2006 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 , 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 Period Covered by this Report: January 1, 2006 through December 31, 2007
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.  To do this, 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 being 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) done in conjunction with ARIES, was August 1, 1998, through August 31, 2000.  Operation of the ARIES station is being extended an additional 2 years, through August 31, 2002, and 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 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 particulate matter (PM)—including PM10, coarse PM, PM2.5, 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 co-pollutants and 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 study of its type (i.e., single-city ED study with speciated PM data).  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 multipollutant analysis.

Progress Summary:

In Year 4 of the project, we focused on the activities described below. 

Completion of Acquisition of Emergency Department Data for the Period 2000-2002 From Metro-Atlanta Hospitals

We have compiled data on more than 1 million ED visits for each year of the extended study period (2000-2002).  We have received data from all of the 40 hospitals that were operating in the period 2000-2002, a remarkable level of cooperation by the hospitals.

Editing and Descriptive Analysis of New Emergency Department Data

As batches of new data from hospitals were received, we comprehensively checked and edited the data.  The task entailed reviewing the data for implausible values and examining distributions to assess whether the data appear reasonable.  We also compared data across hospitals and within hospitals for the earlier period and the current period.  Finally, we have conductive descriptive examinations of the distributions of the key variables in the final outcome database.

Descriptive Analysis of New Air Quality Data.

We have published descriptive spatial and temporal analyses of the air quality data for the extended period 2000-2002 assembled from the Air Quality System, Assessment of Spatial Aerosol Composition in Atlanta, and the ARIES monitor.  In addition, we have conducted intensive work on source apportionment of the available air quality data, which we are currently using in the epidemiologic analysis.

Conducted Epidemiologic Analysis of the Final Database

We have conducted extensive epidemiologic analysis of the relationships of air quality and cardiorespiratory counts in the final database.  The primary approach has entailed time-series analysis of air pollutants of a priori interest and visits for specific cardiorespiratory conditions, controlling for long-term trends and meteorology.  Further analyses have assessed alternative lag structures, meteorological control, subgroups defined by age, place of residence, and comorbid conditions, the impact of measurement error, as well as a variety of other questions.

Work on Methodological Issues

We have also been conducting extensive work on modeling issues relating to the time-series air pollution analyses.  This work assists in optimizing our modeling approach used in the analysis of the study data, as well as having applications to other similar studies.

Future Activities:

: In the final year, we will perform further analyses of the data and prepare additional manuscripts presenting the findings.

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 Marmur A, Unal A, Mulholland JA, Russell AG. Optimization-based source apportionment of PM2.5 incorporating gas-to-particle ratios. Environmental Science & Technology 2005;39(9):3245-3254. R829213 (2006)
R829213 (Final)
R830960 (Final)
R831076 (2004)
R831076 (2007)
R831076 (Final)
R832159 (2005)
R832159 (2006)
R832159 (2007)
R832159 (Final)
  • Abstract from PubMed
  • Full-text: ES&T-Full Text HTML
  • Abstract: ES&T-Abstract
  • Other: ES&T-Full Text PDF
  • Journal Article Wade KS, Mulholland JA, Marmur A, Russell AG, Hartsell B, Edgerton E, Klein M, Waller L, Peel JL, Tolbert PE. Effects of instrument precision and spatial variability on the assessment of the temporal variation of ambient air pollution in Atlanta, Georgia. Journal of the Air & Waste Management Association 2006;56(6):876-888. R829213 (2006)
    R829213 (Final)
    R832159 (2006)
    R832159 (Final)
  • Abstract from PubMed
  • Full-text: Taylor&Francis-Full Text PDF
  • Abstract: Taylor&Francis-Abstract
  • 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, 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
  • 2003 Progress Report
  • 2004
  • 2005 Progress Report
  • Final Report