Faculty Bibliography

The combination of air quality (AQ) data from satellites and low-cost sensor systems, along with output from AQ models, have the potential to augment high-quality, regulatory-grade data in countries with in situ monitoring networks and provide much needed AQ information in countries without them, including Low and Moderate Income Countries (LMICs). We demonstrate the potential of free and publicly available USA National Aeronautics and Space Administration (NASA) resources, which include capacity building activities, satellite data, and global AQ forecasts, to provide cost-effective, and reliable AQ information to health and AQ professionals around the world. We provide illustrative case studies that highlight how global AQ forecasts along with satellite data may be used to characterize AQ on urban to regional scales, including to quantify pollution concentrations, identify pollution sources, and track the long-range transport of pollution. We also provide recommendations to data product developers to facilitate and broaden usage of NASA resources by health and AQ stakeholders.

The health impacts of climate change are substantial and represent a primary motivating factor to mitigate climate change. However, the health impacts in economic models that estimate the social cost of carbon dioxide (SC-CO₂) have generally been made in isolation from health experts and have never been rigorously evaluated. Version 3.10 of the Framework for Uncertainty, Negotiation and Distribution (FUND) model was used to estimate the health-based portion of current SC-CO₂ estimates across low-, middle-, and high-income regions. In addition to the base model, three additional experiments assessed the sensitivity of these estimates to changes in the socio-economic assumptions in the model. Economic impacts from adverse health outcomes represent ∼8.7% of current SC-CO₂ estimates. The majority of these health impacts (74%) were attributable to diarrhea mortality (from both low- and high-income regions) followed by diarrhea morbidity (12%) and malaria mortality (11%); no other health impact makes a meaningful contribution to SC-CO₂ estimates in current economic models. The results of the socio-economic experiments show that the health-based portion of SC-CO₂ estimates are highly sensitive to assumptions regarding income elasticity of health effects, income growth, and use of equity weights. Improving the health-based portion of SC-CO₂ estimates could have substantial impacts on magnitude of the SC-CO₂. Incorporating additional health impacts not previously included in estimates of SC-CO₂ will be a critical component of model updates. This effort will be most successful through coordination between economists and health researchers and should focus on updating the form and function of concentration-response functions.

Wildland fires are diminishing air quality on a seasonal and regional basis, raising concerns about respiratory health risks to the public and occupational groups. This American Thoracic Society (ATS) workshop was convened in 2019 to meet the growing health threat of wildland fire smoke. The workshop brought together a multi-disciplinary group of 19 experts, including wildland fire managers, public health officials, epidemiologists, toxicologists, and pediatric and adult pulmonologists. The workshop examined four major topics: (1) the science of wildland fire incidence and fire management, (2) the respiratory and cardiovascular health effects of wildland fire smoke exposure, (3) communication strategies to address these health risks, and (4) actions to address wildland fire health impacts. Through formal presentations followed by group discussion, workshop participants identified top priorities for fire management, research, communication and public policy to address health risks of wildland fires. The workshop concluded that short-term exposure to wildland smoke causes acute respiratory health effects, especially among those with asthma and chronic obstructive pulmonary disease (COPD). Research is needed to understand long-term health effects of repeated smoke exposures across fire seasons for children, adults and highly exposed occupational groups (especially firefighters). Other research priorities include fire data collection and modeling, toxicology of different fire fuel sources, and the efficacy of health protective measures to prevent respiratory effects of smoke exposure. The workshop committee recommends a unified Federal response to the growing problem of wildland fires, including investment in fire behavior and smoke air quality modeling, research on the health impacts of smoke, and the development of robust clinical and public health communication tools.

Health risks from air pollution continue to be a major concern for residents in Mexico City. These health burdens could be partially alleviated through individual avoidance behavior if accurate information regarding the daily health risks of multiple pollutants became available. A split sample approach was used in this study to create and validate a multi-pollutant, health-based air quality index. Poisson generalized linear models were used to assess the impacts of ambient air pollution (i.e., fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ground-level ozone (O3) on a total of 610,982 daily emergency department (ED) visits for respiratory disease obtained from 40 facilities in the metropolitan area of Mexico City from 2010 to 2015. Increased risk of respiratory ED visits was observed for interquartile increases in the 4-day average concentrations of PM2.5 (Risk Ratio (RR) 1.03, 95% CI 1.01-1.04), O3 (RR 1.03, 95% CI 1.01-1.05), and to a lesser extent NO2 (RR 1.01, 95% CI 0.99"“1.02). An additive, multi-pollutant index was created using coefficients for these three pollutants. Positive associations of index values with daily respiratory ED visits was observed among children (ages 2"“17) and adults (ages 18+). The use of previously unavailable daily health records enabled an assessment of short-term ambient air pollution concentrations on respiratory morbidity in Mexico City and the creation of a health-based air quality index, which is now currently in use in Mexico City.

BACKGROUND:Ambient air pollution is a modifiable risk factor for cardiovascular disease, yet uncertainty remains about the size of risks at lower levels of fine particulate matter (PM2.5) exposure which now occur in the USA and elsewhere. METHODS:We investigated the relationship of ambient PM2.5 exposure with cause-specific cardiovascular disease mortality in 565 477 men and women, aged 50 to 71 years, from the National Institutes of Health-AARP Diet and Health Study. During 7.5 x 106 person-years of follow up, 41 286 cardiovascular disease deaths, including 23 328 ischaemic heart disease (IHD) and 5894 stroke deaths, were ascertained using the National Death Index. PM2.5 was estimated using a hybrid land use regression (LUR) geostatistical model. Multivariate Cox regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CI). RESULTS:Each increase of 10  μg/m3 PM2.5 (overall range, 2.9-28.0  μg/m3) was associated, in fully adjusted models, with a 16% increase in mortality from ischaemic heart disease [hazard ratio (HR) 1.16; 95% CI 1.09-1.22] and a 14% increase in mortality from stroke (HR 1.14; CI 1.02-1.27). Compared with PM2.5 exposure <8  μg/m3 (referent), risks for CVD were increased in relation to PM2.5 exposures in the range of 8-12  μg/m3 (CVD: HR 1.04; 95% CI 1.00-1.08), in the range 12-20  μg/m3 (CVD: HR 1.08; 95% CI 1.03-1.13) and in the range 20+ μg/m3 (CVD: HR 1.19; 95% CI 1.10-1.28). Results were robust to alternative approaches to PM2.5 exposure assessment and statistical analysis. CONCLUSIONS:Long-term exposure to fine particulate air pollution is associated with ischaemic heart disease and stroke mortality, with excess risks occurring in the range of and below the present US long-term standard for ambient exposure to PM2.5 (12  µg/m3), indicating the need for continued improvements in air pollution abatement for CVD prevention.

BACKGROUND:The Air Quality Index (AQI) in the United States is widely used to communicate daily air quality information to the public. While use of the AQI has led to reported changes in individual behaviors, such behavior modifications will only mitigate adverse health effects if AQI values are indicative of public health risks. Few studies have assessed the capability of the AQI to accurately predict respiratory morbidity risks. METHODS AND FINDINGS/RESULTS:In three major regions of California, Poisson generalized linear models were used to assess seasonal associations between 1,373,165 respiratory emergency department visits and short-term exposure to multiple metrics between 2012-2014, including: daily concentrations of NO2, O3, and PM2.5; the daily reported AQI; and a newly constructed health-based air quality index. AQI values were positively associated (average risk ratio = 1.03, 95% CI 1.02-1.04) during the cooler months of the year (November-February) in all three regions when the AQI was very highly correlated with PM2.5 (R2 ≥ 0.89). During the warm season (March-October) in the San Joaquin Valley region, neither AQI values nor the individual underlying air pollutants were associated with respiratory morbidity. Additionally, AQI values were not positively associated with respiratory morbidity in the Southern California region during the warm season, despite strong associations of the individual underlying air pollutants with respiratory morbidity; in contrast, health-based index values were observed to be significantly associated with respiratory morbidity as part of an applied policy analysis in this region, with a combined risk ratio of 1.02 (95% CI: 1.01-1.03). CONCLUSIONS:In regions where individual air pollutants are associated with respiratory morbidity, and during seasons with relatively simple air mixtures, the AQI can effectively serve as a risk communication tool for respiratory health risks. However, the predictive ability of the AQI and any other index is contingent upon the monitored values being representative of actual population exposures. Other approaches, such as health-based indices, may be needed in order to effectively communicate health risks of air pollution in regions and seasons with more complex air mixtures.

Air quality data from satellites and low-cost sensor systems, together with output from air quality models, have the potential to augment high-quality, regulatory-grade data in countries with in situ monitoring networks and provide much-needed air quality information in countries without them. Each of these technologies has strengths and limitations that need to be considered when integrating them to develop a robust and diverse global air quality monitoring network. To address these issues, the American Thoracic Society, the U.S. Environmental Protection Agency, the National Aeronautics and Space Administration, and the National Institute of Environmental Health Sciences convened a workshop in May 2017 to bring together global experts from across multiple disciplines and agencies to discuss current and near-term capabilities to monitor global air pollution. The participants focused on four topics: 1) current and near-term capabilities in air pollution monitoring, 2) data assimilation from multiple technology platforms, 3) critical issues for air pollution monitoring in regions without a regulatory-quality stationary monitoring network, and 4) risk communication and health messaging. Recommendations for research and improved use were identified during the workshop, including a recognition that the integration of data across monitoring technology groups is critical to maximizing the effectiveness (e.g., data accuracy, as well as spatial and temporal coverage) of these monitoring technologies. Taken together, these recommendations will advance the development of a global air quality monitoring network that takes advantage of emerging technologies to ensure the availability of free, accessible, and reliable air pollution data and forecasts to health professionals, as well as to all global citizens.

Rationale: Air quality improvements are increasingly difficult to come by as modern pollution control technologies and measures have been widely implemented in the United States. Although there have been dramatic improvements in air quality over the last several decades, it is important to evaluate changes in the health impacts of air pollution for a more recent time period to better understand the current trajectory of air quality improvements. Objectives: To provide county-level estimates of annual air pollution-related health outcomes across the United States and to evaluate these trends from 2008 to 2017, presented as part of the annual American Thoracic Society (ATS)/Marron Institute "Health of the Air" report. Methods: Daily air pollution values were obtained from the U.S. Environmental Protection Agency's Air Quality System for monitors in the United States from 2008 to 2017. Concentration-response functions used in the ATS/Marron Institute "Health of the Air" report were applied to the pollution increments corresponding to differences between the rolling 3-year design values (reported as the third year) and ATS-recommended levels for annual particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM_2.5; 11 μg/m³), short-term PM_2.5 (25 μg/m³), and ozone (O₃; 60 ppb). Health impacts were estimated at the county level in locations with valid monitor data. Results: Annual excess mortality in the United States due to air pollution levels greater than recommended by the ATS decreased from approximately 12,600 (95% confidence interval [CI], 5,470-21,040) in 2010 to 7,140 (95% CI, 2,290-14,040) in 2017. This improvement can be attributed almost entirely to reductions in PM_2.5-related mortality, which decreased by approximately 60% (reduced from 8,330 to 3,260 annual deaths), whereas O₃-related mortality remained largely unchanged, other than year-to-year variability, over the same time period (reduced from 4,270 to 3,880 annual deaths). Conclusions: Improvements in health impacts attributable to ambient PM_2.5 concentrations have been observed across most regions of the United States over the last decade, although the rate of these improvements has leveled off in recent years. Despite two revisions of the National Ambient Air Quality Standards strengthening the standard for O₃ in 2008 and 2015, there has not yet been a substantial improvement in the health impacts attributable to O₃ during this time period. In many U.S. cities, an increase in the exposed population over the last decade has outpaced the improvements in ambient O₃ concentrations, resulting in a net increase in O₃-related health impacts over time.

Air quality conditions in the U.S. are reported to the general public via the regulatory-based Air Quality Index (AQI). The accuracy of AQI as a risk communication tool is dependent, in part, on an assumption of equivalent health risks for each of the index pollutants. Time-series analyses of 858,030 emergency department visits from 2005–2010 for respiratory diseases in two New York counties (Bronx and Queens) were completed using a Poisson generalized linear model in order to assess the equivalency of respiratory morbidity risk for four index pollutants. Excess respiratory risk per 1-AQI unit was approximately twice as high for ozone (0.16%, 95% confidence interval [CI] [0.08, 0.24]) as compared with sulfur dioxide (0.09%, 95% CI [0.01, 0.16], nitrogen dioxide (0.07%, 95% CI [0.01, 0.15]), and fine particulate matter (0.07%, 95% CI [0.02, 0.12]). Unequal respiratory risks on a per-AQI-unit basis resulted in inconsistencies between reported AQI values and public health risks, especially during the ozone season. While still useful in reporting general air quality conditions to the public, AQI may be insufficiently precise to inform optimal daily behavior modification decisions