Grantee Research Project Results
2003 Progress Report: Health Effects of long-Term Exposure to Particles and Other Air Pollutants in Elderly Nonsmoking California Residents
EPA Grant Number: R827998Title: 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, 2003 through February 28, 2004
Project Amount: $763,910
RFA: Airborne Particulate Matter Health Effects (1999) RFA Text | Recipients Lists
Research Category: Particulate Matter , Air , Human Health
Objective:
The primary objective of this research project is to determine the risk of exposure to long-term ambient concentrations of PM2.5 on all-cause mortality and non-malignant respiratory mortality, as well as lung cancer and cardiovascular disease incidence and mortality using data from a cohort of 6,338 nonsmoking California Seventh-Day Adventists that have been followed prospectively since 1977.
The secondary objectives are to: (1) assess the health effects of long-term concentrations of other air pollutants (i.e., PM10, PM10-2.5, SO4, SO2, O3, and NO2) on the same outcomes as mentioned for the primary objective; (2) assess the health effects of mixed pollutants; (3) assess the health effects of long-term concentrations of all the mentioned air pollutants using multipollutant analyses; and (4) evaluate the health effects of air pollutants in sensitive subgroups.
Progress Summary:
The focus of Year 2 of the project was to update exposure and outcome information from all participants.
Tracing
We attempted to follow up with all persons of the Adventist Health and Smog (AHSMOG) cohort who were alive at the last full followup in 1992. Of these, some were known to be dead; therefore, a total of 4,103 questionnaires were sent out. As of May 11, 2001, the tracing of those alive was completed with a response rate of 87 percent. We believe that this is an excellent response rate because the cohort is becoming very old.
Mortality has been assessed by analyzing computerized record linkage with the National Death Index and California death certificate files and obtaining death certificates from those identified as possibly 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, giving a response rate of 76 percent for all known dead (770 of 1,014).
Methods used for tracing have been the following:
- phone calls to last known address;
- phone calls to person identified by the participant as always knowing their whereabouts;
- record linkage with the California Department of Motor Vehicles;
- mailing list for church paper;
- and church clerks.
Methods used for assessing deaths were:
- information from a spouse, close friend, church clerk, postal returns, etc.;
- computerized record linkage with the California death certificate files;
- computerized record linkage with the National Death Index;
- and death certificates from the state in which the person died.
PM2.5 . Visibility and directly monitored data have been received from the whole State of California, and we have calculated the individual exposure measures using the same methodology as was used previously.
Other Pollutants . Sonoma Technologies has processed the information collected by the California Air Resources Board and has provided us with monthly ambient levels of air pollutants (i.e., PM10, O3, SO2, NO2, and 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 conducted quality checks with data from Sonoma Technologies to ensure the new algorithms produce ambient air pollutant levels comparable to previous algorithms by comparing three overlapping years (1990-1992). The consistency was good for all pollutants. The ZIP Code-specific ambient air pollution levels for all of the pollutants 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. Currently, we are using these in our analyses. Since the start of followup in 1977, there have been a total of 2,462 deaths, of which 2,393 were attributed to natural cause. Of these, 644 resulted from fatal ischemic heart disease, 44 resulted from chronic obstructive lung disease, and 40 from 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 still waiting for medical histories for a few self-reported cancers that have been diagnosed among persons who are living out-of-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 currently is being validated by obtaining medical records from the hospital in which the diagnosis was made. This is being done under a recently funded U.S. Environmental Protection Agency Science To Achieve Results grant.
Progress
Tracing the cohort, which had not been contacted since 1993, turned out to be more challenging and time consuming than expected. We have started analysis of different mortality outcomes as associated with PM and coronary heart disease (CHD) both in the whole cohort and in the sensitive subgroups. We have had some challenges with our statistical models, which caused major delays so that we were not able to submit the papers we had planned in fall 2003; however, this problem now is solved and we are making good progress toward the submission of several papers. Two will be submitted during summer 2004 on the topics of PM as a risk factor for fatal CHD and non-Hodgkins lymphoma. Five other papers are being worked on and will be completed during this no-cost extension year.
Future Activities:
In Year 5 of the project, the second no-cost extension year, we will continue to analyze information and write papers according to the project objectives. Because of problems with our statistical models, the papers we planned to submit in fall 2003 are just now ready for submission. In addition, we are working on five other papers. We will submit all of these within the coming year. The focus of these first papers will be on cardiovascular and cardiopulmonary endpoints. Also, we are evaluating all natural-cause mortality and incidence of lung cancer, non-Hodgkins lymphoma, and breast cancer. In addition, we are evaluating the risk of cardiovascular, cardiopulmonary, and all natural-cause deaths in sensitive subgroups. The analyses will be done both in one- and two-pollutant models. Further, we will study the health effects of mixed pollutants.
Journal Articles:
No journal articles submitted with this report: View all 19 publications for this projectSupplemental 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, Scientific Discipline, Health, Air, ENVIRONMENTAL MANAGEMENT, Geographic Area, particulate matter, Health Risk Assessment, air toxics, Epidemiology, State, Risk Assessments, Susceptibility/Sensitive Population/Genetic Susceptibility, Biochemistry, Atmospheric Sciences, indoor air, tropospheric ozone, genetic susceptability, Biology, Risk Assessment, ambient air quality, elderly adults, PM10, sulfates, Nitrogen dioxide, sensitive populations, PM 2.5, long term exposure, exposure and effects, stratospheric ozone, acute lung injury, ambient air, exposure, air pollution, lung cancer, Sulfur dioxide, particulate exposure, chronic health effects, sensitive subjects, human exposure, Acute health effects, epidemiological studies, elderly, PM, mortality, tobacco smoke, California (CA), indoor air quality, age dependent response, cumulative effects, respiratory, exposure assessment, genetic susceptibility, environmental hazard exposures, toxicsRelevant Websites:
http://www.llu.edu/llu/health/ahsmog.htm Exit
Progress and Final Reports:
Original AbstractThe 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.