1. HEALTH EFFECTS OF
TRAFFIC AIR POLLUTION: new
findings for regulation
Jordi Sunyer
CREAL
June 2010

3. Known adverse effects of airborne particles (PM)
on health WHO air quality guidelines - global update 2005
- Mortality and hospital admissions in chronic obstructive pulmonary
disease patients
- Exacerbation of symptoms and increased use of therapy in asthma
- Mortality and hospital admissions in cardiovascular disease patients
- Mortality and hospital admissions in diabetes mellitus
- Increased risk for myocardial infarction
- Lung inflammation
- Systemic inflammation
- Endothelial and vascular dysfunction
- Development of atherosclerosis
- Increased incidence of infection
- Respiratory cancer

4. Ultrafine particles promote early atherosclerosis
and systemic oxidative stress
Araujo et al. (Circ Research, 2008)

5. Southern California
Association between residential distance to busy roads
and childhood asthma
1
Asthma risk
RR=1.4
s(big3dist, 3)
0
RR=1.0
-1
0
0 100
100 200
200 300
300 400
400 500 meters
500
Distance to busy road
big3dist
McConnell et al, EHP2006

6. Novel evidence
Traffic proximity and chronic disease
HEI report*
Author Outomce Exposure metric
Fickelstein,
Jerrett, & Sears Cardiovascular mortality Distance from freeway or main
2005 Cerebrovascular mortality road (50m)
Ontario, Canada
Hoffmann et al.
2009, Coronory Heart disease Living within 50m major roads
Germany
Morgenstern et al
2007 Munich, Asthma incidence Living ≤50m to major road
Germany
*Source: Health Effects Institute panel on the health effects of traffic-related air pollution. Traffic-related air
pollution: a critical review o the literature on emissions, exposure, and health effects.

7. New evidence
Traffic proximity and exposure
Beckerman et al. 2008

8. Particulate Matter and health effects
Gaps of knowledge
• What is causing health effects?
• What are the sources of the most toxic
agents?
• What are the biological mechanisms of
toxicity of agents?

9. Outline
• 1. Size of PMs
• 2. Coarse PM and Saharan dust
• 3. New effects early in life
• 4. Impact assesment

10. Urban PM fractions and health effects
in Barcelona Mass distribution
Variables n Mean (sd) Min. Max. IQR
PM10-2.5 (µg/m3) 931 14.0 (9.5) 0.1 93.1 11.0
PM2.5-1 (µg/m3) 931 5.5 (3.8) 0.6 45.5 4.5
PM1 (µg/m3) 931 20.0 (10.3) 1.9 80.1 11.1
Correlation PM10-2.5 PM2.5-1 PM1
PM10-2.5 1.00 0.45 0.09
PM2.5-1 1.00 0.24
PM1 1.00

11. Urban PM fractions and health effects
Perez et al.2009
Odds ratio per 10 ug/m3*
Respiratory Cardiovascular Cerebrovascular
Fraction
mortality mortality mortality
1.059 1.098
PM10-2.5 Not significant (1.026-1.094) (1.030-1.171)
Lag1 Lag1
1.206 Not significant Not significant
PM2.5-1 (1.028-1.416)
Lag2
1.028 1.063
PM1 Not significant (1.000-1.058) (1.004-1.124)
Lag1 Lag1
*Only maximum lag effect for tri-pollutant model presented

12. PM fraction composition in Barcelona
Elemental carbon
78%
Adapted from Perez et al. Atmos. Environ. 2008

13. PM fraction composition in Barcelona
Metals
Combustion Break, tire and
road erosion
Adapted Perez et al. Atmos. Environ. 2008

14. Saharan dust outbreaks in Barcelona
•Occur 7-15 times a year
•Predominant in spring and autumn
•On average, outbreak lasts 3-5 days (Rodriguez et. al 2003)

15. Saharan dust and health effects
Distribution daily mass concentrations (µg/m3)
Pollutant n Mean (SD) Min-Max IQR
PM2.5
All days 602 24.9 (11.7) 6.1-85.0 12.8
Saharan dust days 90 29.9 (11.2) 9.8-65.2 12.2
Non Saharan dust 512 24.0 (11.6) 6.1-85.0 11.5
days
PM10-2.5
All days 602 15.1 (9.7) 0.07-93.1 10.7
Saharan dust days 90 16.4 (7.8) 1.6-36.7 11.0
Non Saharan dust 512 14.9 (10.0) 0.07-93.1 10.7
days
R correlation PM2.5-PM10-2.5=0.34 (all days, Lag 1)
R correlation PM2.5-PM10-2.5=0.22 (Saharan dust days, Lag 1)

16. Saharan dust and health effects
Results-Total mortality
Lag 1 per 10 µg/m3*
PM2.5 P PM10-2.5 P
interaction interaction
1.032 1.016
All days -- --
(1.015, 1.05) (0.996, 1.036)
By
Saharan 1.035 1.013
dust days No (1.016, 1.055) (0.992, 1.034)
0.558 0.052
1.050 1.084
Yes
(1.005, 1.097) (1.015, 1.158)
*Two-pollutant model

17. Saharan dust and health effects
Growing evidence

18. Chemical composition of PMs in Barcelona
Saharan dust days (n=9) vs Non-Saharan dust days (n=80)
*: p <0.05 for comparision of mass adjusted concentrations

19. TRAFFIC, SUSCEPTIBILITY AND
CHILDHOOD ASTHMA
(McConell R; Env Health Persp 2006)

20. UFP and brain in rats
• Intratracheal instillation of particles<100 nm labeled
with tech-99, radioactivity was subsequently
detected in the brain (Nemmar AJRCCM 2001)
• Direct translocation Mn (8nm) in contralateral
olfactory bulb (Elder EHP 2006)
• PM>200 nm (TiO2) may be phagocytized by
macrophages and dendritic cells which may carry
the particles to lymph nodes in the lung or to those
closely associated with the lungs (Peters 2006)
• Oxidative stress and pro-inflammatory cytokines
overexpressed in brain tissue (Calderon C 2008,
Campbell 2009)

21. 1. SAMPLING SITES SELECTION
500m- grid Sampling points Cohort addresses
57 sampling points were selected to represent the gradient of exposure in the cohort

22. Sabadell
SPAIN

23. Longitudinal growth curves
Head circumference Estimated fetal weight
3940
350
3660
310 3380
3100
Estimated Fetal Weight (gr)
Head circumference (mm)
270 2820
2540
230
2260
190 1980
1700
150 1420
1140
110
860
70 580
300
female male female male
30 20
10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40
gestational age (weeks) gestational age (weeks)

24. Birth weight (g) for an IQR increase (µg/m3) in exposure to
NO2 during pregnancy and each trimester (Aguilera 2009)
BTEX
9-month -76.6 (-146.3
to -7.0)
1st -52.5 (-125.8
trimester to 20.8)
2nd -101.9 (-176.2
trimester to -27.6)
3rd -59.7 (-130.9
trimester to 11.5)
a Adjusted for child's sex, gestational age, season of conception, parity, maternal educational
level, maternal smoking, maternal height and pre-pregnancy weight and paternal height

25. Change in Z-scores of fetal size and growth
for an IQR increase in exposure to NO2 (µg/m3) between
weeks 1-12
(Aguilera, EHP2010)
10
8
6
4
2
% Change
0
-2
-4
-6
-8
-10
-12
FL HC AC BPD EFW
w_12 w_20 w_32 w_12_20 w _20_32
* Adjusted for season of conception, parity, maternal education, and maternal smoking

26. Mortality
WHO scenario
% of total cases
Indicator Mean (95% CI)
(95% CI)
Deaths per year 3.500 (2.200-4.800) 12% (7%-16%)
Of which
Death due to acute
520 (350-690) 2% (1%-2%)
exposure per year
Infant deaths per year 15 (7-22) 13% (6%-19%)

27. Morbidity per year
WHO scenario
% of total cases
Indicator Mean (95% CI)
(95% CI)
Respiratory
Chronic bronchitis adults 5.100 (550-8.500) 25% (3%-41%)
Acute bronchitis children 31.100 (17.500-40.500) 49% (28%-64%)
Asthma attacks adults 41.500 (21.000-60.500) 11% (6%-16%)
Asthma attacks children 12.400 (6.400-15.200) 11% (6%-14%)
Hospitalizations
Respiratory causes 1.150 (630-1.670)) 3% (2%-5%)
Cardiovascular causes 620 (310-930) 2% (1%-3%)

28. Estimating impact of traffic exposure
Population distribution from roads >10,000 vehicle/day

29. Conclusions: Particle Size
– In urban areas, all PM size fractions have health
effects.
– PMs generated by both traffic-related combustion
and non-combustion processes may increase
mortality.
– PMs generated by both traffic-related combustion
and non-combustion processes may share a
common mechanism of action.

30. Conclusions
• Saharan dust
– In some areas exposure to coarse PMs from
natural sources such as Saharan dust may
increase daily mortality.
• Early life exposure
– Provides unexpected new effects due to air
pollution
• Health impact assessment
– Very likely have been underestimated

31. Thank you
jsunyer@creal.cat

32. Perera FP. Env Health Persp
2006;114:1287-92.
• PAH in particulate mode—collected with
individual pumps during two consecutive days in
181 pregnant women from New York City
(USA)— was associated to mental health
measured at age 3 in the offspring
• Limitations: The short measurement of the
exposure (only two days), their narrow variability
(only low and high levels), and the poor
specificity of PAH (the principal source is
smoking)

33. Suglia SF. Am J Epidemiol
2008;167:280-6.
• Average air pollution during childhood
(carbon particles at home address derived
by spatial modeling) to intelligence at age
9 in 202 children from Boston (USA)
• Limitations: follows only 20% of those
recruited and did not measure
prospectively the variations in air pollution
or the time-activity patterns of the
participants. No adjustment for noise.

34. Non-combustion traffic related particles
is an important source of health effects
Source % of PM10 emissions in
Barcelona
Combustion 56%
Brake erosion 5%
Tire erosion 3%
Pavement erosion 6%
Soil resuspension 30%
Total 100%
Source: Departament de Mediambient i Habitatge, 2007

35. PM10 in Barcelona metropolitan
area
Media anual de PM10 indicador
de la contaminació atmosfèrica
** Mapa elaborado por el Departamento de Medio Ambiente y Vivienda