (Final)
  • Abstract from PubMed
  • Other: GATECH PDF
  • Supplemental Keywords:

    ambient air, exposure, risk, health effects, human health, population, sensitive populations, children, elderly, dose response, chemicals, particulates, volatile organic compound, VOC, metals, nitrogen oxides, sulfates, organics, public policy, socioeconomic, epidemiology, modeling, Georgia, GA, Atlanta, emergency department, ED, particulate matter, PM,, RFA, Health, Scientific Discipline, PHYSICAL ASPECTS, Air, Geographic Area, particulate matter, air toxics, Health Risk Assessment, Epidemiology, State, Risk Assessments, Susceptibility/Sensitive Population/Genetic Susceptibility, Southeast, Disease & Cumulative Effects, Environmental Monitoring, 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:

    Original Abstract
  • 2002 Progress Report
  • 2004
  • 2005 Progress Report
  • Final Report