2014 Progress Report: A National Study to Assess Susceptibility, Vulnerability, and Effect Modification of Air Pollution Health Risks

EPA Grant Number: R834798C005
Subproject: this is subproject number 005 , established and managed by the Center Director under grant R834798
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).

Center: Air Pollution Mixtures: Health Effects across Life Stages
Center Director: Koutrakis, Petros
Title: A National Study to Assess Susceptibility, Vulnerability, and Effect Modification of Air Pollution Health Risks
Investigators: Dominici, Francesca , Bell, Michelle L. , Schwartz, Joel , Zanobetti, Antonella
Institution: Harvard University
EPA Project Officer: Ilacqua, Vito
Project Period: January 1, 2011 through December 31, 2015 (Extended to December 31, 2016)
Project Period Covered by this Report: August 1, 2013 through July 31,2014
RFA: Clean Air Research Centers (2009) RFA Text |  Recipients Lists
Research Category: Health Effects , Air

Objective:

This National study is aimed at identifying factors that explain the heterogeneity of health risks associated with air pollution exposure. We hypothesize that such factors include medical and social conditions, conditions that modify exposure, and differences in pollution composition that modify exposure toxicity. Moreover, we hypothesize that the relevant factors vary among different health outcomes. We are conducting national studies of short- and long-term exposures to individual pollutants, sources, and mixtures. We have established a cohort of 2.3 million Medicare enrollees residing in Massachusetts and surrounding states and are following its members prospectively for cause-specific hospital admissions and mortality for the period 2000-2014, and also are studying all live births in eastern Massachussetts, geo-coded to exact address and followed for adverse birth outcomes.

Progress Summary:

It has been a very productive year with 16 published manuscripts (only for the years 2013 and 2014), and many more papers in progress. The published work addresses the specific aims of Project 5 and is in the areas of health effects of air pollution mixtures, health effects of extreme weather, climate change and adaptation, development of statistical methods for estimating the health effects of mixture and causal inference methods to assess the public health impact of air quality regulations. Details are summarized below.

Epidemiological studies: We are making progress toward all the aims by conducting epidemiological studies and also by developing statistical methods. In Bell et al. (2013, 2014a), we have reviewed recent literature to summarize the state of scientific evidence on effect modification. We focused on time series and case-crossover studies of the effects of short-term exposure to PM or ozone on mortality and morbidity. In Bell et al. (2014b), we have estimated the association of PM2.5 constituents and sources with hospital admissions in four counties in Connecticut and Massachusetts (USA) for persons ≥ 65 years of age. In Correia et al. (2013) we completed and published a nationwide epidemiological study on changes in PM2.5 in recent years and increases in life expectancy for 545 U.S. counties. In Kloog et al. (2012, 2013, 2014), we have further improved models to predict exposure to fine particulate matter at a finer spatial scale and at daily level for all the United States. In Zanobetti et al. (2014) we have a paper in press that uses the Medicare data to estimate the short-term effects of PM2.5 on mortality separately for Medicare enrollees who have had a previous hospitalization for diabetes or a neurological disorder. In Kioumourtzoglou et al. (2013, 2014) we have estimated effects of primary organic particles on emergency hospital admissions among the elderly in three U.S. cities and we have conducted a study in Boston to assess the impact of source contribution uncertainty on the effects of source-specific PM2.5 on hospital admissions. Finally, in Dominici et al. (2014), we have published a thought provoking commentary in Science contrasting analyses of observational data versus a quasi-experimental design in air pollution epidemiology.

Development of innovative statistical methods: In Bobb et al. (2013), we have developed a new class of Bayesian hierarchical models to estimating the joint effect associated with simultaneous exposure to more than one pollutant. We have applied this newly developed method to a multi-site time series study to estimate the joint effect of PM10 and ozone on mortality. In Bobb et al. (2014), we have conducted a study to estimate the trend over time of the risk of mortality associated with short term exposure to temperature. We found evidence that the trend is declining, and that air conditioning use is not a factor that explains such a decline. In Cefalu et al. (2014) we have conducted a study to better understand the role of confounders when some of these confounders also are used to predict exposure to air pollution. Using theoretical arguments and simulation studies, we show that the bias of a health-effect estimate is influenced by the exposure prediction model, the type of confounding adjustment used in the health-effects regression model, and the relationship between these two. Moreover, we argue that even with a health-effects regression model that properly adjusts for confounding, the use of a predicted exposure can bias the health-effect estimate unless all confounders included in the health-effects regression model also are included in the exposure prediction model. In Zigler et al. (2014) we argue that the regulatory environment surrounding air pollution control policies warrants a new type of epidemiological evidence. Whereas air pollution epidemiology historically has informed policies with estimates of exposure-response relationships between pollution and health outcomes, these estimates alone cannot support current debates surrounding the actual health impacts of air quality regulations. This commentary argues that directly evaluating specific control strategies is distinct from estimating exposure-response, and that increased emphasis on estimating effects of well-defined regulatory interventions would enhance the evidence supporting policy decisions. In this commentary, we sharpen the analytic distinctions between studies that directly evaluate policies and those that estimate exposure-response, with particular focus on perspectives for causal inference. There we argue that potential-outcomes perspectives can elevate current policy debates with more direct evidence of the extent to which complex regulatory interventions impact health. Finally, in Chung et al. (2014), we have developed a Bayesian spatially varying coefficient model for estimating the health effects of long-term PM2.5 exposure and the effect modification by the chemical composition.

Future Activities:

During the next year, we will continue to utilize the great amount of synergy and productivity among the members of the team in pursuing the objectives of the project.  Matt Cefalu, a recently appointed post-doctoral fellow, Itai Kloog, Joel Schwartz and Francesca Dominici are conducting a study to better understand the role of confounders when some of these confounders also are used to predict exposure to air pollution. Kloog, Schwartz and Nordio are continuing to improve and refine exposure prediction models for fine particulate matter. Dominici is extending her previous work on PM2.5 and life expectancy, by looking specifically at which components of PM2.5 are the main drivers of documented improvement in life expectancy. Zanobetti, Dominici, Bell and Bobb are all heavily involved in studies of climate change and health outcomes. Zanobetti and Kioumourtzoglou are assessing if the association between long-term PM2.5 exposure varies by location across the United States, depending on the pollution mixtures at each location. They also investigate whether the long-term PM2.5-mortality association is modified by temperature. Zanobetti also is extending her work on the association between short-term PM2.5 exposures and neurological outcomes, by examining if long-term exposures also are related to such outcomes.

We will continue analysis of national short- and long-term exposures to individual pollutants, sources, and mixtures at a national scale. We also will continue the development and analysis of a cohort of Medicare enrollees in Massachusetts and surrounding states for cause-specific hospital admissions and mortality; studying all live births in eastern Massachussetts, geo-coded to exact address and followed for adverse birth outcomes.

 


Journal Articles on this Report : 16 Displayed | Download in RIS Format

Other subproject views: All 24 publications 23 publications in selected types All 23 journal articles
Other center views: All 280 publications 225 publications in selected types All 225 journal articles
Type Citation Sub Project Document Sources
Journal Article Bell ML, Zanobetti A, Dominici F. Evidence on vulnerability and susceptibility to health risks associated with short-term exposure to particulate matter: a systematic review and meta-analysis. American Journal of Epidemiology 2013;178(6):865-876. R834798 (2013)
R834798 (2014)
R834798C005 (2013)
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R834894 (2013)
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  • Journal Article Bell ML, Ebisu K, Leaderer BP, Gent JF, Lee HJ, Koutrakis P, Wang Y, Dominici F, Peng RD. Associations of PM2.5 constituents and sources with hospital admissions:analysis of four counties in Connecticut and Massachusetts (USA) for persons ≥ 65 years of age. Environmental Health Perspectives 2014;122(2):138-144. R834798 (2013)
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  • Journal Article Bell ML, Zanobetti A, Dominici F. Who is more affected by ozone pollution? A systematic review and meta-analysis. American Journal of Epidemiology 2014;180(1):15-28. R834798C005 (2014)
    R834894 (Final)
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  • Journal Article Bobb JF, Dominici F, Peng RD. Reduced hierarchical models with application to estimating health effects of simultaneous exposure to multiple pollutants. Journal of the Royal Statistical Society: Series C (Applied Statistics) 2013;62(3):451-472. R834798 (2012)
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  • Journal Article Bobb JF, Peng RD, Bell ML, Dominici F. Heat-related mortality and adaptation to heat in the United States. Environmental Health Perspectives 2014;122(8):811-816. R834798 (2014)
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  • Journal Article Cefalu M, Dominici F. Does exposure prediction bias health-effect estimation?: The relationship between confounding adjustment and exposure prediction. Epidemiology 2014;25(4):583-590. R834798C005 (2014)
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  • Journal Article Chung Y, Dominici F, Wang Y, Coull BA, Bell ML. Associations between long-term exposure to chemical constituents of fine particulate matter (PM2.5) and mortality in Medicare enrollees in the eastern United States. Environmental Health Perspectives 2015;123(5):467-474. R834798 (2014)
    R834798 (2015)
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  • Journal Article Correia AW, Pope III CA, Dockery DW, Wang Y, Ezzati M, Dominici F. Effect of air pollution control on life expectancy in the United States: an analysis of 545 U.S. counties for the period 2000 to 2007. Epidemiology 2013;24(1):23-31. R834798 (2012)
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  • Journal Article Dominici F, Greenstone M, Sunstein CR. Particulate matter matters. Science 2014;344(6181):257-259. R834798C005 (2014)
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  • Journal Article Kioumourtzoglou MA, Coull BA, Dominici F, Koutrakis P, Schwartz J, Suh H. The impact of source contribution uncertainty on the effects of source-specific PM2.5 on hospital admissions: a case study in Boston, MA. Journal of Exposure Science and Environmental Epidemiology 2014;24(4):365-371. R834798 (2014)
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  • Journal Article Kioumourtzoglou M-A, Zanobetti A, Schwartz JD, Coull BA, Dominici F, Suh HH. The effect of primary organic particles on emergency hospital admissions among the elderly in 3 US cities. Environmental Health 2013;12(1):68 (10 pp.). R834798 (2013)
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  • Journal Article Kloog I, Melly SJ, Ridgway WL, Coull BA, Schwartz J. Using new satellite based exposure methods to study the association between pregnancy PM2.5 exposure, premature birth and birth weight in Massachusetts. Environmental Health 2012;11:40 (8 pp.). R834798 (2012)
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  • Journal Article Kloog I, Nordio F, Coull BA, Schwartz J. Incorporating local land use regression and satellite aerosol optical depth in a hybrid model of spatiotemporal PM2.5 exposures in the Mid-Atlantic states. Environmental Science & Technology 2012;46(21):11913-11921. R834798 (2013)
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  • Journal Article Kloog I, Ridgway B, Koutrakis P, Coull BA, Schwartz JD. Long-and short-term exposure to PM2.5 and mortality: using novel exposure models. Epidemiology 2013;24(4):555-561. R834798 (2013)
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  • Journal Article Zanobetti A, Dominici F, Wang Y, Schwartz JD. A national case-crossover analysis of the short-term effect of PM2.5 on hospitalizations and mortality in subjects with diabetes and neurological disorders. Environmental Health 2014;13(1):38 (11 pp.). R834798C005 (2014)
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  • Journal Article Zigler CM, Dominici F. Point: clarifying policy evidence with potential-outcomes thinking--beyond exposure-response estimation in air pollution epidemiology. American Journal of Epidemiology 2014;180(12):1133-1140. R834798C005 (2014)
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  • Supplemental Keywords:

    Scientific Discipline, Air, air toxics, Health Risk Assessment, Air Pollution Effects, Biochemistry, Biology, ambient air quality, children's health, complex mixtures, health effects, sensitive populations, air pollutants, biological sensitivities, exposure and effects, lung epithelial cells, susceptible populations, chemical composition, neurotoxicity, toxicity, coronary artery disease, cardiopulmonary, cardiotoxicity, environmental effects, human health, mortality

    Relevant Websites:

    http://www.hsph.harvard.edu/clarc/Exit

    Progress and Final Reports:

    Original Abstract
    2010 Progress Report
    2011 Progress Report
    2012 Progress Report
    2013 Progress Report


    Main Center Abstract and Reports:

    R834798    Air Pollution Mixtures: Health Effects across Life Stages

    Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
    R834798C001 Relative Toxicity of Air Pollution Mixtures
    R834798C002 Cognitive Decline, Cardiovascular Changes, and Biological Aging in Response to Air Pollution
    R834798C003 Identifying the Cognitive and Vascular Effects of Air Pollution Sources and Mixtures in the Framingharn Offspring and Third Generation Cohorts
    R834798C004 Longitudinal Effects of Multiple Pollutants on Child Growth, Blood Pressure and Cognition
    R834798C005 A National Study to Assess Susceptibility, Vulnerability, and Effect Modification of Air Pollution Health Risks