Grantee Research Project Results

2002 Progress Report: Health Effects of long-Term Exposure to Particles and Other Air Pollutants in Elderly Nonsmoking California Residents

EPA Grant Number: R827998
Title: Health Effects of long-Term Exposure to Particles and Other Air Pollutants in Elderly Nonsmoking California Residents
Investigators: Knutsen, Synnove F. , Abbey, David E. , Beeson, Larry
Institution: Loma Linda University
EPA Project Officer: Chung, Serena
Project Period: March 1, 2000 through February 28, 2003 (Extended to February 28, 2005)
Project Period Covered by this Report: March 1, 2002 through February 28, 2003
Project Amount: $763,910
RFA: Airborne Particulate Matter Health Effects (1999) RFA Text |  Recipients Lists
Research Category: Particulate Matter , Human Health , Air

Objective:

The primary objective of this project is to determine the risk of exposure to long-term ambient concentrations of particulate matter (PM), specifically PM2.5 on all-cause mortality, nonmalignant respiratory mortality, and lung cancer and cardiovascular disease incidence and mortality, using data from a cohort of 6,338 nonsmoking California Seventh-day Adventists that has been prospectively followed since 1977.

The secondary objectives are to assess the health effects of: (1) long-term concentrations of other air pollutants (PM10, PM10-2.5, SO4, SO2, O3, NO2) on the same outcomes as mentioned for the primary objective; (2) mixed pollutants; (3) long-term concentrations of all the mentioned air pollutants using multipollutant analysis; and (4) air pollutants in sensitive subgroups.

Progress Summary:

The focus of the second year was to complete the update of exposure and outcome information from all participants.

Tracing

The attempt was to follow up on all persons of the Adventist Health and Smog Study (AHSMOG) cohort who were alive at the last full followup in 1992. Of these, some were known dead, and thus a total of 4,103 questionnaires were distributed. As of May 11, 2001, the tracing of those alive was completed with a response rate of 87 percent. We believe this is an excellent response rate because the cohort is becoming very old.

Mortality has been assessed by computerized record linkage with the National Death Index and the California Death Certificate files and by obtaining death certificates from those identified as probably part of the AHSMOG cohort. All relevant death certificates have been requested, and a total of 1,014 deaths since 1992 have been confirmed.

Surrogate interviews have been completed with a close friend or relative of those who are deceased with a response rate of 76 percent of all known dead (770 of 1,014).

The following methods have been used for tracing:

(1) Phone calls to the last known address.
(2) Phone calls to the person identified by the participant as always knowing their whereabouts.
(3) Record linkage with the California Department of Motor Vehicles.
(4) Mailing list for church paper.
(5) Church clerks.

The following methods have been used for assessing deaths:

(1) Information from spouse, close friend, church clerk, postal returns, etc.
(2) Computerized record linkage with the California Death Certificate files.
(3) Computerized record linkage with the National Death Index.
(4) Obtaining death certificates from the state in which the person died.

Estimates of Ambient Air Pollution

PM2.5. Visibility data as well as directly monitored data have been received from the entire State of California, and we have calculated the individual exposure measures using the same methodology as before.

Other Pollutants. Sonoma Technologies has processed the information collected by the California Air Resources Board (CARB) and has provided us with monthly ambient levels of air pollutants (PM10, O3, SO2, NO2, SO4) by ZIP Code through March 2000. Since 1992, several air monitoring stations have been discontinued, and others have been started. This has created some challenges when developing new algorithms for assessing ZIP Code-specific, ambient-air pollution levels. Floyd Peterson has done quality checks with data from Sonoma Technologies to ensure that the new algorithms produce comparable ambient-air pollutant levels as previous algorithms by comparing 3 overlapping years (1990-1992). The consistency was good for all pollutants. The ZIP Code-specific, ambient-air pollution levels for all the pollutants thus have been linked to each individual in our cohort.

Assessment of Outcome

All death certificates have been coded by a certified nosologist, and all mortality outcomes have been updated. We currently are using these in our analyses.

Since the start of follow-up in 1977, there are a total of 2,462 deaths, of which 2,393 were deaths from natural causes. Of these, 644 were attributed to fatal, ischemic heart disease; 44 to chronic, obstructive lung disease; and 40 to fatal lung cancer. A total of 47 incident lung cancers have occurred in the cohort through 1998.

For other incident cancers, the record linkage with the California Cancer Registry has been completed, but we are waiting for medical histories for a few self-reported cancers that have been diagnosed among persons who are living out of the state. This grant was funded only to assess the relationship between incident lung cancer and ambient levels of air pollution.

We have incident myocardial infarction (MI) for 6-year followup (1977-1982). For the time period after 1982, we have self-reported information on incident MI. This information is being validated by obtaining medical records from the hospital in which the diagnosis was made. This is being done under a new, recently funded U.S. Environmental Protection Agency Science to Achieve Results (STAR) grant.

Progress

Tracing the cohort, which was not contacted since 1993, turned out to be more challenging than expected and has taken longer than anticipated. We have started analysis of different mortality outcomes as associated with PM and coronary heart disease, both in the whole cohort and in the sensitive subgroups.

Future Activities:

Year 4 of the project, the no-cost extension year, mostly will consist of analyses and writing of papers. We expect several publications resulting from this work, the first three being ready for submission in the summer of 2003. The focus of these first papers will be cardiovascular endpoints. We then will continue with lung cancer, nonmalignant respiratory mortality, hospitalizations, and all-cause mortality.

Further, we will study the health effects of mixed pollutants and the risk of the specified outcomes in sensitive subgroups. We also expect to analyze the risk of the different outcomes using multipollutant models.

Journal Articles:

No journal articles submitted with this report: View all 19 publications for this project

Supplemental Keywords:

ambient air, ozone, exposure, risk, risk assessment, health effects, human health, sensitive populations, carcinogen, population, elderly, cumulative effects, susceptibility, epidemiology, modeling, monitoring, analytical, southwest, California, CA., RFA, Health, Scientific Discipline, Air, Geographic Area, ENVIRONMENTAL MANAGEMENT, Susceptibility/Sensitive Population/Genetic Susceptibility, Health Risk Assessment, Risk Assessments, State, particulate matter, Biology, genetic susceptability, Epidemiology, tropospheric ozone, indoor air, Atmospheric Sciences, Biochemistry, air toxics, Risk Assessment, cumulative effects, California (CA), indoor air quality, environmental hazard exposures, sensitive populations, Nitrogen dioxide, age dependent response, stratospheric ozone, lung cancer, mortality, respiratory, long term exposure, human exposure, elderly, acute lung injury, particulate exposure, PM10, genetic susceptibility, Acute health effects, epidemiological studies, exposure, PM, chronic health effects, ambient air, toxics, air pollution, ambient air quality, elderly adults, human health risk, PM 2.5, sulfates, tobacco smoke, Sulfur dioxide, exposure and effects, exposure assessment

Relevant Websites:

http://www.llu.edu/llu/health/ahsmog.htm Exit

Progress and Final Reports:

Original Abstract

2000 Progress Report

2001 Progress Report

2003 Progress Report

Final Report