Measuring the Health Impacts of Measuring the Health Impacts of Air Pollution in Toronto and Air Pollution in Toronto and

HamiltonHamilton

Murray M. Finkelstein PhD MD

• Associate Professor, Department of Family Medicine and McMaster Institute of

Environment and Health, McMaster U.• Department of Family Medicine,

University of Toronto

Air Pollution and Human HealthAir Pollution and Human Health

• London smog episode demonstrated that extreme air pollution episodes can have adverse effects on health

• What about more moderate and usual pollution conditions?

Studies 1990 – PresentStudies 1990 – PresentTwo Major DesignsTwo Major Designs

• 1. Time Series Studies– Look at daily changes in hospitalization or

mortality in relation to pollution changes in preceding days

• 2. Cohort Studies– Look at long-term mortality of a defined group

in relation to pollution levels

Pollution and Mortality in Pollution and Mortality in Vancouver: Vedal et al 2003Vancouver: Vedal et al 2003

Health OutcomesHealth Outcomes

• Feeling Unwell

• Emergency Department Visits

• Hospitalization

• Mortality

Acute 1. Feeling UnwellAcute 1. Feeling Unwell

• Stieb and colleagues used data from the National Population Health Survey to look at Disability Days (sum of days spent in bed or cut down on activities)

in 2 week period before NPHS interview in relation to pollution levels in Toronto

1994-1999

Acute 2. Feeling UnwellAcute 2. Feeling Unwell

• Levels of carbon monoxide and particulate matter (PM2.5) were significantly associated with number of disability days.

• 30% increase in DDays for 0.2 ppm increase in CO (Mean level in Toronto 1.0)

• 20% increase in DDays for 7 microgm/m3 increase in PM2.5 (Mean level in Toronto 11 microgm/m3)

Acute 3. HospitalizationAcute 3. Hospitalization

• Burnett et al studied the relation between hospitalization for acute respiratory diseases in children under 2 years of age and warm season levels of ozone in Toronto

Acute 4. HospitalizationAcute 4. Hospitalization

• A 35% increase in the daily hospitalization rate for respiratory problems (May–August) was associated with a 45 parts per billion increase in the 5-day average of the daily maximum ozone concentration.

• The mean summer average of the ozone level was 45 ppb.

Acute 5. MortalityAcute 5. Mortality

• Burnett and colleagues reported that Particulate matter and carbon monoxide were also associated with daily mortality in Toronto over the 15-year period 1980 to 1994

Summary of Acute StudiesSummary of Acute Studies

• Studies of short term excursions in air pollution levels in Toronto over the past 20 years find associations with feelings of ill-health, hospitalization for respiratory and cardiovascular diseases, and mortality from cardiopulmonary diseases.

Chronic Urban ExposuresChronic Urban Exposures

• What about long-term exposures in Southern Ontario?

The Hamilton / Toronto Cohort The Hamilton / Toronto Cohort StudyStudy

• Funded by the Toxic Substances Research Initiative of Health Canada. Study Continuation funded by CIHR.

• P.I. Murray Finkelstein McMaster/ U of T

and Mike Jerrett , McMaster• Co-investigators: Malcolm Sears, Dave Verma

(McMaster) &

Ken Chapman (U of T)

The Hamilton / Toronto Cohort The Hamilton / Toronto Cohort Study SubjectsStudy Subjects

• Cohort of 110,000 individuals assembled from respiratory and family medicine clinics in Hamilton and Toronto

Income and Particles in HamiltonIncome and Particles in HamiltonSubjects from Firestone ClinicSubjects from Firestone Clinic

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Hamilton Harbour

Lake Ontario

Õ

50 - 77#

44 - 50#

39 - 44#

32 - 39#

20 - 32#

Subjects (TSP ug/m3)

St. Joseph'sHospital

N

TSP Exposures of Firestone SubjectsTSP Exposures of Firestone Subjects

Traffic Pollution ExposuresTraffic Pollution Exposures

• Indicator of traffic pollution exposure: Residence within 50m of a major urban road or 100m of a highway

p < 0.01

0

.05

.1

.15

.2

.25

Pro

babi

lity

Cir

cula

tory

Dea

th

0 2 4 6 8 10Years Since Entry

Near Major Road

Further from Major Road

CCirculatory Mortality in the Firestone Cohort

p = 0.8

0

.05

.1

.15

.2

Pro

babi

lity

of R

espi

rato

ry D

eath

0 2 4 6 8 10Years Since Entry

Near Major Road

Further from Major Road

Respiratory Mortality in the Firestone Cohort

Toronto Sampling LocationsToronto Sampling Locations

Distribution of NODistribution of NO22 in Toronto in Toronto

Mortality among Toronto Clinic Mortality among Toronto Clinic SubjectsSubjects

Relative Risk of Circulatory Mortality

Relative Risk of Respiratory

Mortality

Residence Near Major Road or Highway

1.55

(1.02 – 2.35)

1.04

(0.65 – 1.68)

NO2 per ppb 1.05

(1.02 – 1.08)

1.00

(0.97 - 1.04)

Summary of Chronic Studies in Summary of Chronic Studies in Hamilton and Toronto (I)Hamilton and Toronto (I)

• There is a non-homogeneous distribution of urban pollution

• Poorer neighbourhoods in Hamilton have higher levels of pollutants

Summary of Chronic Studies in Summary of Chronic Studies in Hamilton and Toronto (II)Hamilton and Toronto (II)

• There is an association between traffic-related pollution in Hamilton and Toronto and increased rates of circulatory disease hospitalization and mortality