MODELLING OF AIR POLLUTION AND HEALTH EFFECTS in INDIA …
Transcript of MODELLING OF AIR POLLUTION AND HEALTH EFFECTS in INDIA …
MODELLING OF AIR POLLUTION AND HEALTH EFFECTS in INDIA
THE NEXUS OF CLIMATE AND HEALTHCentre for Global Health Delivery & Harvard Global Health Institute
23rd February, 2021
Poornima Prabhakaran MBBS MSc PhD
Head-Environmental Health & Additional Professor
Deputy Director, Centre for Environmental Health
Public Health Foundation of India
Consultant, Centre for Chronic Disease Control
Ambient PM2.5 Variation Over Time
99% of districts above WHO annual exposure guidelines60% above National Ambient Air Quality Standards
Source: Urbanemissions.info 2
Air Pollution: Headline for 2017• Annual population-weighted mean exposure to ambient particulate matter
PM2·5 in India was 90 μg/m3 (more than twice the recommended values by the National Ambient Air Quality Standards in India)
• Indo Gangetic plain has the highest exposure
• Proportion of population using solid fuels in India: 55·5%: exceeds 75% in the low SDI states of Bihar, Jharkhand, and Odisha
• 1·24 million deaths ( 1 in 8 total deaths) attributable to air pollution: 0·67 million from ambient particulate matter pollution and 0·48 million from household air pollution.
• >50% 0f deaths premature ( <70 years of age)
• Average of 1.7 years loss in life expectancy The Lancet Planetary Health 2019 3, e26-e39DOI: (10.1016/S2542-5196(18)30261-4)
Balakrishnan et al The Lancet Planetary Health 2019 3, e26-e39DOI: (10.1016/S2542-5196(18)30261-4)
Chronic Diseases linked to Air Pollution…………what is known?
?? Hypertension , Diabetes and Obesity
Indians have one of the highest risk for CVD and diabetes in the world
Others: Heart Failure; Dementia; cognitive impairment
Mechanisms of increased risk for CVD from air pollution : A summary
• Endothelial dysfunction
• Inflammation/ Lipid peroxidation
• Increased BP
• Abnormalities of Heart rhythm
• Metabolic abnormalities
• Atherosclerosis
• Hypertension
• Arrhythmias
• LV dysfunction
• Ischemic Heart D
• Peripheral Vasc. D
• Congestive HF
• Arrhythmias/Sudden death
PM2.5 & others
Do we have evidence in India for health effects of air pollution?
• Studies linking maternal exposure and birth outcomes
• Studies linking adult exposure and respiratory health
• Cross-sectional studies linking acute air pollution episodes and rise in emergency room footfall for acute respiratory infections
• Studies from global burden of disease estimates and exposure –response functions using data from developed countries
Contextualized local studies based on exposure assessments-
modelled/ measured and longitudinal datasets of health outcomes in India ???
What can be done ? What have we done so far??
What more can we do---and together?
The CArdiometabolic Risk Reduction in South Asia CARRS Study - Sampling
Wards
Census Enumeration Blocks (CEBs)
Households
Individuals : 1 M and 1 F
Two metropolitan cities- Delhi and Chennai
8000 Adults aged ≥ 20 years , 2010
Sampling: Multi-stage cluster random sampling, stratified for gender
Primary sampling units
Delhi and Chennai: Ward
Collaboration between CCDC, PHFI , AIIMS, MDRF in India and Emory University, USA
Example: Delhi
1st Follow-up Survey
2nd Follow-up Survey
(B)
Cohort 1
2011
3rd Follow-up Survey
The CARRS Study - Design
Community Population
Community Population
Random Sample Cross-
Sectional Survey (B)
Random Sample Cross-
Sectional Survey (B)
4th Follow -up Survey (B)
2012 2013 2014 2015
Cohort 2
1st Follow-up Survey
2016
2018
Robust exposure assessment ( PM2.5) at fine resolution
Link exposure to CV Risk factors and outcomes
Capacity building in the science of air pollution
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Main
Objectives
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Air Pollution and Cardiometabolic health: The Geo-Health Program
Goal: A fully integrated research and training program on air pollution and cardiometabolic diseases with policy relevance to improve health of Indians
Develop an exposure model to predict daily PM2.5 concentrations at a 1 km2 spatial resolution for Delhi
A total of 1635 grids, 7 years (2010-16), 2557 days
4180695 observations
Main Objective : Link PM 2.5 levels to incident CVD risk factors and outcomes in Delhi and Chennai
Air Pollution and Cardiometabolic health: The Geo-Health Program
Area: 1484 km2
Air Pollution and Cardiometabolic health: The Geo-Health Program
Data from multiple sources
Monitoring data
AOD Land Use Variables
Chemical Transport
Model
Adjusted for meteorological
variables
Air Pollution and Cardiometabolic health: The Geo-Health Program Structure of Model : “Ensemble modelling”
+ +
Mandal S, Madhipatla KK, Guttikunda S, Kloog I, Prabhakaran D, Schwartz JD. Ensemble averaging based assessment of spatiotemporal variations in
ambient PM2.5 concentrations over Delhi, India, during 2010-2016. Atmos Environ (1994). 2020 Mar 1;224.
Air Pollution and Cardiometabolic health: The Geo-Health Program Some interesting results
Initial estimates of PM2.5 exposures over Delhi
• 3296 individuals from 2248 households with 3 BP measures over 7 years
• Long- & short-term exposure to ↑ particulate matter concentrations associated with ↑ BP & risk of developing HTN in urban India
• Every +25 µ/ m3 of PM2.5 : ↑ BP by 3.5-5mmHg depending on BMI
• Achieving national ambient air quality standards can potentially ↓ prevalence of HTN by 15% in urban Delhi
• Implications for health care access and delivery
• Treating Sick populations: Non-Personal policy interventions can have major benefits
Air Pollution and Cardiometabolic health: The Geo-Health Program Summary
Prabhakaran D, Mandal S, Krishna B, Magsumbol M, Singh K, Tandon N, Venkat NarayanKM, Shivashankar R, Kondal D, Ali MK, Srinath Reddy K,
Schwartz JD. Exposure to Particulate Matter Is Associated With Elevated Blood Pressure and Incident Hypertension in Urban India.Hypertension.
2020 Oct;76(4):1289-1298. doi: 10.1161/HYPERTENSIONAHA.120.15373. Epub2020 Aug 17.
Average increase in SBP and DBP per interquartile increase in PM2.5
Interaction with Central adiposity
PM2.5 Fasting Plasma Glucose and HbA1c
Delhi Chennai
Unpublished results-please don’t share
Personal Exposure Monitoring Study – PI Kishore Madhipatla
Aim: To characterize personal exposure of PM2.5 , Black Carbon, and heavy metals among
100 adults belonging to various age and socio-economic groups residing in Delhi
Air Pollution
monitor
GPS pouch
Specifications 1. Personal air pollution Monitor
Model: pDR 1500, Thermo Scientific.,
Waltham, MA
Sampling frequency: 1 min
Sampling time: 24h (once in summer and
once in winter)
Sampling Technique: Photometry (Real-
time) and Gravimetry (Federal
Reference Method)
Tubing. Tygon (anti-static)
Filter material: Teflon
2. GPS enabled with a tri-axial
accelerometer
Model: eTrex 30, Garmin., Olathe, KS
Sampling frequency: 1 min
Participants profile
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Total Participants: 100
Nested in CARRS
longitudinal cohort in
Delhi
Age group: 30-60
Non- smokers
Non-pregnant women
Occupation >40 different professions
List of occupations of few participants
Type of
neighbourhood
Total
Participants
Slum 18
JJ colony 25
Non-Slum 57
Location Total
Participants
Urban-Delhi 90
Rural-Delhi 10
Driver
Paratha-wala
Carpenter
Property dealer
Electronics
technician
Flour mill worker
Metal Smith
Farmer
Travel agent
Shop Keeper
Vegetable seller
Textile industry
worker
Teacher
Water supplier
Delivery executive
Tailor
IT employee
Housewife
Flower seller
Household
industry worker
Domestic maid
Brick Kiln Owner
Government peon
Marketing
Executive
PM2.5 exposure profile
Fig: Left hand side image shows PM2.5 exposure profile of one of the participants (who works as an office-assistant in an office in New
Delhi) during summer-2019. The right hand side graph represents her activity based exposures over the day of measurement.
Travel Occupational Cooking SleepingExposures:
Personal PM2.5 exposures variability across occupations
Capacity Building Initiatives
1. Short Term• 1-2 week training programmes for faculty and health system professionals• Establishing linkages with national and international institutions for exchange
programmes -Emory, Michigan, HSPH, Columbia, Israel, Queensland, UK, Europe
3. Long Term• Development of an integrated MPH/PhD programme in Environmental Health• Establish systematic evidence base for multiple exposures and health impacts
2. Medium Term• Pilot grants for young researchers/faculty at PHFI & TISS• Short-term exchange programs • Career development workshops with national and international experts• Aid in the development of evidence informed policy
Establish a critical mass of environmental
health researchers and policymakers in
India
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Completed Courses:• Introduction to Environmental Health (September 2016)• Air pollution, Climate and Health – Methods & Modelling (January 2017)• Research Ethics for Environmental Health (February 2017)• Workshop on Remediation of Polluted Sites (August 2017) • Principles of Toxicology (September 2017)• Introduction to Environmental Health (September 2017)• Air pollution, Climate and Health – Methods & Modelling (January 2018)• Occupational and Environmental Medicine (March 2018)• Risk Assessment (May 2018)• Food and the Environment, 23-27 July 2018• Environmental Exposure Assessment, 22-27 October 2018, • A short course was organised in Delhi with Prof. Petros Koutrakis and his post-doctoral fellow Dr. Annelise
Bloomberg (Harvard T.H. Chan School of Public Health), Prof. Tarun Gupta (IIT-Kanpur) from 10-14, December 2018
• A three-day ethics course , 17-19, December 2018 • Environmental and occupation health , 7-11th January, 2019• System science approaches for clean cooking (with Boston College and Indian and Bangladesh GEO-Health Hubs),
11-13, February 2019• Occupation medicine, 18-22, February, 2019 • Satellite –based exposure assessments with NASA scientists- Feb 2020
Short-term training
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Short courses: Participants profile
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• Beneficiaries represent a number of National institutions including medical colleges, universities, research organizations, government institutions, and think tanks
• Most from public health or medical background with master’s level or higher training
• Participants from the Bangladesh and Ghana GEOHealth Hubs have also attended courses, joint courses are planned for coming years
Over 300
beneficiaries till
date
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Future directions: Expansion of the PM2.5 model nationwideConsortium for Health effects of AIR
Pollution in India (CHAIR-India)*-May 2019
NATIONWIDE EXPOSURE MODEL for PM2.5
• Daily 1x1 km predictions
• 2008-2020
• Covering rural and urban areas
Health association studies Useful in existing cohorts of:
• Maternal and child health• Cardiovascular health• Pulmonary health• Diabetes and metabolic health• Cognitive function
Prabhakaran, P., et al. (2020). "Building capacity for air pollution epidemiology in India.
" Environmental Epidemiology 4(5): e117
• To develop a nation-wide exposure model for daily ambient PM2.5 and ambient temperature from 2008-2020 at a spatial resolution of 1x1km and locally at 200x200m in India; interactions with heat and flooding
• Link our national estimates of PM2.5 and temperature to health data to quantify the associations between PM2.5 and ambient temperature, independently and jointly on the following major public health endpoints:
Total Mortality
Cardiometabolic outcomes
Lung function outcomes
Other health outcomes- multiple studies and research groups in the CHAIR consortium
• Create a public website with environmental data on a 1x1km grid that can be used by planners, policy makers and general public to increase awareness and aid decision-making
• Specifically engage with key stakeholders using a dedicated communications strategy that will increase the efficiency of the project, disseminate results well beyond the scientific community and facilitate translation of project deliverables into policy action
Climate, Health and AIr pollution Research in India (CHAIR-India) Addressing Gaps in Achieving the Sustainable Development Goals(3,11 and 13)
New Frontiers
Significance of CHAIR consortium model
Results will be highly relevant to Indian environmental health policy
Open-sourcing PM2.5 model
Access to PM2.5 predictions
Temperature
Greenspace
Population and land-use data
Accelerate research activity
Facilitate public health planning and interventions
Increase public awareness
Capacity building through training programs
Areas of concern
• Access to data
• Funding
• Sustainability
• Capacity building – Placement(demand vs supply), job creation strategies for both public health and environmental sciences -?Integration
THANK YOU FOR YOUR ATTENTION
With sincere thank you and appreciation to all my colleagues at Centre for Environmental Health, Public
Health Foundation of India &
Centre for Chronic Disease Control, New Delhi