Health Impacts of Diesel

8/9/2019 Health Impacts of Diesel

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Health

Impacts

of

Diesel,

Based

on

DatafromtheNational-ScaleAir

ToxicsAssessment(NATA)

October2009

Preparedby:

DonaldMcCubbin,Ph.D.

Preparedfor:

CleanAirTaskForce


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TableofContentsTableofContents.................................................................................................................................11. Introduction....................................................................................................................................22. Methods.........................................................................................................................................3

2.1 AnnualAverageAmbientDieselConcentrations............................................................................... 3

2.2 EstimatingCasesofDieselRelatedHumanHealthImpacts.............................................................. 3

2.3 ValuingEstimatedHealthImpacts..................................................................................................... 4

3. Results............................................................................................................................................8AppendixA. HumanHealthImpactFunctionDetails...........................................................................9

A.1 DerivingHealthImpactFunctions...................................................................................................... 9

A.2 PM2.5HealthImpactFunctions........................................................................................................ 12

References.........................................................................................................................................29


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1. Introduction

Dieselparticlescausewidespreaddamagetohumanhealth. Thisreportestimatestheimpactofonroad

andoffroadsourcesofdieselparticles.

Thecontributionofdieselparticlestoambientparticlelevelslessthanorequalto2.5microns(PM2.5)in

aerodynamicdiameterarefromtheNationalScaleAirToxicsAssessment(NATA)program. The

epidemiologicalstudiesandmethodsusedtoestimatethehealthimpactsofdieselarethesameas

thoseusedbytheU.S.EnvironmentalProtectionAgency(EPA)inrecentregulatoryimpactassessments

(e.g.,U.S.EPA2008a;2008b;2009).

InSection2,IbrieflydescribethestudiesandmethodsthatIusedtoestimatethehealthimpactsof

diesel. AdditionaldetailsonthestudiesareprovidedinAppendixA. AndinSection3,Ibriefly

summarizethenationallevelhealthimpacts.


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2.Methods

ToestimatethedieselPM2.5relatedhumanhealthimpactsandvaluetheseimpacts,Iuseversion4.0oftheEnvironmentalBenefitsMappingandAnalysisProgram(BenMAP).1 ThefirststepinusingBenMAPis

tochangeinambientairquality,inthiscasethecontributionofdirectdieselparticlestoannualaverage

ambientPM2.5levels. (NoimpactsofdieselrelatedNOxandVOCemissionsonambientPM2.5are

considered.) GiventheannualchangeindieselPM2.5concentrations,BenMAPcalculatestheassociated

changeinadversehealtheffects,suchasprematuremortality. Toestimatetheeconomicvalueofthese

healtheffects,IusedEPAunitvaluesandperformedthecalculationswithSAS(version9.2).

2.1AnnualAverageAmbientDieselConcentrations

TheNATAprogramestimatedtractleveldirectdieselparticlecontributionstoambientPM2.5concentrationsforonroadandoffroadsources. AtractlevelfilewasaccessedfromtheNATAwebsite

(http://www.epa.gov/ttn/atw/nata2002/tables.html)andthenformattedforuseinBenMAP.

2.2 EstimatingCasesofDiesel-RelatedHumanHealthImpacts

Thefirststepinestimatinghealthimpactsinvolvesthespecificationofhealthimpactfunctions,which

quantifytherelationshipbetweenchangesinairpollutionandadversehealthimpacts. Atypicalhealth

impactfunctionforPM2.5hasfourcomponents:

Effectestimate. Aneffectestimate(beta)quantifiesthechangeinhealtheffectsperunitofchangeinPM2.5,andisderivedfromanepidemiologicalstudy.

PM2.5change. TheestimatedchangeintheconcentrationofambientPM2.5. Incidencerate. Thebaselineincidencerateforthehealtheffectduetoallcauses. Population. Theaffectedpopulation;theagerangeincludeddependsontheagesincludedin

theepidemiologicalstudy.

Thetypicalloglinearhealthimpactfunctionlooksasfollows:

Anothercommonformforhealthimpactfunctionsisthelogistic,whichappearsasfollows:

1ThekeydifferencebetweenBenMAPversions3.0and4.0isthatversion4.0hasupdatedmortalityincidence

ratesbasedonratesfortheperiod20042006(asopposedto19961998).


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AllofthehealthimpactfunctionsIuseareinoneofthesetwomainforms. Bothtypeshavethesame

fourelements. AppendixAderivesthesetwoformsandprovidesadditionaldetailsonindividual

studies. Table1presentsthePM2.5relatedhealthendpointsincludedinthisanalysis.

Table1. EpidemiologicalStudiesUsedtoEstimateAdverseHealthImpactsofDieselParticles

Endpoint Author AgeMortality,AllCause Ladenetal 2599

Mortality,AllCause Popeetal(2002) 3099

Mortality,AllCause Woodruffetal(1997) Infant

ChronicBronchitis Abbeyetal(1995c) 2799

HeartAttack,Nonfatal Petersetal(2001) 1899

HA,AllCardiovascular(lessMyocardialInfarctions) Moolgavkar(2000b) 1864

HA,AllCardiovascular(lessMyocardialInfarctions) Moolgavkar(2003) 6599

HA,CongestiveHeartFailure Ito(2003) 6599

HA,Dysrhythmia Ito(2003) 6599

HA,IschemicHeartDisease(lessMyocardialInfarctions) Ito(2003) 6599

HA,Pneumonia Ito(2003) 6599HA,ChronicLungDisease(lessAsthma) Moolgavkar(2000a) 1864

HA,ChronicLungDisease Ito(2003) 6599

HA,ChronicLungDisease Moolgavkar(2003) 6599

HA,Asthma Sheppard(2003) 064

EmergencyRoomVisits,Asthma Norrisetal(1999) 017

AcuteBronchitis Dockeryetal(1996) 812

LowerRespiratorySymptoms SchwartzandNeas(2000) 714

UpperRespiratorySymptoms Popeetal(1991) 911

AsthmaExacerbation,Cough Ostroetal(2001) 618

AsthmaExacerbation,ShortnessofBreath Ostroetal(2001) 618

AsthmaExacerbation,Wheeze Ostroetal(2001) 618

AsthmaExacerbation,Cough Vedaletal(1998) 618WorkLossDays(WLD) Ostro(1987) 1864

MinorRestrictedActivityDays(MRAD) Ostroand Rothschild(1989) 1864

Note:HA=hospitaladmissions.

2.3 ValuingEstimatedHealthImpacts

Estimatingtheeconomicbenefitoftheestimatedchangeinhealthincidence,Imultipliedthenumberof

adversecasesofaspecifictypeofeffect(e.g.,mortality)byitsassociatedunitvalueandthenadjusted

fortheestimatedchangeinincomebetween1990and2002:

Table2presentsthemeanestimateoftheunitvaluesusedinthisanalysis. Asdescribedinthenext

subsection,theapproachIusetoadjustforincomefollowstheapproachusedbyEPAinrecent

regulatoryanalyses. Inadditiontoadjustingforincome,Ialsoadjustthemortalityestimatetoaccount

foranassumeddistributionofdeathsovertime. Thismortalityadjustment(describedbelow)isalsoan

approachusedbyEPAinrecentregulatoryanalyses.


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Table2. UnitValuesforEconomicValuationofHealthEndpoints(basedon2002 incomeand2008$)

HealthEndpoint AgeRange UnitValueMortality* 0 99 $8,300,000

ChronicBronchitis 27 99 $450,000

AcuteMyocardialInfarction,Nonfatal** 0 24 $92,000

AcuteMyocardialInfarction,Nonfatal 25 44 $103,000




HA,AllCardiovascular(lessAMI) 18 64 $31,700

HA,AllCardiovascular(lessAMI) 65 99 $29,500

HA,CongestiveHeartFailure 65 99 $21,200

HA,Dysrhythmia 65 99 $21,200

HA,IschemicHeartDisease(lessAMI) 65 99 $36,100

HA,Pneumonia 65 99 $24,800

HA,ChronicLungDisease(lessAsthma) 1864 $17,200

HA,ChronicLungDisease 65 99 $18,700

HA,Asthma 0 64 $10,800

AsthmaERVisits*** 0 17 $399AcuteBronchitis 8 12 $470

LowerResp.Symptoms 7 14 $20

UpperResp.Symptoms 9 11 $31

AsthmaExacerbation,Cough 6 18 $54

AsthmaExacerbation,ShortnessofBreath 6 18 $54

AsthmaExacerbation,Wheeze 6 18 $54

WorkLossDays(WLD) 18 64 $161

MinorRestrictedActivityDays(MRAD) 18 64 $67

NOTE:Numbersroundedtothreesignificantdigits. HA=hospitaladmissions. *Mortalityvalueafteradjustment

for20yearlag.**Theagespecificacutemyocardialinfarctionunitvaluesarebasedonanaverageoftwo

estimates:onebasedonRussell(1998)andonebasedonWittels(1990). **TheasthmaERvisitvalueisan

averageoftwoestimates:onebasedonSmithetal(1997)andtheotherbasedonStanfordetal(1999).****

Countyspecificmediandailywage.

IncomeAdjustment

Thereisevidencethataspeoplesincomeincreases,theirwillingnesstopay(WTP)toavoidadverse

healthimpactsalsoincreases. EconomistsestimateelasticitiestodescribebywhatpercentWTPgoes

upforagivenpercentageincreaseinincome. Asitturnsout,theseestimatedelasticitiesaremuchless

thanone,however,thereisconsiderableuncertaintyovertheprecisevalue. Ifollowtheapproachused

byEPAinrecentregulatoryanalyses(U.S.EPA2008b),whichusedelasticityestimatesthatvarybytype

ofhealtheffect,withrelativelyminoreffectshavingasmallerelasticitythanmoresevereeffects.


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Table3. ElasticityofWTPbyTypeofHealthEffectHealthEffect CentralElasticityEstimateMinorHealthEffect 0.14

Severe&ChronicHealthEffects 0.45

PrematureMortality 0.4

Source:EPA(2005,p.418).

Multiplyingtheseelasticitiesbyhistoricalandforecastedincomedata,EPAdevelopedincome

adjustmentfactorswhichIuseinthisreport. Table4presentstheyear2002incomeadjustmentfactors

thatIuse,alongwiththeinterveningyearsbetween1990(theassumedincomeyearforthevaluation

estimates)and2002(theyearofinterest).

Table4. IncomeAdjustmentFactorsbyTypeofHealthEffect

Year Mortality Severe Minor1990 1.000 1.000 1.000

1991 0.992 0.991 0.997

1992 0.998 0.998 0.999

1993 1.003 1.003 1.001

1994 1.013 1.014 1.004

1995 1.017 1.019 1.006

1996 1.024 1.027 1.008

1997 1.034 1.039 1.012

1998 1.039 1.044 1.013

1999 1.043 1.048 1.015

2000 1.039 1.043 1.013

2001 1.044 1.049 1.015

2002 1.050 1.056 1.017

NotethatbecauseofalackofdataonthedependenceofCOIonincome,andalackofdataon

projectedgrowthinaveragewages,noadjustmentsaremadetobenefitsestimatesbasedontheCOI

approachortoworklossdaysandworkerproductivitybenefitsestimates.Thislackofadjustmentwould

tendtoresultinanunderpredictionofbenefitsinfutureyears,becauseitislikelythatincreasesinreal

U.S.incomewouldalsoresultinincreasedCOI(due,forexample,toincreasesinwagespaidtomedical

workers)andincreasedcostofworklossdaysandlostworkerproductivity(reflectingthatifworker

incomesarehigher,thelossesresultingfromreducedworkerproductionwouldalsobehigher).

MortalityAdjustment

Thedelay,orlag,betweenchangesinPMexposuresandchangesinmortalityratesisnotprecisely

known. Thecurrentscientificliteratureonadversehealtheffects,suchasthoseassociatedwithPM


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(e.g.,smokingrelateddisease),andthedifferenceintheestimatedeffectofchronicexposurestudies

versusdailymortalitystudies,suggeststhatitislikelythatnotallcasesofavoidedprematuremortality

associatedwithagivenincrementalreductioninPMexposurewouldoccurinthesameyearasthe

exposurereduction.

FollowingrecentEPAanalyses(U.S.EPA2006,p.521),Iassumea20yearlagstructure,with30percentofprematuredeathsoccurringinthefirstyear,50percentoccurringevenlyoveryears2to5afterthe

reductioninPM2.5,and20percentoccurringevenlyoveryears6to20afterthereductioninPM2.5.It

shouldbenotedthattheselectionofa20yearlagstructureisnotdirectlysupportedbyanyPMspecific

literature. Rather,itisintendedtobeareasonableestimateoftheappropriatetimedistributionof

avoidedcasesofPMrelatedmortality. AsnotedbyEPA,thedistributionofdeathsoverthelatency

periodisintendedtoreflectthecontributionofshorttermexposuresinthefirstyear,cardiopulmonary

deathsinthe2 to5yearperiod,andlongtermlungdiseaseandlungcancerinthe6 to20yearperiod.

Finally,itisimportanttokeepinmindthatchangesinthelagassumptionsdonotchangethetotal

numberofestimateddeathsbutratherthetimingofthosedeaths.

Specifyingthelagisimportantbecausepeoplearegenerallywillingtopaymoreforsomethingnowthan

forthesamethinglater. Theywould,forexample,bewillingtopaymoreforareductionintheriskof

prematuredeathinthesameyearasexposureisreducedthanforthatsameriskreductiontobe

receivedthefollowingyear. Thistimepreferenceforreceivingbenefitsnowratherthanlateris

expressedbydiscountingbenefitsreceivedlater. Theexactdiscountratethatisappropriate(i.e.,that

representspeoplestimepreference)isatopicofmuchdebate. EPAhasoftenusedadiscountrateof

threepercent,andIuseathreepercentrateforthisanalysisinconjunctionwiththe20yearlag

structuredescribedabove.


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3. Results

Table5summarizestheonroadandoffroaddieselimpacts. Detailsonthecalculationsareprovidedin

Chapter2andAppendixA.

Table5. Onroad&OffroadDieselHealthImpactsin2002

OnRoadDiesel OffRoad DieselHealthImpact Cases Value(million

2008$) Cases Value(million2008$)Mortality,Adult(Ladenetal,2006) 11,200 $84,200 23,900 $180,000

Mortality,Adult(Popeetal,2002) 4,360 $32,800 9,350 $70,300

Mortality,Infant 39 $324 86 $710

ChronicBronchitis 2,880 $1,300 6,250 $2,810HeartAttack,Nonfatal 6,330 $727 13,500 $1,550

HA,AllCardiovascular 2,020 $58 4,360 $126

HA,Respiratory 1,470 $27 3,180 $58

ERVisits,Asthma 3,920 $2 8,500 $3

AcuteBronchitis 7,870 $4 16,900 $8

LowerResp.Symptoms 93,800 $2 202,000 $4

UpperResp.Symptoms 71,300 $2 156,000 $5

AsthmaExacerbation 154,000 $8 336,000 $18

WLD 616,000 $99 1,350,000 $217

MRAD 3,590,000 $240 7,850,000 $526

Note:HA=hospitaladmissions. ER=emergencyroom.WLD=worklossdays. MRAD=minorrestrictedactivity

days. Resultsroundedtothreedigits.


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AppendixA. HumanHealthImpactFunction

Details

Thisappendixpresentsthederivationofthetwomainhealthimpactfunctionsusedinthisanalysis(log

linearandlogistic),aswellasdetailsoneachfunctionused.

A.1 DerivingHealthImpactFunctions

Below,Ipresentaderivationofthemeancoefficientestimatesforloglinearandlogistichealthimpact

functions.

Log-Linear

Derivation

PM

c

c

c

c

Bey

PMy

PMPMPM

conditionscontrolunderlevelsPMPM

conditionsbaselineunderlevelsPMPM

yyy

conditionscontrolunderIncidencey

conditionsbaselineunderIncidencey

=

+=

=

=

=

=

=

=

)ln(

0

0

0

0

=

=

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0

0

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PMPM

PM

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PM

BeBeBey

BeBey

Bey

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( )

( )( )

=

=

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=

PM

PM

PMPM

PMPMPM

eyy

eyy

eBey

eBey c

11

1

1

1

0

0

0

00

LogisticDerivation

riablevaPMtheoftcoefficien

tscoefficienofvector

riablesvaplanatoryexofvectorX

PMPMPM

conditionscontrolunderlevelsPMPM

conditionsbaselineunderlevelsPMPM

yyy

conditionscontrolunderIncidencey

conditionsbaselineunderIncidencey

c

c

c

c

=

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eratioodds

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c

cPM

PM

c

c

y

ye

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=

=

11

1

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cc

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cc

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yeyyy

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PMc

PMc


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A.2 PM2.5HealthImpactFunctions

Thisanalysisusesarangeofhealthimpactfunctions,includingthosetoestimateprematuremortality,

chronicbronchitis,andhospitaladmissions.Thesehealthimpactfunctionsarethesameonesusedin

recentEPAregulatoryimpactanalyses(e.g.,U.S.EPA2008b).

NotethattheinputtoBenMAPistheannualaveragecontributionofdieselparticlestopopulation

exposureofPM2.5. ToestimatethechangeinhealtheffectsassociatedwithdailychangesinPM2.5,

BenMAPassumesthattheannualchangeisareasonableproxyandmultipliestheresultby365. Since

thehealthimpactfunctionsarereasonablylinear,theeffectofthisassumptionissmall,generallywithin

afewpercent,evenforfairlyextremeassumptions.

Below,IpresentatablewiththehealthimpactfunctionsusedtoestimatePM2.5relatedadversehealth

effects. Followingthistable,Ipresentabriefsummaryofeachofthestudiesalongwithdetailsnotin

thesummarytable.


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Table6. DetailsofPM2.5HumanHealthImpactFunctions

EndpointName Study Location Age Beta StdErrorAdultmortality Ladenetal(2002) 6cities 2599 0.014842 0.004170Adultmortality Popeetal(2002) 51cities 3099 0.005827 0.002157Infantmortality

Woodruff

et

al(1997) 86

cities 0

0

0.003922 0.001221ChronicBronchitis Abbeyetal(1995c) California 2799 0.013185 0.006796

HeartAttack,Nonfatal Petersetal(2001) Boston,MA 1899 0.024121 0.009285

CongestiveHeartFailure Ito(2003) Detroit,MI 6599 0.003074 0.001292

Dysrhythmia Ito(2003) Detroit,MI 6599 0.001249 0.002033

IschemicHeartDisease(lessAMI) Ito(2003) Detroit,MI 6599 0.001435 0.001156

ChronicLungDisease Ito(2003) Detroit,MI 6599 0.001169 0.002064

Pneumonia Ito(2003) Detroit,MI 6599 0.003979 0.001659

AllCardiovascular(lessAMI) Moolgavkar(2000b) LosAngeles,CA 1864 0.001400 0.000341

ChronicLungDisease(lessAsthma) Moolgavkar(2000b) LosAngeles,CA 1864 0.002200 0.000733

AllCardiovascular(lessAMI) Moolgavkar(2003) LosAngeles,CA 6599 0.001580 0.000344

ChronicLungDisease Moolgavkar(2003) LosAngeles,CA 6599 0.001850 0.000524

Asthma Sheppard(2003) Seattle,WA 064 0.003324 0.001045

EmergencyRoomVisits,Asthma Norrisetal(1999) Seattle,WA 017 0.016527 0.004139MinorRestrictedActivityDays(MRAD) Ostro&Rothschild

(1989)

Nationwide 1864 0.007410 0.000700

AcuteBronchitis Dockeryetal(1996) 24communities 812 0.027212 0.017096

WorkLossDays(WLD) Ostro(1987) Nationwide 1864 0.004600 0.000360

LowerRespiratorySymptoms SchwartzandNeas

(2000)

6U.S.cities 714 0.019012 0.006005

AsthmaExacerbation,Cough Ostroetal(2001) LosAngeles,CA 618 0.000985 0.000747

AsthmaExacerbation,Shortnessof

Breath

Ostroetal LosAngeles,CA 618 0.002565 0.001335

AsthmaExacerbation,Wheeze Ostroetal LosAngeles,CA 618 0.001942 0.000803

AsthmaExacerbation,Cough Vedaletal(1998) Vancouver,CAN 618 0.007696 0.003786

UpperRespiratorySymptoms Popeetal(1991) UtahValley 911 0.0036 0.0015


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Mortality,AllCause(Ladenetal.2006)TheLadenetal(2002)analysisisalongitudinalcohorttrackingstudythatusesthesamesixcitycohort

astheoriginalDockeryetal(1993)study,andtheKrewskietal(2000)reanalysis. Akeydifferenceis

thattheLadenetalstudyusedalongerfollowupperiod.

ThecoefficientandstandarderrorforPM2.5areestimatedfromtherelativerisk(1.16)and

95%confidenceinterval(1.071.26)associatedwithachangeinannualmeanexposureof

10.0 g/m3(Ladenetal.2006,p.667).

FunctionalForm:LoglinearCoefficient:0.014842

StandardError:0.004170IncidenceRate:countyspecificannualallcausemortalityrateperpersonages25andolderPopulation:populationofages25andolder.

Mortality,AllCause(Popeetal.2002)

ThePopeetal(2002)analysisisalongitudinalcohorttrackingstudythatusesthesameAmerican

CancerSocietycohortastheoriginalPopeetal(1995)study,andtheKrewskietal(2000)reanalysis.

Popeetal(2002)analyzedsurvivaldataforthecohortfrom1982through1998,9yearslongerthanthe

originalPopestudy. Popeetal(2002)followedKrewskietal(2000)andPopeetal(1995,Table2)and

reportedresultsforallcausedeaths,lungcancer(ICD9code:162),cardiopulmonarydeaths(ICD9

codes:401440and460519),andallotherdeaths.2Liketheearlierstudies,Popeetal(2002)found

thatmeanPM2.5issignificantlyrelatedtoallcauseandcardiopulmonarymortality. Inaddition,Popeet

al(2002)foundasignificantrelationshipwithlungcancermortality,whichwasnotfoundintheearlier

studies. Noneofthethreestudiesfoundasignificantrelationshipwithallotherdeaths.

ThecoefficientandstandarderrorforPM2.5usingtheaverageof7983and9900PMdataare

estimatedfromtherelativerisk(1.06)and95%confidenceinterval(1.021.11)associatedwithachange

inannualmeanexposureof10 g/m3.Popeetal(2002,Table2).


StandardError:0.002157IncidenceRate:countyspecificannualallcausemortalityrateperpersonages30andolderPopulation:populationofages30andolder.

InfantMortality(Woodruffetal.1997)

Inastudyoffourmillioninfantsin86U.S.metropolitanareasconductedfrom1989to1991,Woodruff

etal(1997)foundasignificantlinkbetweenPM10exposureinthefirsttwomonthsofaninfantslife

withtheprobabilityofdyingbetweentheagesof28daysand364days. PM10exposurewassignificant

forallcausemortality. PM10wasalsosignificantforrespiratorymortalityinaveragebirthweight

infants,butnotlowbirthweightinfants.

2 Allcausemortalityincludesaccidents,suicides,homicidesandlegalinterventions. Thecategoryallotherdeathsis

allcausemortalitylesslungcancerandcardiopulmonarydeaths.


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Thecoefficientandstandarderrorarebasedontheoddsratio(1.04)and95%confidenceinterval(1.02

1.07)associatedwitha10 g/m3changeinPM10(Woodruffetal.1997,Table3).

FunctionalForm:LogisticCoefficient:0.003922StandardError:0.001221IncidenceRate:countyspecificannualpostneonatal3infantdeathsperinfantundertheageofonePopulation:populationofinfantsunderoneyearold.ChronicBronchitis (Abbeyetal.1995b)Abbeyetal(1995b)examinedtherelationshipbetweenestimatedPM2.5(annualmeanfrom1966to

1977),PM10(annualmeanfrom1973to1977)andTSP (annualmeanfrom1973to1977)andthesame

chronicrespiratorysymptomsinasamplepopulationof1,868CalifornianSeventhDayAdventists. The

initialsurveywasconductedin1977andthefinalsurveyin1987. Toensureabetterestimateof

exposure,thestudyparticipantshadtohavebeenlivinginthesameareaforanextendedperiodof

time. Insinglepollutantmodels,therewasastatisticallysignificantPM2.5relationshipwithdevelopmentofchronicbronchitis,butnotforAODorasthma;PM10wassignificantlyassociatedwith

chronicbronchitisandAOD;andTSPwassignificantlyassociatedwithallcasesofallthreechronic

symptoms. Otherpollutantswerenotexamined.

Theestimatedcoefficient(0.0137)ispresentedforaoneg/m3changeinPM2.5(Abbeyetal.1995b,

Table2). Thestandarderroriscalculatedfromthereportedrelativerisk(1.81)and95%confidence

interval(0.983.25)fora45g/m3changeinPM2.5(Abbeyetal.1995b,Table2).

FunctionalForm:LogisticCoefficient:0.0137

StandardError:0.00680IncidenceRate:annualbronchitisincidencerateperperson(Abbeyetal.1993,Table3)=0.00378Population:populationofages27andolder4withoutchronicbronchitis=95.57%ofpopulation27+.5

AcuteMyocardialInfarction(HeartAttacks),Nonfatal(Petersetal.2001)

Petersetal(2001)studiedtherelationshipbetweenincreasedparticulateairpollutionandonsetof

heartattacksintheBostonareafrom1995to1996. TheauthorsusedairqualitydataforPM10,PM102.5,

PM2.5,blackcarbon,O3,CO,NO2,andSO2inacasecrossoveranalysis. Foreachsubject,thecase

periodwasmatchedtothreecontrolperiods,each24hoursapart. Inunivariateanalyses,theauthors

observedapositiveassociationbetweenheartattackoccurrenceandPM2.5levelshoursbeforeanddays

beforeonset. Theauthorsestimatedmultivariateconditionallogisticmodelsincludingtwohourand

twentyfourhourpollutantconcentrationsforeachpollutant. Theyfoundsignificantandindependent

associationsbetweenheartattackoccurrenceandbothtwohourandtwentyfourhourPM2.5

concentrationsbeforeonset. SignificantassociationswereobservedforPM10aswell. Noneoftheother

3Postneonatalreferstoinfantsthatare28daysto364daysold.

4Usingthesamedataset,Abbeyetal(1995a,p.140)reportedtherespondentsin1977rangedinagefrom27to95.

5TheAmericanLungAssociation (2002b,Table4) reportsachronicbronchitisprevalencerateforages18andoverof

4.43%(AmericanLungAssociation2002b).


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particlemeasuresorgaseouspollutantsweresignificantlyassociatedwithacutemyocardialinfarction

forthetwohourortwentyfourhourperiodbeforeonset.

Themeanageofparticipantswas62yearsold,with21%ofthestudypopulationundertheageof50. In

ordertocapturethefullmagnitudeofheartattackoccurrencepotentiallyassociatedwithairpollution

andbecauseagewasnotlistedasaninclusioncriteriaforsampleselection,BenMAPassumesanagerangeof18andoverinthehealthimpactfunction. AccordingtotheNationalHospitalDischargeSurvey,

therewerenohospitalizationsforheartattacksamongchildren


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StandardError:0.001045IncidenceRate:regionspecificdailyhospitaladmissionrateforasthmaadmissionsperperson


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Ages65andolder(Moolgavkar2003)Thecoefficientandstandarderrorarecalculatedfromanestimatedpercentagechangeof1.85

andt

statisticof3.53fora10 g/m3increaseinPM2.5inthe2daylagGAM30dfstringent(108)model

(Moolgavkar2003,Table17).


StandardError:0.000519IncidenceRate:regionspecificdailyhospitaladmissionrateforchroniclungdiseaseadmissionsperperson65+(ICDcodes490496)

Population:populationofages65andolder.HospitalAdmissionsforAllCardiovascular(Moolgavkar2000b;2003)

Moolgavkar(2000b)examinedtheassociationbetweenairpollutionandcardiovascularhospital

admissions(ICD390448)intheChicago,LosAngeles,andPhoenixmetropolitanareas. Hecollecteddailyairpollutiondataforozone,SO2,NO2,CO,andPM10inallthreeareas. PM2.5datawasavailable

onlyinLosAngeles. ThedatawereanalyzedusingaPoissonregressionmodelwithgeneralizedadditive

modelstoadjustfortemporaltrends. Separatemodelswererunfor0to5daylagsineachlocation.

Amongthe65+agegroup,thegaseouspollutantsgenerallyexhibitedstrongereffectsthanPM10or

PM2.5. ThestrongestoveralleffectswereobservedforSO2andCO. Inasinglepollutantmodel,PM2.5

wasstatisticallysignificantforlag0andlag1. IncopollutantmodelswithCO,thePM2.5effectdropped

outandCOremainedsignificant. Forages2064,SO2andCOexhibitedthestrongesteffectandany

PM2.5effectdroppedoutincopollutantmodelswithCO.

InresponsetoconcernswiththeSplusissue,Moolgavkar(2003)reanalyzedhisearlierstudy. Inthereanalysis,hereportedthatmoregeneralizedadditivemodelswithstringentconvergencecriteriaand

generalizedlinearmodelsresultedinsmallerrelativeriskestimates. Notalloftheoriginalresultswere

replicated,soBenMAPusesamixofhealthimpactfunctionsfromthereanalysisandfromtheoriginal

study(whenthereanalyzedresultswerenotavailable). ThePM2.5CRfunctionsarebasedonsingle

pollutantandcopollutant(PM2.5andCO)models.

NotethatMoolgavkar(2000b)reportedresultsthatincludeICDcode410(heartattack). Iestimate

avoidednonfatalheartattacksusingtheresultsreportedbyPetersetal(2001). Inordertoavoid

doublecountingheartattackhospitalizations,ICDcode410wasexcludedfromthebaselineincidence

rateusedinthisfunction.

8AlthoughMoolgavkar(2000a)reportsresultsforthe2064yearoldagerange,forcomparabilitytootherstudies,we

applytheresultstothepopulationofages18to64.


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Ages18to64(Moolgavkar2000a)Thesinglepollutantcoefficientandstandarderrorarecalculatedfromanestimatedpercentchangeof

1.4andtstatisticof4.1fora10 g/m3increaseinPM2.5inthezerolagmodel(Moolgavkar2000b,Table

4).


StandardError:0.000341IncidenceRate:regionspecificdailyhospitaladmissionrateforallcardiovascularadmissionsperpersonages18to64(ICDcodes390409,411429)

Population:populationofages18to64.9Ages65andolder(Moolgavkar2003)Thesinglepollutantcoefficientandstandarderrorarecalculatedfromanestimatedpercentchangeof

1.58andtstatisticof4.59fora10 g/m3increaseinPM2.5inthe0daylagGAM30dfstringent(108)

model(Moolgavkar2003,Table12).


StandardError:0.000342IncidenceRate:regionspecificdailyhospitaladmissionrateforallcardiovascularadmissionsperperson65+(ICDcodes390409,411429)

Population:populationofages65andolder.HospitalAdmissionsforRespiratory&CardiovascularCauses(Ito2003)

Lippmannetal(2000)studiedtheassociationbetweenparticulatematteranddailymortalityand

hospitalizationsamongtheelderlyinDetroit,MI. Datawereanalyzedfortwoseparatestudyperiods,

19851990and19921994. The19921994studyperiodhadagreatervarietyofdataonPMsizeand

wasthemainfocusofthereport. Theauthorscollectedhospitalizationdataforavarietyof

cardiovascularandrespiratoryendpoints. TheyuseddailyairqualitydataforPM10,PM2.5,andPM102.5in

aPoissonregressionmodelwithgeneralizedadditivemodels(GAM)toadjustfornonlinearrelationships

andtemporaltrends. Insinglepollutantmodels,allPMmetricswerestatisticallysignificantfor

pneumonia(ICDcodes480486),PM102.5andPM10weresignificantforischemicheartdisease(ICDcode

410414),andPM2.5andPM10weresignificantforheartfailure(ICDcode428). Therewerepositive,but

notstatisticallysignificantassociations,betweenthePMmetricsandCOPD(ICDcodes490496)anddysrhythmia(ICDcode427). InseparatecopollutantmodelswithPMandeitherozone,SO2,NO2,or

CO,theresultsweregenerallycomparable. ThePM2.5CRfunctionsarebasedonresultsofthesingle

pollutantmodelandcopollutantmodelwithozone.

9AlthoughMoolgavkar(2000a)reportsresultsforthe2064yearoldagerange,forcomparabilitytootherstudies,we

applytheresultstothepopulationofages18to64.


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InresponsetoconcernswiththeSplusissue,Ito(2003) reanalyzedthestudybyLippmannetal(2000).

ThereanalysisbyItoreportedthatmoregeneralizedadditivemodelswithstringentconvergencecriteria

andgeneralizedlinearmodelsresultedinsmallerrelativeriskestimates.

ChronicLungDiseaseThecoefficientandstandarderrorarebasedontherelativerisk(1.043)and95%confidenceinterval

(0.9021.207)fora36 g/m3increaseinPM2.5inthe3daylagGAMstringentmodel(Ito2003,Table8).


StandardError:0.002064IncidenceRate:regionspecificdailyhospitaladmissionrateforchroniclungdiseaseadmissionsperperson65+(ICDcodes490496)

Population:populationofages65andolder.PneumoniaTheestimatedPM2.5coefficientandstandarderrorarebasedonarelativeriskof1.154(95%CI 1.027,

1.298)duetoaPM2.5changeof36 g/m3inthe1daylagGAMstringentmodel(Ito2003,Table7).


StandardError:0.001659IncidenceRate:regionspecificdailyhospitaladmissionrateforpneumoniaadmissionsperperson65+(ICDcodes480487)

Population:populationofages65andolder.DysrhythmiaThecopollutantcoefficientandstandarderrorarecalculatedfromarelativeriskof1.046(95%CI0.906

1.207)fora36 g/m3increaseinPM2.5inthe1daylagGAMstringentmodel(Ito2003,Table10).


StandardError:0.002033IncidenceRate:regionspecificdailyhospitaladmissionratefordysrhythmiaadmissionsperperson65+(ICDcode427)

Population:populationofages65andolder.CongestiveHeartFailureThecopollutantcoefficientandstandarderrorarecalculatedfromarelativeriskof1.117(95%CI1.020




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StandardError:0.001292IncidenceRate:regionspecificdailyhospitaladmissionrateforcongestiveheartfailureadmissionsperperson65+(ICDcode428)

Population:populationofages65andolder.IschemicHeartDiseaseThecopollutantcoefficientandstandarderrorarecalculatedfromarelativeriskof1.053(95%CI0.971



StandardError:0.001156IncidenceRate:regionspecificdailyhospitaladmissionrateforischemicheartdiseaseadmissionsperperson65+(ICDcodes411414)10

Population:populationofages65andolder.EmergencyRoomVisitsforAsthma(Norrisetal.1999)

Norrisetal(1999)examinedtherelationbetweenairpollutioninSeattleandchildhood(


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livingin24communitiesinU.S.andCanada. Healthdatawerecollectedin19881991,andsingle

pollutantmodelswereusedintheanalysistotestanumberofmeasuresofparticulateairpollution.

Dockeryetalfoundthatannuallevelofsulfatesandparticleacidityweresignificantlyrelated to

bronchitis,andPM2.1andPM10weremarginallysignificantlyrelatedtobronchitis.11Theyalsofound

nitrateswerelinkedtoasthma,andsulfateslinkedtochronicphlegm. Itisimportanttonotethatthe

studyexaminedannualpollutionexposures,andtheauthorsdidnotruleoutthatacute(daily)

exposurescouldberelatedtoasthmaattacksandotheracuteepisodes.

Bronchitiswascountedinthestudyonlyiftherewerereportsofsymptomsinthepast12

months(Dockeryetal.1996,p.501). Itisunclear,however,ifthecasesofbronchitisareacuteand

temporary,orifthebronchitisisachroniccondition. DockeryetalfoundnorelationshipbetweenPM

andchroniccoughandchronicphlegm,whichareimportantindicatorsofchronicbronchitis. Iassume

thatthehealthimpactfunctionbasedonDockeryetalismeasuringacutebronchitis.

Theestimatedlogisticcoefficientandstandarderrorarebasedontheoddsratio(1.50)and95%

confidenceinterval(0.912.47)associatedwithbeinginthemostpollutedcity(PM2.1

=20.7 g/m3)

versustheleastpollutedcity(PM2.1=5.8 g/m3)(Dockeryetal.1996,Tables1and4).Theoriginalstudy

usedPM2.1,however,BenMAPusesthePM2.1coefficientandapplyittoPM2.5data.


StandardError:0.017096IncidenceRate:annualbronchitisincidencerateperperson=0.043(AmericanLungAssociation2002c,Table11)

Population:populationofages812.LowerRespiratorySymptoms(SchwartzandNeas2000)

SchwartzandNeas(2000)usedlogisticregressiontolinklowerrespiratorysymptomsandcoughin

childrenwithcoarsePM10,PM2.5,sulfateandH+(hydrogenion). Childrenwereselectedforthestudyif

theywereexposedtoindoorsourcesofairpollution:gasstovesandparentalsmoking. Thestudy

enrolled1,844childrenintoayearlongstudythatwasconductedindifferentyears(1984to1988)insix

cities. Thestudentswereingradestwothroughfiveatthetimeofenrollmentin1984. Bythe

completionofthefinalstudy,thecohortwouldthenbeintheeighthgrade(ages1314);thissuggests

anagerangeof7to14.

Thecoefficientandstandarderrorarecalculatedfromthereportedoddsratio(1.33)and95%confidenceinterval(1.111.58)associatedwitha15g/m3changeinPM2.5(SchwartzandNeas2000,

Table2).

FunctionalForm:Logistic11TheoriginalstudymeasuredPM2.1,howeverwhenusingthestudy'sresultsweusePM2.5. Thismakesonlyanegligible

difference,assumingthattheadverseeffectsofPM2.1andPM2.5arecomparable.


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23

Coefficient:0.01901

StandardError:0.006005IncidenceRate:dailylowerrespiratorysymptomincidencerateperperson=0.0012(Schwartzetal.1994,Table2).

Population:populationofages7to14.

MinorRestrictedActivityDays(Ostro1989)

OstroandRothschild(1989)estimatedtheimpactofPM2.5andozoneontheincidenceofminor

restrictedactivitydays(MRADs)andrespiratoryrelatedrestrictedactivitydays(RRADs)inanational

sampleoftheadultworkingpopulation,ages18to65,livinginmetropolitanareas. Theannualnational

surveyresultsusedinthisanalysiswereconductedin19761981. ControllingforPM2.5,twoweek

averageozonehashighlyvariableassociationwithRRADsandMRADs. Controllingforozone,twoweek

averagePM2.5wassignificantlylinkedtobothhealthendpointsinmostyears.12 TheCRfunctionforPM

isbasedonthiscopollutantmodel.

Usingtheresultsofthetwopollutantmodel,separatecoefficientsweredevelopedforeachyearinthe

analysis,whichwerethencombinedforuseinthisanalysis. Thecoefficientisaweightedaverageofthe

coefficientsinOstroandRothschild(1989,Table4)usingtheinverseofthevarianceastheweight. The

standarderrorofthecoefficientiscalculatedasfollows,assumingthattheestimatedyearspecific

coefficientsareindependent.


StandardError:0.00070IncidenceRate:dailyincidencerateforminorrestrictedactivitydays(MRAD)=0.02137(OstroandRothschild1989,p.243)

Population:adultpopulationages18to64.13WorkLossDays(Ostro1987)

Ostro(1987)estimatedtheimpactofPM2.5ontheincidenceofworklossdays(WLDs),restrictedactivity

days(RADs),andrespiratoryrelatedRADs(RRADs)inanationalsampleoftheadultworkingpopulation,

ages18to65,livinginmetropolitanareas. Theannualnationalsurveyresultsusedinthisanalysiswere

conductedin19761981. OstroreportedthattwoweekaveragePM2.5levelsweresignificantlylinkedto

worklossdays,RADs,andRRADs,howevertherewassomeyeartoyearvariabilityintheresults.14

12Thestudyusedatwoweekaveragepollutionconcentration;theCRfunctionusesadailyaverage,whichisassumed

tobeareasonableapproximation.13Thestudyisbasedonaconveniencesampleofnonelderlyindividuals. ApplyingtheCRfunctiontothisage

groupislikelyaslightunderestimate,asitseemslikelythatelderlyareatleastassusceptibletoPMasindividuals

under65.14Thestudyusedatwoweekaveragepollutionconcentration;theCRfunctionusesadailyaverage,whichisassumed

tobeareasonableapproximation.


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Separatecoefficientsweredevelopedforeachyearintheanalysis(19761981);thesecoefficientswere

pooled. Thecoefficientusedintheconcentrationresponsefunctionpresentedhereisaweighted

averageofthecoefficientsinOstro(1987,Table3)usingtheinverseofthevarianceastheweight.

ThecoefficientusedintheCRfunctionisaweightedaverageofthecoefficientsinOstro(1987,Table3)

usingtheinverseofthevarianceastheweight. Thestandarderrorofthecoefficientiscalculatedasfollows,assumingthattheestimatedyearspecificcoefficientsareindependent.


StandardError:0.00036IncidenceRate:dailyworklossdayincidencerateperpersonages18to64=0.00595(U.S.BureauoftheCensus1997,No.22;Adamsetal.1999,Table41)

Population:adultpopulationages18to64.15

AsthmaExacerbation:

Pooling

Ostro

et

al.

(2001)

and

Vedal

et

al.

(1998)

IpooltheresultsofstudiesbyOstroetal(2001)andVedaletal(1998)togetanestimateoflower

respiratorysymptomsinasthmatics. IuseasimpleaverageoftheresultswhenIpoolunlikethe

analysisperformedforCleanAirInterstateRule(U.S.EPA2005,Table47). Inadditiontothelower

respiratoryestimate,IincludeanupperrespiratoryestimatebasedonastudybyPopeetal(1991).

Tocharacterizeasthmaexacerbationsinchildren,EPAusestwostudiesthatfollowedpanelsof

asthmaticchildren.Ostroetal(2001)followedagroupof138AfricanAmericanchildreninLosAngeles

for13weeks,recordingdailyoccurrencesofrespiratorysymptomsassociatedwithasthma

exacerbations(e.g.,shortnessofbreath,wheeze,andcough).Thisstudyfoundastatisticallysignificant

associationbetweenPM2.5,measuredasa12houraverage,andthedailyprevalenceofshortnessof

breathandwheezeendpoints.Althoughtheassociationwasnotstatisticallysignificantforcough,the

resultswerestillpositiveandclosetosignificance;consequently,EPAincludesthisendpoint,alongwith

shortnessofbreathandwheeze,ingeneratingincidenceestimates.

Vedaletal(1998)followedagroupofelementaryschoolchildren,including74asthmatics,locatedon

thewestcoastofVancouverIslandfor18monthsincludingmeasurementsofdailypeakexpiratoryflow

(PEF)andthetrackingofrespiratorysymptoms(e.g.,cough,phlegm,wheeze,chesttightness)through

theuseofdailydiaries.AssociationbetweenPM10andrespiratorysymptomsfortheasthmatic

populationwasonlyreportedfortwoendpoints:coughandPEF.BecauseitisdifficulttotranslatePEF

measuresintoclearlydefinedhealthendpointsthatcanbemonetized,EPAonlyincludedthecoughrelatedeffectestimatefromthisstudyinquantifyingasthmaexacerbations.

15Thestudyisbasedonaconveniencesampleofnonelderlyindividuals. ApplyingtheCRfunctiontothisage

groupislikelyaslightunderestimate,asitseemslikelythatelderlyareatleastassusceptibletoPMasindividuals

under65.


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25

EPAemployedthefollowingpoolingapproachincombiningestimatesgeneratedusingeffectestimates

fromthetwostudiestoproduceasingleasthmaexacerbationincidenceestimate. First,EPApooledthe

separateincidenceestimatesforshortnessofbreath,wheeze,andcoughgeneratedusingeffect

estimatesfromtheOstroetal(2001)study,becauseeachoftheseendpointsisaimedatcapturingthe

sameoverallendpoint(asthmaexacerbations)andtherecouldbeoverlapintheirpredictions.The

pooledestimatefromtheOstroetal.studyisthenpooledwiththecoughrelatedestimategenerated

usingtheVedaletalstudy.Therationaleforthissecondpoolingstepissimilartothefirst;bothstudies

areattemptingtoquantifythesameoverallendpoint(asthmaexacerbations).

Topreventdoublecounting,EPA(2005,p.438)focusedtheestimationonasthmaexacerbations

occurringinchildrenandexcludedadultsfromthecalculation. Asthmaexacerbationsoccurringin

adultsareassumedtobecapturedinthegeneralpopulationendpointssuchasworklossdaysand

MRADs.Consequently,ifEPAhadincludedanadultspecificasthmaexacerbationestimate,thiswould

likelyhavedoublecountedincidenceforthisendpoint.However,becausethegeneralpopulation

endpointsdonotcoverchildren(withregardtoasthmaticeffects),ananalysisfocusedspecificallyon

asthmaexacerbationsforchildren(6to18yearsofage)couldbeconductedwithoutconcernfor

doublecounting.

AsthmaExacerbation:Cough,Wheeze,andShortnessofBreath(Ostroetal.2001)

Ostroetal.(2001)studiedtherelationbetweenairpollutioninLosAngelesandasthmaexacerbationin

AfricanAmericanchildren(8to13yearsold)fromAugusttoNovember1993. Theyusedairqualitydata

forPM10,PM2.5,NO2,andO3inalogisticregressionmodelwithcontrolforage,income,timetrends,and

temperaturerelatedweathereffects.1 Asthmasymptomendpointsweredefinedintwoways:

probabilityofadaywithsymptomsandonsetofsymptomepisodes. Newonsetofasymptom

episodewasdefinedasadaywithsymptomsfollowedbyasymptomfreeday. TheauthorsfoundcoughprevalenceassociatedwithPM10andPM2.5andcoughincidenceassociatedwithPM2.5,PM10,and

NO2. Ozonewasnotsignificantlyassociatedwithcoughamongasthmatics.

NotethatthestudyfocusedonAfricanAmericanchildrenages8to13yearsold. EPAappliesthe

functionbasedonthisstudytothegeneralpopulationages6to18yearsold.

AsthmaExacerbation,CoughThecoefficientandstandarderrorarebasedonanoddsratioof1.03(95%CI0.981.07)fora30 g/m3

increasein12houraveragePM2.5concentration(Ostroetal.2001,Table4,p.204).


StandardError:0.0007471Theauthorsnotethattherewere26daysinwhichPM2.5concentrationswerereportedhigherthanPM10

concentrations. Themajorityofresultstheauthorsreportedwerebasedonthefulldataset. Theseresultswereusedfor

thebasisfortheCRfunctions.


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26

IncidenceRate:dailycoughrateperperson(Ostroetal.2001,p.202) =0.145Population:asthmaticpopulationages6to18=5.67%.2AsthmaExacerbation,ShortnessofBreathThecoefficientandstandarderrorarebasedonanoddsratioof1.08(95%CI1.001.17)fora30 g/m3



StandardError:0.001335IncidenceRate:dailyshortnessofbreathrateperperson(Ostroetal.2001,p.202)=0.074Population:asthmaticpopulationages6to18=5.67%.AsthmaExacerbation,WheezeThecoefficientandstandarderrorarebasedonanoddsratioof1.06(95%CI1.011.11)fora30 g/m3



StandardError:0.000803IncidenceRate:dailywheezerateperperson(Ostroetal.2001,p.202) =0.173Population:asthmaticpopulationages6to18=5.67%.AsthmaExacerbation,Cough(Vedaletal.1998)

Vedaletal.(1998)studiedtherelationshipbetweenairpollutionandrespiratorysymptomsamong

asthmaticsandnonasthmaticchildren(ages6to13)inPortAlberni,BritishColumbia,Canada. Four

groupsofelementaryschoolchildrenweresampledfromapriorcrosssectionalstudy:(1)allchildren

withcurrentasthma,(2)childrenwithoutdoctordiagnosedasthmawhoexperiencedadropinFEVafter

exercise,(3)childrennotingroups1or2whohadevidenceofairwayobstruction,and(4)acontrol

groupofchildrenwithmatchedbyclassroom.

Theauthorsusedlogisticregressionandgeneralizedestimatingequationstoexaminetheassociation

betweendailyPM10levelsanddailyincreasesinvariousrespiratorysymptomsamongthesegroups. In

theentiresampleofchildren,PM10wassignificantlyassociatedwithcough,phlegm,nosesymptoms,andthroatsoreness. Amongchildrenwithdiagnosedasthma,theauthorsreportasignificant

associationbetweenPM10andcoughsymptoms,whilenoconsistenteffectswereobservedintheother

groups. Sincethestudypopulationhasanoverrepresentationofasthmatics,duetothesampling

2TheAmericanLungAssociation(2002a,Table7)estimatesasthmaprevalenceforchildren517at5.67%(basedondata

fromthe1999NationalHealthInterviewSurvey).


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27

strategy,theresultsfromthefullsampleofchildrenarenotgeneralizeabletotheentirepopulation.

TheCRfunctionpresentedbelowisbasedonresultsamongasthmaticsages6to18.

ThePM10coefficientandstandarderrorarebasedonanincreaseinoddsof8%(95%CI016%)reported

intheabstractfora10 g/m3increaseindailyaveragePM10.


StandardError:0.003786IncidenceRate:dailycoughrateperperson(Vedaletal.1998,Table1,p.1038) =0.086Population:asthmaticpopulationages6to18=5.67%.3UpperRespiratorySymptoms(Pope1991)

Usinglogisticregression,Popeetal.(1991)estimatedtheimpactofPM10ontheincidenceofavarietyof

minorsymptomsin55subjects(34schoolbasedand21patientbased)livingintheUtahValley

fromDecember1989throughMarch1990. ThechildreninthePopeetal.studywereaskedtorecord

respiratorysymptomsinadailydiary. Withthisinformation,thedailyoccurrencesofupperrespiratory

symptoms(URS)andlowerrespiratorysymptoms(LRS)wererelatedtodailyPM10concentrations. Pope

etal.describeURSasconsistingofoneormoreofthefollowingsymptoms: runnyorstuffynose;wet

cough;andburning,aching,orredeyes. Levelsofozone,NO2,andSO2werereportedlowduringthis

period,andwerenotincludedintheanalysis.

Thesampleinthisstudyisrelativelysmallandismostrepresentativeoftheasthmaticpopulation,

ratherthanthegeneralpopulation. Theschoolbasedsubjects(ranginginagefrom9to11)were

chosenbasedonapositiveresponsetooneormoreofthreequestions:everwheezedwithoutacold,

wheezedfor3daysormoreoutoftheweekforamonthorlonger,and/orhadadoctorsaythechild

hasasthma(Popeetal.1991,p.669). Thepatientbasedsubjects(ranginginagefrom8to72)were

receivingtreatmentforasthmaandwerereferredbylocalphysicians. Regressionresultsfortheschool

basedsample(Popeetal.1991,Table5)showPM10significantlyassociatedwithbothupperandlower

respiratorysymptoms. ThepatientbasedsampledidnotfindasignificantPM10effect. Theresultsfrom

theschoolbasedsampleareusedhere.

Thecoefficientandstandarderrorforaoneg/m3changeinPM10isreportedinPopeetal(1991,Table

5).


StandardError:0.0015

3TheAmericanLungAssociation(AmericanLungAssociation2002a)estimatesasthmaprevalenceforchildren517at

5.67%(basedondatafromthe1999NationalHealthInterviewSurvey).


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IncidenceRate:dailyupperrespiratorysymptomincidencerateperperson=0.3419(Popeetal.1991,Table2)

Population:asthmaticpopulationages9to11=5.67%ofpopulationages9to11.4

4 TheAmericanLungAssociation(2002a,Table7)estimatesasthmaprevalenceforchildrenages5to17at5.67%(based

ondatafromthe1999NationalHealthInterviewSurvey).


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