The objective of the article was to investigate associations between traffic and outdoor air pollution levels near residences and poorly controlled asthma among adults diagnosed as having asthma in Los Angeles and San Diego counties.
The authors estimated traffic density (TD) within 500 feet of 2001 California Health Interview Survey (CHIS) respondents' reported residential cross-street intersections. They then assigned annual average concentrations at government monitoring stations within a 5 mile radius of reported residential cross-street intersections of:
1. ozone
2. nitrogen dioxide
3. particulate matter (PM) 2.5 and 10 micrometers or less in diameter
4. carbon monoxide
In order to obtain the study population, 19,664 individuals were interviewed; 2,237 (11.4%) were diagnosed by a physician as having asthma. These individuals’ residence locations were entered into a database. The final study population was 1,609 adults (others were excluded because of missing data).
Exposure evaluation was evaluated by examining traffic density, which was based on a 500 foot buffer around person's probable home street segment. From the nearest measuring station within 5 miles of the respondent, the authors determined annual average concentrations of: ozone, nitrogen dioxide, particulate matter 2.5 micrometers or less or 10 micrometers or less, carbon monoxide.
For the statistical analysis, traffic density was divided into three tiers:
1. Low TD (20th percentile or less)
2. Medium TD (21-80 percentil)
3. High TD (> 80th percentile)
The results can be summarized in the following 4 main points:
1. There was a 2-fold increase in poorly controlled asthma among asthmatic adults (OR 2.11, 95% CI 1.38-3.23) in the highest quintile of traffic density after adjusting for age, sex, race, and poverty.
2. Similar increases were seen for nonelderly adults, men, and women. The strongest associations were seen in elderly adults (OR 3, 95% CI 1.13-7.91).
3. Ozone exposures were associated with poorly controlled asthma among two subgroups:
- elderly adults (OR 1.7, CI 0.91-3.18 per 1 pphm)
- men (OR 1.76, CI 1.05-2.94 per 1 pphm)
4. Particulate matter 10 micrometers or less affected primarily women (OR 2.06, CI 1.17-3.61), even at levels below national air quality standard.
The authors’ conclusion? Heavy traffic and high air pollution levels near residences are associated with poorly controlled asthma.
While this may seem like a relatively straightforward conclusion based on the data, this study had some very significant caveats to keep in mind:
1. Misclassification of exposures from stations:
- Traffic pollutants can have a strong spatial gradient, meaning levels detected at measuring stations might not reflect actual exposure levels of individuals.
2. Resident variability:
- The study did not take into account variables such as personal mobility, occupation-related exposures, or indoor exposures.
3. Temporal ambiguity
- This study was based on cross-sectional survey data, so the length of time any individual lived in a neighborhood was unknown.
4. Medication use
- Individuals’ use of medications was unknown; use could reduce symptoms and lead to underestimated prevalence of poorly controlled asthma.
Y-Y Meng, et al. Traffic and outdoor air pollution levels near residences and poorly controlled asthma in adults.
Although these caveats exist, I almost wonder if the study is actually better with these faults, since that would be the 'normal/average' daily routine. If the study did control for those, the significance may be less, but not factual. Sometimes I wonder if some studies should be conducted in this more realistic manner.
ReplyDeleteI once talked with a group of norwegian scientists about this very same subject. In Norway and other northern countries they have inversions, which results in pollution trapped near the ground. This often happens in the winter months when the temperature is very cold and can often last weeks. Nanoparticles from vehicle emissions form and can enter the air pathway. Once in the air pathway, the particles are able to freely enter cells due to their size often causing damage in the lung and now studies have shown damage to the heart and possibly other tissues. The particles cause inflammation in surrounding tissue and other immune reactions that could lead to asthma.
ReplyDeleteI think there are problems with just "adjusting" for poverty in the analysis. There is most likely a poverty by air-pollution interaction going on. People who are poor usually live near high pollution areas and they are less likely to have well controlled asthma. So it is hard to determine whether it is their living in a high pollution area or if it is due to their socio economic status that makes their asthma worse. Adjusting for poverty does not get to the answer.
ReplyDeleteAlthough this article seemed to provide relatively convincing results, it seemed as if there were so few controls within the study that it would be difficult to be sure whether or not the the severity of the asthma was induced by the high concentrations of pollution as a result of heavy traffic. It has been shown that individuals that live below the poverty line have the highest prevalence of smoking, which often leads to COPD. I wonder if this may have lead to inaccurate conclusions on the actual cause and severity of the asthma. Also, i think it would be interesting to examine whether or not pollution induced asthma puts you at greater risk for developing COPD, as asthma is already a known cause of the disease.
ReplyDeleteI still think implication of the study is significant. Especially, economical situation may or may not be a big factor as relatively wealthy people also live in cities like Manhattan. Simpler study design is hard to be made because it’s usually masks the pure effect of what the researcher would like to look at. It seems this study still found the significant results. I think implication of the study is significant.
ReplyDelete