Grantee Research Project Results

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 , Ryan, P. Barry , Russell, Armistead G. , Flanders, Dana , Mulholland, James , Todd, Knox , Waller, Lance , Klein, Mitchel , Lyles, Robert
Current Investigators: Tolbert, Paige , Ryan, P. Barry , Sarnat, Stefanie Ebelt , Russell, Armistead G. , Flanders, Dana , Mulholland, James , Peel, Jennifer , Sarnat, Jeremy , Todd, Knox , Metzger, Kristina , Waller, Lance , Klein, Mitchel , Lyles, Robert
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: Particulate Matter , Air Quality and Air Toxics , Human Health , Air

Description:

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.

Approach:

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 107 publications for this project

Journal Articles:

Journal Articles have been submitted on this project: View all 29 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, Air, Scientific Discipline, PHYSICAL ASPECTS, Geographic Area, Susceptibility/Sensitive Population/Genetic Susceptibility, Health Risk Assessment, Physical Processes, Risk Assessments, State, particulate matter, genetic susceptability, Epidemiology, Southeast, tropospheric ozone, Disease & Cumulative Effects, air toxics, Environmental Monitoring, clinical studies, sensitive populations, Atlanta, Georgia, health effects, environmental hazard exposures, health risks, inhaled, aerosol, human health, pulmonary disease, asthma, stratospheric ozone, elderly, sensitive subgroups, human exposure, measurement methods , Nitrogen Oxides, PM10, pulmonary, Acute health effects, children, particulates, cardiopulmonery responses, effects assessment, Aerosol Research and Inhalation Epidemiology Study (ARIES), Study of Particulates and Health in Atlanta (SOPHIA), COPD, exposure, nitrogen oxides (Nox), risk, cardiotoxicity, air pollutants, ecological risk, ambient air, VOCs, air contaminant exposure, inhaled particles, toxics, ambient air quality, elderly adults, Volatile Organic Compounds (VOCs), Georgia (GA), modeling, air pollution, metals, cardiopulmonary, acute cardiovascular effects, human health risk, ambient measurement methods, PM 2.5, airway disease, ambient particulates, public health, cardiopulmonary response, exposure and effects, inhalation

Progress and Final Reports:

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.