Multi-City Study of Air Pollution and Health Effects in Latin America

Transcription

1 Multi-City Study of Air Pollution and Health Effects in Latin America Nelson Gouveia USP, Brazil Isabelle Romieu INSP, Mexico Luis Cifuentes PUC, Chile

2 Background: information on health effects associated to air pollution is very sparse and concentrated not geographically representative difficult to understand the magnitude of the problem what is the impact of AP on sensitive populations (children) to what extent the socio-economic conditions do modify the association between air pollution and health

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4 Primary Objectives: - develop a common protocol for the design and analysis of time series data from multiple LAC cities to be followed by all centers involved in the project; - conduct a coordinated analysis to examine the effect of exposure to outdoor levels of air pollution on mortality from all causes and in subgroups defined by age and cause in different cities in LAC; - assess the impact of air pollution in sensitive populations such as infants and young children;

5 - develop meta-analyses including results of all the cities analyzed; - contribute to the international scientific discussion on the conduct and interpretation of time-series studies of the effects of short-term exposure; - provide relevant information to decision makers in the LA Region to support prevention and control strategies of air pollution.

6 Table 1- Population (x1,000) and other characteristics of the participating cities Country City Pop Total Pop <5 Pollutants measured Years of available data No. of monitoring stations Brazil 1 São Paulo 10, PM 10, CO, NO 2, O Rio de Janeiro 5, PM 10, CO, NO 2, O Vitória TSP, PM 10, CO, NO 2, O Porto Alegre 1, PM 10, O Chile 1 Santiago 6, PM 2.5, PM 10, CO, NO 2, O (4) 8 2 Antofagasta PM Calama PM Copiapo PM Temuco PM 2.5, PM (2) Mexico 1 Mexico City 18,011 1,808 TSP, PM 10, NO x, CO, O Toluca TSP, PM 10, NO x, CO, O Guadalajara 1, TSP, PM 10, NO x, CO, O Monterrey 1, TSP, PM 10, NO x, CO, O Juarez City 1, TSP, PM 10, NO x, CO, O

7 Table 2. Annual averages of air pollutant in the cities included in the analysis Country Brazil Chile Mexico Vitória Calama Santiago Copiapo Temuco City Porto Alegre Rio de Janeiro São Paulo Antofagasta Guadalajara Cuidad Juarez Mexico City Monterrey Valle De Toluca Years PM 10 (µg/m3)

8 Causes of death Table 3: Causes of death, age groups and gender Age groups Gender ICD-9 ICD-10 Observations All disease all ages <1, 1-5, 5-14, >65 stratified by male and female A00-T98 Z00-Z99 All disease causes include all non-traumatic, non-suicidal and non-poisoning causes. Cardio-pulmonary All ages >65 stratified by male and female I00-I99 J00-J98 Includes both cardiovascular and respiratory causes Respiratory all ages J00-J98 < 1, 1-5, >65 Cardiovascular all ages I00-I99 >65 Cerebrovascular all ages I60-I69 >65 Lower respiratory infections < , J10-J22 Includes influenza which at this level is usually pneumonic. Chronic obstructive pulmonary diseases (COPD) all ages > J40-J44 J46-J47 Asthma is left out External deaths Corresponding age groups V01-Y98 These groups will be used as controls, since there should not be an association with them

9 Steps: Data collection and quality assurance Assessment of the availability and completeness of data in other large Latin American cities Analysis single-city analysis (first stage analysis). Heterogeneity will be explored and data combined using meta-regression models (second stage analysis). Exploration of potential effect modification of SEP (second stage analysis using multi-level modeling)

10 Table 4. Metrics and measurement methods used for pollution data Pollutant Metric used Measurement Method Brazil Mexico Chile PM 10, PM h average TEOM, Beta attenuation TEOM, Beta Attenuation, TEOM, Gravimetric, Gravimetric Sulphur dioxide (SO 2 ) 24 h average UV fluorescence UV fluorescence (TECO Model 43) UV fluorescence Nitrogen dioxide (NO 2 ) 24 h average Chimioluminescence Chimioluminescen ce (TECO Model 42) Chimioluminescence Ozone (O 3 ) 1h max and 8h average Chimioluminescence and spectrophotometry UV Spectrophotometry UV (model RS Dasibi) Chimioluminescence Carbon monoxide (CO) 8 h average Non-dispersive infrared Infra red spectrophotomy absorption Non-dispersive infrared

11 Table 5. Death certificate s information available in electronic format by country Type Item Brazil Mexico Chile Death data Place of registry of death Date of death Locality of death By District By District By District Type of death Fetal or non-fetal Fetal or non-fetal Cause of death Primary Primary Primary and contributing Place of death Hospital/home/other Hospital/home/other Hospital/home/other Autopsy performed? Deceased data Date of birth Age Sex Race Marital status Education level Years of schooling Years of schooling Years of schooling Ocupation Residence data Street, District, City District, City District, City Medical Insurance

12 Table 6 Percent of missing values for major variables of the death certificate for recent years by country Variables Mexico (%) Brasil (SP) (%) Chile (%) Date of birth Date of death Age Sex Place of residence Cause of death Education level* (*) for individuals aged 20 or over.

13 Secondary objectives Gather data from other countries/cities to increase the regional representativeness of our analysis. Explore the feasibility of evaluating the potential role of socio-economic position (SEP) as a modifier of the effect of air pollution and mortality using common SEP indicators in the Mexico, Brazil and Chile;

14 What this study adds accurate estimates of the impact of air pollution on health in the population of the LAC detailed impact on susceptible population (children, SEP) exploration of potential causes of heterogeneity summarized effect representative for the entire region information to support local environmental health policies contribute to human resource development in the Region