1. 1 Acute Health Effects from Changes in Air Pollution and Weather in Heart Failure Mark Goldberg, PhD Department of Medicine McGill University

5. Findings for Postmenopauasal Breast Cancer

6. 6 Total Cardiovascular Mortality (ICD9: 400-440) PM 2.5 : 12% (95%CI: 1.09-1.15) increase in mortality rate for an increase of 10 μg/m 3 other pollutants: no strong evidence of association

7. Research Questions for Acute Effects Does the number of adverse health events on a particular day increase if environmental conditions change on that day or on previous days? How far back in time (lag) do these changes affect health? If yes, are there certain populations particularly susceptible to these conditions?

8. Donora, Pennsylvania (Oct 26-31, 1948) 14,000 residents 20 people died and over 7,000 were hospitalized London, UK (Dec 5-9, 1952) 3,000 more deaths Air Pollution Episodes

9. 9 Aug 14 2002: PM 2.5 =37μg/m 3 ~72 times lower than the 1952 London episode

10. 10 Aug 27 2002: PM 2.5 =3μg/m 3

11. Air Pollution Episode London, 1958-1959 Flu epidemic Feb 18-20 Excess mortality~200-250 NB: Mortality after removing 15-day running average

13. Estimated attributable number of deaths in various smog episodes occurring in London, England, 1948-1962 Year Dates of episode Number of days Estimated attributable deaths Maximum 24-hour pollution (μg/m 3 ) British smokeSO 2 1948Nov 26 – Dec 16700-80027802150 1952Dec 5 – Dec 844,00044603830 1956Jan 3 – Jan 641,00028301430 1957Dec 2 – Dec 54700-80024173335 1959Jan 26 – Jan 316200-25017231850 1962Dec 3 – Dec 7570031443834

14. 14 Studies in Montreal Daily nonaccidental mortality in Montreal, from Quebec death certificates, 1984-2002 Daily weather conditions recorded at Dorval International Airport, 1984-2002 Daily average concentrations of air pollutants (e.g., NO 2, O 3 ) from the various monitoring stations in Montreal

15. 15 Principal Air Pollution Monitors in Montreal

16. Time Series for Ozone, 1984- 2002, Montreal. The solid line represents the long-term trend in the data.

17. Time Series for NO 2, 1984-2002, Montreal. The solid line represents the long-term trend in the data.

18. Daily Nonaccidental Mortality, 1984-2002, Montreal The solid line represents the long-term trend in the data.

19. Temporal Cycles in Mortality

20. Filtered Mortality Time Series: Nonaccidental Causes

21. Montreal 1984-1993

23. Daily Maximum Temperature, 1984-2002, Montreal. The solid line represents the long-term trend in the data.

24. 24 Air Pollution is a Complex Mixture

25. 25 Nonaccidental Mortality and Ozone

26. Pooled Estimates of the Percent Increase in Daily Mortality Pollutant Change in daily average concentration Studies not using GAMs Studies using GAMs Percent increase 95% CIPercent increase 95% CI PM 10 31.3 μg/m 3 1.30.8-1.92.21.6-2.8 CO1.1 ppm4.71.1-8.41.61.1-2.1 NO 2 24.0 ppb1.00.3-1.83.42.5-4.2 O3O3 31.2 ppb1.40.4-2.41.71.1-2.2 SO 2 9.4 ppb0.90.6-1.21.00.7-1.4 From: Stieb et al. J Air Waste Manag.Assoc. 2003;53:258-61

27. 27 Susceptible Populations: Time Series Study of Non- accidental Mortality Among Persons With Specific Health Conditions

28. Congestive Heart Failure

29. Diabetes and Cardiovascular Disease

30. Possible Mechanisms

31. 31 Particle Retention in Human Lungs Mexico City air sample Lung of Mexico City resident 1  m Data from Michael Brauer, U. of British Columbia.

32. 32 Controlled Human Exposure Studies. Human Exposure Facility at the Gage Occupational and Environmental Health Unit of the University of Toronto Direct controlled human exposure studies to determine dose-response relationships of individual pollutants (if any) and uncover biological mechanisms. Findings: Inflammatory response after exposure Thickening of arterial walls

33. 33 Possible Mechanisms Source: Brook et al 2004 Circulation

34. Effects of Temperature

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36. 36 Myocardial Infarction Hospitalizations and Maximum Temperature

37. 37 Climate Change

38. 38 Changes in the Distribution of Weather

39. 39 Mortality from the 2003 Heat Wave CountryDate Estimated no. of attributable deaths ItalyJuly-Aug20,089 FranceAug19,490 GermanyAugust5,250 UKAugust2,045 PortugalAugust2,007 India/Bangl a- desh/Pakist an May-June1,472 SwitzerlandJuly1,039 NetherlandsAugust1,200 BelgiumAugust150

40. 40 Montreal: Recent Trends (April to September, inclusive) Red = Maximum temperature Blue = No. of days >25°C

41. 41 Distribution of Maximum Daily Temperature, Montreal, 2003

42. 42 Sometime in the Future when Mean Global Temperatures have Increased by 3°C

43. Excess Mortality from Climate Change, Montreal, Spring-Summer 2001 (57 days >25°C): Excess no. of deaths on days >25°C = 212 Projected to 2100 (97 days >25°C): Excess no. of deaths on days >25°C = 454 Attributable to Global Warming (3°C): 454 - 212 = 242 deaths ~1.3 deaths/day during the “warm” season

44. Daily Diary Study of Congestive Heart Failure Nadia Giannetti, McGill Rick Burnett, Health Canada Nancy Mayo, McGill Marie-France Valois, McGill Jay Brophy, McGill

45. 45 Objective To determine whether daily exacerbations in essential signs, symptoms, and physiologic indicators are associated with daily variations in concentrations of ambient air pollution and changing weather patterns

46. 46 Design Daily diary of signs and symptoms Daily measurements of: oxygen saturation, pulse rate weight blood pressure Daily measurements of air pollutants and weather conditions from fixed-site stations

47. 47 Design ~2 months duration per subject Very poor pumping of heart (ventricular ejection fraction <35%) Published: Occupational and Environmental Medicine 2008;65:659-6 and Environ Res 2009;109:166-174

48. 48 Page 2

49. 49 Go Back

50. Pulse Oximeter

51. 51 Results

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56. 56 New Panel Study

57. 57 Modifications Increased sample size Expanded daily diary Environmental measurements inside and outside of the home Temperature, RH CO, PM 2.5, NO X Air infiltration rates GPS device to estimate exposures outside of home

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60. 60 GPS Outdoor Indoor