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US Six Cities and Relevance for Clean Air Policy in Ireland
Clean Air Conference 2015 September 28, 2015
Wood Quay Venue, Dublin
Douglas W. Dockery Professor of Environmental Epidemiology
Harvard School of Public Health
Dublin Coal Ban On September 1, 1990, the
marketing, sale, and distribution of bituminous coals was banned within the city of Dublin (Air Pollution Act, 1987).
0
20
40
60
80
100
120
140
µg/m
3Dublin Black Smoke
Ban on Coal Sales
14.6 µg/m3
50.2 µg/m3
Bans on Coal Sales
September 1, 1990 -Dublin October 1, 1995 -Cork October 1, 1998 -Limerick -Dundalk -Drogheda -Wexford -Arklow
98th percentiles of Daily Black Smoke Concentrations in Major Urban Areas
Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality
DUBLIN CORK
1990 Ban 1995 Ban 1998 Ban
What are the effects of repeated, long term exposures to Fine Particles?
Satellite-Derived PM2.5: 2001–2006 Average
Von Donkelaar et al Envir Hlth Pers 2010;118:847
Six Cities Adult Mortality Study Random sample of
8411 adults in six cities Dirty: Steubenville,
OH & St. Louis, MI Moderate: Watertown,
MA & Harriman, TN Clean: Topeka, KS &
Portage, WI Enrolled 1974-77 14-16 years of
mortality follow-up
Dockery et al, NEJM 1993;329:1753
Follow-up
Six Cities Adult Mortality Study Random sample of
8411 adults in six cities Dirty: Steubenville,
OH & St. Louis, MI Moderate: Watertown,
MA & Harriman, TN Clean: Topeka, KS &
Portage, WI Enrolled 1974-77 14-16 years of
mortality follow-up
Dockery et al, NEJM 1993;329:1753
Six Cities Adult Mortality
0.7
0.8
0.9
1.0
1.1
1.2
1.3
1.4
0 10 20 30 40
PM2.5 (µg/m3)
Mor
talit
y Ri
sk R
atio
Steubenville
Topeka Watertown
Kingston St. Louis
Portage
EPA NAAQS
Six Cities Mortality Follow-up 1974 to 1989 follow-up
Annual returned postcards and National Death Index
1,364 deaths 104,243 person
years
PM2.5 measurements 1979-1986
1990 to 1998 follow-up National Death Index
search 1,368 deaths
54,735 person years
PM2.5 estimated from
PM10 1990-1998
Laden et al, AJRCCM 2006;54:709
Six Cities Cohort Follow-up
Laden et al, AJRCCM 2006;54:709
0.7
0.8
0.9
1.0
1.1
1.2
1.3
1.4
0 5 10 15 20 25 30 35
PM2.5 (µg/m3)
Mor
talit
y R
isk
Rat
io Steubenville
Topeka
Watertown
Kingston
St. Louis Portage
Improved air quality leads to reduced mortality
Can we see effect of air pollution controls in US?
Age-adjusted death rates: United States, 1960-2005
600
800
1,000
1,200
1,400
Rat
e pe
r 100
,000
pop
ulat
ion
1970 1980 1990
Age-adjusted
1960 0
2000 2005
County life expectancies at birth for white males and females;1997–2001
CJL Murray et al, Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med. 2006 Sep;3(9):e260
Trends in the Levels of the Six Criteria Pollutants Relative to U.S. National Standards: 1980 - 2006
51 Metropolitan areas (dots); Study Counties (shaded gray)
Life Expectancy vs PM2.5 1978-82
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30 35PM2.5 (µg/m3)
Life
Exp
ecta
ncy
Steubenville
Topeka
Boston
EPA NAAQS
Pope, Ezzati, Dockery. NEJM 2009; 360:376
Life Expectancy vs PM2.5 1997-2001
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30 35PM2.5 (µg/m3)
Life
Exp
ecta
ncy
Topeka
Boston
Steubenville
EPA NAAQS
Pope, Ezzati, Dockery. NEJM 2009; 360:376
Life Expectancy vs PM2.5 1980-2000
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30PM2.5 (µg/m3)
Life
Exp
ecta
ncy
Topeka
Pope, Ezzati, Dockery. NEJM 2009; 360:376
Life Expectancy vs PM2.5 1980-2000
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30PM2.5 (µg/m3)
Life
Exp
ecta
ncy
Pope, Ezzati, Dockery (NEJM 2009)
EPA NAAQS
Health benefits below current NAAQS
CAFE Stage I Limit Value
CAFE Stage II Limit Value
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30
Life
Exp
ecta
ncy
PM2.5 (µg/m3)
Coleraine St PM2.5 9.7 µg/m3
↓
2012 Life Expectancy 80.9 year
1990 Life Expectancy 74.8 year
What would these results say about air pollution in Ireland?
PM2.5 in 1990?
Black Smoke Before and After Bans
Goodman et al, JAWMA 2009
71
72
73
74
75
76
77
78
79
80
81
5 10 15 20 25 30 35
Life
Exp
ecta
ncy
PM2.5 (µg/m3)
CORK Black Smoke
Pre-Ban 32.4 µg/m3
↓ ↑
Post-Ban 17.2 µg/m3
3.8 yr
Implications of US data for Cork?
65
67
69
71
73
75
77
79
81
0 10 20 30 40 50
Life
Exp
ecta
ncy
PM2.5 (µg/m3)
1984-90 50.2 µg/m3
↑ 1990-96 14.6 µg/m3 9.0 yr
Implications of US data for Dublin?
0 2 4 6 8 10
Galway
Celbridge
Leixlip
Naas
Waterford
Limerick
Dundalk
Drogheda
Arklow
Cork
Dublin
20
00
Ban
19
98
Ban
19
95
Ban
19
90
Ban
Estimated Extra Years Life Expectancy
Implications of US data?
Median 3.5 yrs
How big is 3.5 year increase in life expectancy? 68 year old nonsmoking male
Additional life expectancy 15.5 years
Additional 3.5 years life expectancy 19.0 years
+
How big is 3.5 year increase in life expectancy in population of Ireland? Tobacco Smoking
6.8 years reduced life expectancy for average smoker (Streppel et al, Tob Cont 2007)
31% Current Smoking in Ireland(2009) (Special Eurobarometer 332) 6.8 yr among 31% of population
2.1 yr longer life expectancy in population Diabetes
7.8 years for men, 8.4 years for women (Fromer et al, Arch Int Med 2007)
4.7% Diabetes Mielitus in Ireland (2005) (Institute of Public Health in Ireland, 2006.)
8 yr among 4.7% of population 0.4 yr longer life expectancy in population
Fine particle air pollution Median 3.5 years for reduction in Black Smoke due to ban 100% of population affected
3.5 yr longer life expectancy in population
Conclusions PM2.5 associated significant life
shortening (mortality) Improved air quality leads to
measurably improved public health Benefits at all levels of air pollution Even in clean communities
Ireland likely has substantially longer life expectancy due to ban on coal sales
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