JEP  Vol.4 No.12 A , December 2013
Short-Term Effects of Ozone and PM2.5 on Mortality in 12 Canadian Cities
Abstract: Numerous recent epidemiological studies have linked health effects with short-term exposure to air pollution levels commonly found in North America. The association between two key pollutants—ozone and fine particulate matter— and mortality in 12 Canadian cities was explored in a time-series study. City-specific estimates were obtained using Poisson regression models, adjusting for the effects of seasonality and temperature. Estimates were then pooled across cities using the inverse variance method. For a 10 ppb increase in 1-hr daily maximum ozone levels, significant associations were in the range of 0.56% - 2.47% increase in mortality. For a 10 μg/m3 increase in the 24-hr average PM2.5 concentration of, significant associations varied between 0.91% and 3.17% increase in mortality. Generally, stronger associations were found among the elderly. Effects estimates were robust to adjustment for seasonality, but were sensitive to lag structures. There was no evidence for effect modification of the mortality-exposure association by city-level ecologic covariates.
Cite this paper: N. Farhat, T. Ramsay, M. Jerrett and D. Krewski, "Short-Term Effects of Ozone and PM2.5 on Mortality in 12 Canadian Cities," Journal of Environmental Protection, Vol. 4 No. 12, 2013, pp. 18-32. doi: 10.4236/jep.2013.412A1003.

[1]   World Health Organization, “Tackling the Global Clean Air Challenge,” 2011.

[2]   J. Evans, A. van Donkelaar, R. Martin, R. T. Burnett, D. Rainham, N. Birkett and D. Krewski, “Estimates of Global Mortality Due to Particulate Air Pollution Using Satellite Imagery,” Environmental Research, Vol. 120, 2013, pp. 33-42.

[3]   Canadian Medical Association, “No Breathing Room— National Cost of Illness Study,” Summary Report, 2008.

[4]   S. Shang, Z. Sun, J. Cao, X. Wang, L. Zhong, X. Bi, H. Li, W. Liu, T. Zhu and W. Huang, “Systematic Review of Chinese Studies of Short-Term Exposure to Air Pollution and Daily Mortality,” Environment International, Vol. 54, 2013, pp. 100-111.

[5]   A. Zanobetti, M. Franklin, P. Koutrakis and J. Schwartz, “Fine Particulate Air Pollution and Its Components in Association with Cause-Specific Emergency Admissions,” Environmental Health, Vol. 8, 2009.

[6]   E. Samoli, M. Stafoggia, S. Rodopoulou, B. Ostro, C. Declercq, E. Alessandrini, J. Díaz, A. Karanasiou, A. G. Kelessis, A. Le Tertre, G. Randi, C. Scarinzi, S. F. Zauli-Sajani and F. Forastiere, “Associations between Fine and Coarse Particles and Mortality in Mediterranean Cities: Results from the MED-PARTICLES Project,” Environmental Health Perspectives, Vol. 121, 2013, pp. 932-938.

[7]   R. D. Peng, E. Samoli, L. Pham, F. Dominici, G. Touloumi, T. Ramsay, R. T. Burnett, D. Krewski, A. Le Tertre, A. Cohen, R. W. Atkinson, H. R. Anderson, K. Katsouyani and J. M. Samet, “Acute Effects of Ambient Ozone on Mortality in Europe and North America: Results from the APHENA Study,” Air Quality, Atmosphere & Health, Vol. 6, No. 2, 2013, pp. 445-453.

[8]   H. R. Anderson, R. Atkinson, J. L. Peacock, L. Martson and K. Konstantinou, “Meta-Analysis of Times Series Studies and Panel Studies of Particulate Matter and Ozone,” Report of a WHO Task Group, World Health Organization, Copenhagen, 2004.

[9]   M. L. Bell, A. McDermott, S. L. Zeger, J. M. Samet and F. Dominici, “Ozone and Short-Term Mortality in 95 US Urban Communities, 1987-2000,” Jama-Journal of the American Medical Association, Vol. 292, No. 19, 2004, pp. 2372-2378.

[10]   M. L. Bell and F. Dominici, “Effect Modification by Community Characteristics on the Short-Term Effects of Ozone Exposure and Mortality in 98 US Communities,” American Journal of Epidemiology, Vol. 167, 2008, pp. 986-997.

[11]   A. Gryparis, B. Forsberg, K. Katsouyanni, A. Analitis, G. Touloumi, J. Schwartz, E. Samoli, S. Medina, H. R. Anderson, E. M. Niciu, H. E. Wichmann, B. Kriz, M. Kosnik, J. Skorkovsky, J. M. Vonk and Z. Dortbudak, “Acute Effects of Ozone on Mortality from the ‘Air Pollution and Health: A European Approach’ Project,” American Journal of Respiratory and Critical Care Medicine, Vol. 170, 2004, pp. 1080-1087.

[12]   R. Klemm and R. Mason, “Replication of Reanalysis of Harvard Six-City Mortality Study,” In: Revised Analyses of Time Series Studies of Air Pollution and Health, Special Report, Health Effects Institute, Boston, 2003, pp. 165-172.

[13]   B. Ostro, R. Broadwin, S. Green, W. Y. Feng and M. Lipsett, “Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE,” Environmental Health Perspectives, Vol. 114, 2006, pp. 29-33.

[14]   S. Schwartz, “Daily Deaths Associated with Air Pollution in Six US Cities and Short-Term Mortality Displacement in Boston,” Revised Analyses of Time Series Studies of Air Pollution and Health, Special Report, Health Effects Institute, Boston, 2003, pp. 219-226.

[15]   R. Simpson, G. Williams, A. Petroeschevsky, T. Best, G. Morgan, L. Denison, A. Hinwood, G. Neville and A. Neller, “The Short-Term Effects of Air Pollution on Daily Mortality in Four Australian Cities”, Australian and New Zealand Journal of Public Health, Vol. 29, 2005, pp. 205-212.

[16]   D. M. Stieb, S. Judek and R. T. Burnett, “Meta-Analysis of Time-Series Studies of Air Pollution and Mortality: Effects of Gases and Particles and the Influence of Cause of Death, Age, and Season,” Journal of the Air & Waste Management Association, Vol. 52, No. 4, 2002, pp. 470-484.

[17]   Y. Chen, Q. Y. Yang, D. Krewski, Y. Shi, R. T. Burnett and K. McGrail, “Influence of Relatively Low Level of Particulate Air Pollution on Hospitalization for COPD in Elderly People,” Inhalation Toxicology, Vol. 16, 2004, pp. 21-25.

[18]   M. S. Goldberg, R. T. Burnett, J. C. Bailar, J. Brook, Y. Bonvalot, R. Tamblyn, R. Singh, M. F. Valois and R. Vincent, “The Association between Daily Mortality and Ambient Air Particle Pollution in Montreal, Quebec 2. Cause-Specific Mortality,” Environmental Research, Vol. 86, No. 1, 2001, pp. 26-36.

[19]   S. Parodi, M. Vercelli, E. Garrone, V. Fontana and A. Izzotti, “Ozone Air Pollution and Daily Mortality in Genoa, Italy between 1993 and 1996,” Public Health, Vol. 119, No. 9, 2005, pp. 844-850.

[20]   R. D. Peng, F. Dominici and T. A. Louis, “Model Choice in Time Series Studies of Air Pollution and Mortality,” Journal of the Royal Statistical Society Series A—Statistics in Society, Vol. 169, No. 2, 2006, pp. 179-198.

[21]   R. T. Burnett, M. Smith-Doiron, D. Stieb, M. E. Raizenne, J. R. Brook, R. E. Dales, J. A. Leech, S. Cakmak and D. Krewski, “Association between Ozone and Hospitalization for Acute Respiratory Diseases in Children Less than 2 Years of Age,” American Journal of Epidemiology, Vol. 153, No. 5, 2001, pp. 444-452.

[22]   B. B. Jalaludin, T. Chey, B. I. O’Toole, W. T. Smith, A. G. Capon and S. R. Leeder, “Acute Effects of Low Levels of Ambient Ozone on Peak Expiratory Flow Rate in a Cohort of Australian Children,” International Journal of Epidemiology, Vol. 29, No. 3, 2000, pp. 549-557.

[23]   C. A. Lin, M. A. Martins, S. C. L. Farhat, C. A. Pope, G. M. S. Conceicao, V. M. Anastacio, M. Hatanaka, W. C. Andrade, W. R. Hamaue, G. M. Bohm and P. H. N. Saldiva, “Air Pollution and Respiratory Illness of Children in Sao Paulo, Brazil,” Paediatric and Perinatal Epidemiology, Vol. 13, No. 4, 1999, pp. 475-488.

[24]   A. Peters, D. W. Dockery, J. Heinrich and H. E. Wichmann, “Short-Term Effects of Particulate Air Pollution on Respiratory Morbidity in Asthmatic Children,” European Respiratory Journal, Vol. 10, 1997, pp. 872-879.

[25]   Q. Y. Yang, Y. Chen, Y. Shi, R. T. Burnett, K. McGrail and D. Krewski, “Association between Ozone and Respiratory Admissions among Children and the Elderly in Vancouver, Canada,” Inhalation Toxicology, Vol. 15, No. 13, 2003, pp. 1297-1308.

[26]   Health Canada, “Canada-United States Border Air Quality Strategy: Great Lakes Basin Airshed Management Framework,” 2006.

[27]   T. F. Bateson, B. A. Coull, B. Hubbell, K. Ito, M. Jerrett, T. Lumley, D. Thomas, S. Vedal and M. Ross, “Panel Discussion Review: Session Three—Issues Involved in Interpretation of Epidemiologic Analyses—Statistical Modeling,” Journal of Exposure Science and Environmental Epidemiology, Vol. 17, 2007, pp. S90-S96.

[28]   F. Dominici, A. McDermott and T. J. Hastie, “Improved Semiparametric Time Series Models of Air Pollution and Mortality,” Journal of the American Statistical Association, Vol. 99, 2004, pp. 938-948.

[29]   T. O. Ramsay, R. T. Burnett and D. Krewski, “The Effect of Concurvity in Generalized Additive Models Linking Mortality to Ambient Particulate Matter,” Epidemiology, Vol. 14, 2003, Vol. 18-23.

[30]   J. M. Samet, F. Dominici, A. McDermott and S. L. Zeger, “New Problems for an Old Design: Time Series Analyses of Air Pollution and Health,” Epidemiology, Vol. 14, 2003, pp. 11-12.

[31]   Health Effects Institute, “Revised Analyses of Time-Series Studies of Air Pollution and Health—Special Report,” Health Effects Institute, Boston, 2003.

[32]   K. Katsouyani, J. M. Samet, H. R. Anderson, R. W. Atkinson, A. Le Tertre, S. Medina, E. Samoli, G. Touloumi, R. T. Burnett, D. Krewski, T. Ramsay, F. Dominici, R. D. Peng, J. Schwartz and A. Zanobetti, “Air Pollution and Health: A European and North American Approach (APHENA),” Health Effects Institute, 2009.

[33]   C. S. Berkey, D. C. Hoaglin, A. Antczak-Bouckoms, F. Mosteller and G. A. Colditz, “Meta-Analysis of Multiple Outcomes by Regression with Random Effects,” Statistics in Medicine, Vol. 17, 1998, pp. 2537-2550.<2537::AID-SIM953>3.0.CO;2-C

[34]   T. B. Huedo-Medina, J. Sanchez-Meca, F. Marin-Martinez and J. Botella, “Assessing Heterogeneity in Meta-Analysis: Q Statistic or I-2 Index?” Psychological Methods, Vol. 11, No. 2, 2006, pp. 193-206.

[35]   R Development Core Team, “R: A Language and Environment for Statistical Computing,” R Foundation for Statistical Computing, Vienna, 2007.

[36]   G. Touloumi, R. Atkinson, A. Le Tertre, E. Samoli, J. Schwartz, C. Schindler, J. M. Vonk, G. Rossi, M. Saez, D. Rabszenko and K. Katsouyanni, “Analysis of Health Outcome Time Series Data in Epidemiological Studies,” Environmetrics, Vol. 15, No. 2, 2004, pp. 101-117.

[37]   F. Ballester, P. Rodriguez, C. Iniguez, M. Saez, A. Daponte, I. Galan, M. Taracido, F. Arribas, J. Bellido, F. B. Cirarda, A. Canada, J. J. Guillen, F. Guillen-Grima, E. Lopez, S. Perez-Hoyos, A. Lertxundi and S. Toro, “Air Pollution and Cardiovascular Admissions Association in Spain: Results within the EMECAS Project,” Journal of Epidemiology and Community Health, Vol. 60, No. 4, 2006, pp. 328-336.

[38]   F. Dominici, R. D. Peng, M. L. Bell, L. Pham, A. Mc-Dermott, S. L. Zeger and J. M. Samet, “Fine Particulate Air Pollution and Hospital Admission for Cardiovascular and Respiratory Diseases,” Journal of the American Medical Association, Vol. 295, No. 10, 2006, pp. 1127-1134.

[39]   L. J. Welty and S. L. Zeger, “Are the Acute Effects of Particulate Matter on Mortality in the National Morbidity, Mortality, and Air Pollution Study the Result of Inadequate Control for Weather and Season? A Sensitivity Analysis Using Flexible Distributed Lag Models,” American Journal of Epidemiology, Vol. 162, No. 1, 2005, pp. 80-88.

[40]   World Health Organization, “Health Aspects of Air Pollution with Particulate Matter, Ozone and Nitrogen Dioxide,” Report on a WHO Working Group. WHO Regional Office for Europe, Copenhagen, 13-15 January 2003, pp. 1-92.

[41]   A. L. F. Braga, A. Zanobetti and J. Schwartz, “The Lag Structure between Particulate Air Pollution and Respiratory and Cardiovascular Deaths in 10 US Cities,” Journal of Occupational and Environmental Medicine, Vol. 43, No. 11, 2001, pp. 927-933.

[42]   EPA, “Fourth External Review for Air Quality Criteria for Particulate Matter (Draft),” 2003.

[43]   Y. H. Zhang, W. Huang, S. J. London, G. X. Song, G. H. Chen, L. L. Jiang, N. Q. Zhao, B. H. Chen and H. D. Kan, “Ozone and Daily Mortality in Shanghai, China,” Environmental Health Perspectives, Vol. 114, No. 8, 2006, pp. 1227-1232.

[44]   F. J. Kelly, “Oxidative Stress: Its Role in Air Pollution and Adverse Health Effects,” Occupational and Environmental Medicine, Vol. 60, No. 8, 2003, pp. 612-616.

[45]   J. Schwartz, D. W. Dockery and L. M. Neas, “Is Daily Mortality Associated Specifically with Fine Particles?” Journal of the Air & Waste Management Association, Vol. 46, No. 10, 1996, pp. 927-939.

[46]   H. Kim, Y. Kim and Y. C. Hong, “The Lag-Effect Pattern in the Relationship of Particulate Air Pollution to Daily Mortality in Seoul, Korea,” International Journal of Biometeorology, Vol. 48, No. 1, 2003, pp. 25-30.

[47]   S. Ahmad, A. Ahmad, G. McConville, B. K. Schneider, C. B. Allen, R. Manzer, R. J. Mason and C. W. White, “Lung Epithelial Cells Release ATP during Ozone Exposure: Signaling for Cell Survival,” Free Radical Biology and Medicine, Vol. 39, No. 2, 2005, pp. 213-226.

[48]   N. Kunzli, M. Jerrett, W. J. Mack, B. Beckerman, L. LaBree, F. Gilliland, D. Thomas, J. Peters and H. N. Hodis, “Ambient Air Pollution and Atherosclerosis in Los Angeles,” Environmental Health Perspectives, Vol. 113, No. 2, 2005, pp. 201-206.

[49]   I. S. Mudway, N. Stenfors, A. Blomberg, R. Helleday, C. Dunster, S. L. Marklund, A.J. Frew, T. Sandstrom and F. J. Kelly, “Differences in Basal Airway Antioxidant Concen-Trations Are Not Predictive of Individual Responsiveness to Ozone: A Comparison of Healthy and Mild Asthmatic Subjects,” Free Radical Biology and Medicine, Vol. 31, No. 8, 2001, pp. 962-974.

[50]   R. D. Brook, B. Franklin, W. Cascio, Y. L. Hong, G. Howard, M. Lipsett, R. Luepker, M. Mittleman, J. Samet, S. C. Smith and I. Tager, “Air Pollution and Cardiovascular Disease—A Statement for Healthcare Professionals from the Expert Panel on Population and Prevention Science of the American Heart Association,” Circulation, Vol. 109, No. 21, 2004, pp. 2655-2671.

[51]   W. P. Watkinson, M. J. Campen, J. P. Nolan and D. L. Costa, “Cardiovascular and Systemic Responses to Inhaled Pollutants in Rodents: Effects of Ozone and Particulate Matter,” Environmental Health Perspectives, Vol. 109, No. S4, 2001, pp. 539-546.

[52]   P. S. Gilmour, D. M. Brown, T. G. Lindsay, P. H. Beswick, W. MacNee and K. Donaldson, “Adverse Health Effects of PM(10) Particles: Involvement of Iron in Generation of Hydroxyl Radical,” Occupational and Environmental Medicine, Vol. 53, No. 12, 1996, pp. 817-822.

[53]   R. J. Pritchard, A. J. Ghio, J. R. Lehmann, D. W. Winsett, J. S. Tepper, P. Park, M. I. Gilmour, K. L. Dreher and D. L. Costa, “Oxidant Generation and Lung Injury after Particulate Air Pollutant Exposure Increase with the Concentrations of Associated Metals,” Inhalation Toxicology, Vol. 8, No. 5, 1996, pp. 457-477.

[54]   E. W. Spannhake, S. P. M. Reddy, D. B. Jacoby, X. Y. Yu, B. Saatian and J. Y. Tian, “Synergism between Rhinovirus Infection and Oxidant Pollutant Exposure Enhances Airway Epithelial Cell Cytokine Production,” Environmental Health Perspectives, Vol. 110, No. 7, 2002, pp. 665-670.

[55]   J. T. Zelikoff, M. W. Frampton, M. D. Cohen, P. E. Morrow, M. Sisco, Y. Tsai, M. J. Utell and R. B. Schlesinger, “Effects of Inhaled Sulfuric Acid Aerosols on Pulmonary Immunocompetence: A Comparative Study in Humans and Animals,” Inhalation Toxicology, Vol. 9, No. 8, 1997, pp. 731-752.

[56]   Q. H. Sun, A. X. Wang, X. M. Jin, A. Natanzon, D. Duquaine, R. D. Brook, J. G. S. Aguinaldo, Z. A. Fayad, V. Fuster, M. Lippmann, L. C. Chen and S. Rajagopalan, “Long-Term Air Pollution Exposure and Acceleration of Atherosclerosis and Vascular Inflammation in an Animal Model,” Journal of the American Medical Association, Vol. 294, No. 23, 2005, pp. 3003-3010.

[57]   A. Le Tertre, S. Medina, E. Samoli, B. Forsberg, P. Michelozzi, A. Boumghar, J. M. Vonk, A. Bellini, R. Atkinson, J. G. Ayres, J. Sunyer, J. Schwartz and K. Katsouyanni, “Short-Term Effects of Particulate Air Pollution on Cardiovascular Diseases in Eight European Cities,” Journal of Epidemiology and Community Health, Vol. 56, No. 10, 2002, pp. 773-779.

[58]   M. L. Bell, J. M. Samet and F. Dominici, “Time-Series Studies of Particulate Matter,” Annual Review of Public Health, Vol. 25, 2004, pp. 247-280.

[59]   M. S. Goldberg, R. T. Burnett and J. R. Brook, “Counterpoint: Time-Series Studies of Acute Health Events and Environmental Conditions Are Not Confounded by Personal Risk Factors,” Regulatory Toxicology and Pharmacology, Vol. 51, No. 2, 2008, pp. 141-147.

[60]   N. A. Janssen, J. J. de Hartog, G. Hoek, B. Brunekreef, T. Lanki, K. L. Timonen and J. Pekkanen, “Personal Exposure to Fine Particulate Matter in Elderly Subjects: Relation between Personal, Indoor, and Outdoor Concentrations,” Journal of the Air & Waste Management Association, Vol. 50, No. 7, 2000, pp. 1133-1143.

[61]   D. Kim, A. Sass-Kortsak, J. T. Purdham, R. E. Dales and J. R. Brook, “Associations between Personal Exposures and Fixed-Site Ambient Measurements of Fine Particulate Matter, Nitrogen Dioxide, and Carbon Monoxide in Toronto, Canada,” Journal of Exposure Science and Environmental Epidemiology, Vol. 16, No. 2, 2006, pp. 172-183.

[62]   G. Hoek, B. Brunekreef, S. Goldbohm, P. Fischer and P. A. van den Brandt, “Association between Mortality and Indicators of Traffic-Related Air Pollution in the Netherlands: A Cohort Study,” Lancet, Vol. 360, No. 9341, 2002, pp. 1203-1209.

[63]   M. Jerrett, R. T. Burnett, R. J. Ma, C. A. Pope, D. Krewski, K. B. Newbold, G. Thurston, Y. L. Shi, N. Finkelstein, E. E. Calle and M. J. Thun, “Spatial Analysis of Air Pollution and Mortality in Los Angeles,” Epidemiology, Vol. 16, No. 6, 2005, pp. 727-736.

[64]   S. L. Zeger, D. Thomas, F. Dominici, J. M. Samet, J. Schwartz, D. Dockery and A. Cohen, “Exposure Measurement Error in Time-Series Studies of Air Pollution: Concepts and Consequences,” Environmental Health Perspectives, Vol. 108, No. 5, 2000, pp. 419-426.

[65]   E. Samoli, R. D. Peng, T. Ramsay, G. Touloumi, F. Dominici, R. W Atkinson, A. Zanobetti, A. Le Tertre, H. R. Anderson, J. Schwartz, A. Cohen, D. Krewski, J. M. Samet and K. Katsouyani, “What Is the Impact of Systematically Missing Exposure Data on Air Pollution Health Effect Estimates?”

[66]   P. Bellini, M. Baccini, A. Biggeri and B. Terracini, “The Meta-Analysis of the Italian Studies on Short-Term Effects of Air Pollution (MISA): Old and New Issues on the Interpretation of the Statistical Evidences,” Environmetrics, Vol. 18, No. 3, 2007, pp. 219-229.

[67]   M. Goldberg, “On the Interpretation of Epidemiological Studies of Ambient Air Pollution,” Journal of Exposure Science and Environmental Epidemiology, Vol. 17, No. S2, 2007, pp. S66-S70.

[68]   R. T. Burnett, J. R. Brook, W. T. Yung, R. E. Dales and D. Krewski, “Association between Ozone and Hospitalization for Respiratory Diseases in 16 Canadian Cities,” Environmental Research, Vol. 72, No. 1, 1997, pp. 24-31.

[69]   D. M. Stieb, R. C. Beveridge, B. H. Rowe, S. D. Walter and S. Judek, “Assessing Diagnostic Classification in an Emergency Department: Implications for Daily Time Series Studies of Air Pollution,” American Journal of Epidemiology, Vol. 148, No. 7, 1998, pp. 666-670.

[70]   M. J. Daniels, F. Dominici, J. M. Samet and S. L. Zeger, “Estimating Particulate Matter-Mortality Dose-Response Curves and Threshold Levels: An Analysis of Daily Time-Series for the 20 Largest US Cities,” American Journal of Epidemiology, Vol. 152, No. 5, 2000, pp. 397-406.

[71]   J. Schwartz, “Assessing Confounding, Effect Modification, and Thresholds in the Association between Ambient Particles and Daily Deaths,” Environmental Health Perspectives, Vol. 108, No. 6, 2000, pp. 563-568.