Abstract
Despite substantial improvements in ambient air quality in the past decades, ozone (O3), nitrogen dioxide (NO2), and fine particulate matter (PM2.5) remain as concerns. As these pollutants exist as mixtures in ambient environments, some combinations of these pollutants may be more harmful to human health than other combinations. Identifying harmful pollutant mixtures can help develop multi-pollutant control strategies to better protect health. Current methods exhibit limitations in identifying harmful mixtures. We aim to identify harmful compositions of three-pollutant mixtures in 85 US counties during 1999–2010. We developed a new method called PANCAKE to quantify O3-NO2-PM2.5 mixtures. O3-NO2-PM2.5 mixtures are categorized into 27 composition types based on combinations of different O3, NO2, and PM2.5 levels. We identified harmful compositions by estimating the effect of each composition of O3-NO2-PM2.5 mixture compared to the reference composition on cardiovascular admissions among Medicare patients. We found that a mixture with relatively low levels of some pollutants combined with relatively high levels of other pollutants can be equally or more harmful than a mixture with high levels of all pollutants. Eight out of the 27 composition types, often with NO2 levels > 17.3 ppb and PM2.5 levels > 8.8 μg/m3 combined with any levels of O3, were associated with significantly increased cardiovascular admission rates compared to the reference composition. These harmful compositions overall occurred in about 40–50% of days in winter, metropolitan areas, or the East North Central region. Mixture composition plays an important role in determining health risks and may be worth considering when developing air pollution control strategies.
Similar content being viewed by others
References
Adamson IY, Vincent R, Bjarnason SG (1999) Cell Injury and Interstitial Inflammation in Rat Lung after Inhalation of Ozone and Urban Particulates. Am J Respir Cell Mol Biol 20(5):1067–1072. https://doi.org/10.1165/ajrcmb.20.5.3468
Bell ML, Ebisu K, Peng RD, Samet JM, Dominici F (2009) Hospital Admissions and Chemical Composition of Fine Particle Air Pollution. Am J Respir Crit Care Med 179(12):1115–1120. https://doi.org/10.1164/rccm.200808-1240OC
Billionnet C, Sherrill D, Annesi-Maesano I (2012) Estimating the Health Effects of Exposure to Multi-Pollutant Mixture. Ann Epidemiol 22(2):126–141. https://doi.org/10.1016/j.annepidem.2011.11.004
Bobb JF, Valeri L, Henn BC, Christiani DC, Wright RO, Mazumdar M, Godleski JJ, Coull BA (2014) Bayesian Kernel Machine Regression for Estimating the Health Effects of Multi-Pollutant Mixtures. Biostatistics. https://doi.org/10.1093/biostatistics/kxu058
Brunekreef B, Holgate ST (2002) Air Pollution and Health. Lancet 360(9341):1233–1242. https://doi.org/10.1016/S0140-6736(02)11274-8
Burnett RT, Brook J, Dann T, Delocla C, Philips O, Cakmak S, Vincent R, Goldberg MS, Krewski D (2000) Association between Particulate- and Gas-Phase Components of Urban Air Pollution and Daily Mortality in Eight Canadian Cities. Inhal Toxicol 12(Suppl 4):15–39. https://doi.org/10.1080/08958370050164851
Cakmak S, Dales RE, Vida CB (2009) Components of Particulate Air Pollution and Mortality in Chile. Int J Occup Environ Health 15(2):152–158. https://doi.org/10.1179/oeh.2009.15.2.152
Centers for Disease Control and Prevention. NCHS Urban-Rural Classification Scheme for Counties [Internet]. 2014 [cited 2017 May 3]. Available from: https://www.cdc.gov/nchs/data_access/urban_rural.htm
Colvile RN, Hutchinson EJ, Mindell JS, Warren RF (2001) The Transport Sector as a Source of Air Pollution. Atmos Environ 35(9):1537–1565. https://doi.org/10.1016/S1352-2310(00)00551-3
Crouse DL, Peters PA, Hystad P, Brook JR, van Donkelaar A, Martin RV, Villeneuve PJ et al (2015) Ambient PM2.5, O3, and NO2 Exposures and Associations with Mortality over 16 Years of Follow-Up in the Canadian Census Health and Environment Cohort (CanCHEC). Environ Health Perspect 123(11):1180. https://doi.org/10.1289/ehp.1409276
Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL, Samet JM (2006) Fine Particulate Air Pollution and Hospital Admission for Cardiovascular and Respiratory Diseases. JAMA 295(10):1127–1134. https://doi.org/10.1001/jama.295.10.1127
Dominici F, Peng RD, Barr CD, Bell ML (2010) Protecting Human Health from Air Pollution: Shifting from a Single-Pollutant to a Multi-Pollutant Approach. Epidemiology (Cambridge, Mass.) 21(2):187–194. https://doi.org/10.1097/EDE.0b013e3181cc86e8
Drechsler-Parks DM (1995) Cardiac Output Effects of O3 and NO2 Exposure in Healthy Older Adults. Toxicol Ind Health 11(1):99–109. https://doi.org/10.1177/074823379501100109
Ferreira TM, Forti MC, de Freitas CU, Nascimento FP, Junger WL, Gouveia N (2016) Effects of Particulate Matter and Its Chemical Constituents on Elderly Hospital Admissions Due to Circulatory and Respiratory Diseases. Int J Environ Res Public Health 13(10):947. https://doi.org/10.3390/ijerph13100947
Franklin M, Schwartz J (2008) The Impact of Secondary Particles on the Association between Ambient Ozone and Mortality. Environ Health Perspect 116(4):453–458. https://doi.org/10.1289/ehp.10777
Franklin M, Koutrakis P, Schwartz P (2008) The Role of Particle Composition on the Association between PM2.5 and Mortality. Epidemiology (Cambridge, Mass.) 19(5):680–689
Gass K, Balachandran S, Chang HH, Russell AG, Strickland MJ (2015) Ensemble-Based Source Apportionment of Fine Particulate Matter and Emergency Department Visits for Pediatric Asthma. Am J Epidemiol 181(7):504–512. https://doi.org/10.1093/aje/kwu305
Gelzleichter TR, Witschi H, Last JA (1992) Concentration-Response Relationships of Rat Lungs to Exposure to Oxidant Air Pollutants: A Critical Test of Haber’s Law for Ozone and Nitrogen Dioxide. Toxicol Appl Pharmacol 112(1):73–80
Gong H, Wong R, Sarma RJ, Linn WS, Sullivan ED, Shamoo DA, Anderson KR, Prasad SB (1998) Cardiovascular Effects of Ozone Exposure in Human Volunteers. Am J Respir Crit Care Med 158(2):538–546. https://doi.org/10.1164/ajrccm.158.2.9709034
Hesterberg TW, Bunn WB, McClellan RO, Hamade AK, Long CM, Valberg PA (2009) Critical Review of the Human Data on Short-Term Nitrogen Dioxide (NO2) Exposures: Evidence for NO2 No-Effect Levels. Crit Rev Toxicol 39(9):743–781. https://doi.org/10.3109/10408440903294945
Hong YC, Leem JH, Ha EH, Christiani DC (1999) PM(10) Exposure, Gaseous Pollutants, and Daily Mortality in Inchon, South Korea. Environ Health Perspect 107(11):873–878
Huang Y-CT, Rappold AG, Graff DW, Ghio AJ, Devlin RB (2012) Synergistic Effects of Exposure to Concentrated Ambient Fine Pollution Particles and Nitrogen Dioxide in Humans. Inhal Toxicol 24(12):790–797. https://doi.org/10.3109/08958378.2012.718809
Ji M, Cohan DS, Bell ML (2011) Meta-Analysis of the Association between Short-Term Exposure to Ambient Ozone and Respiratory Hospital Admissions. Environ Res Lett 6(2):024006. https://doi.org/10.1088/1748-9326/6/2/024006
Kheirbek I, Haney J, Douglas S, Ito K, Matte T (2016) The Contribution of Motor Vehicle Emissions to Ambient Fine Particulate Matter Public Health Impacts in New York City: A Health Burden Assessment. Environ Health 15(1):89. https://doi.org/10.1186/s12940-016-0172-6
Kodinariya TM, Makwana PR (2013) Review on Determining Number of Cluster in K-Means Clustering. Int J 1(6):90–95
Koken PJM, Piver WT, Ye F, Elixhauser A, Olsen LM, Portier CJ (2003) Temperature, Air Pollution, and Hospitalization for Cardiovascular Diseases among Elderly People in Denver. Environ Health Perspect 111(10):1312–1317
Laden F, Neas LM, Dockery DW, Schwartz J (2000) Association of Fine Particulate Matter from Different Sources with Daily Mortality in Six U.S. Cities. Environ Health Perspect 108(10):941–947
Last JA, Sun WM, Witschi H (1994) Ozone, NO, and NO2: Oxidant Air Pollutants and More. Environ Health Perspect 102(Suppl 10):179
Linn WS, Szlachcic Y, Gong H, Kinney PL, Berhane KT (2000) Air Pollution and Daily Hospital Admissions in Metropolitan Los Angeles. Environ Health Perspect 108(5):427–434
Lippmann M, Schlesinger RB (2000) Toxicological Bases for the Setting of Health-Related Air Pollution Standards. Annu Rev Public Health 21(1):309–333. https://doi.org/10.1146/annurev.publhealth.21.1.309
Lippmann M, Ito K, Hwang J-S, Maciejczyk P, Chen L-C (2006) Cardiovascular Effects of Nickel in Ambient Air. Environ Health Perspect 114(11):1662–1669
Liu JC, Wilson A, Mickley LJ, Dominici F, Ebisu K, Wang Y, Sulprizio MP et al (2017) Wildfire-Specific Fine Particulate Matter and Risk of Hospital Admissions in Urban and Rural Counties. Epidemiology 28(1):77–85. https://doi.org/10.1097/EDE.0000000000000556
Mauderly JL, Samet JM (2009) Is There Evidence for Synergy Among Air Pollutants in Causing Health Effects. Environ Health Perspect 117(1):1–6. https://doi.org/10.1289/ehp.11654
Mauderly JL, Burnett RT, Castillejos M, Özkaynak H, Samet JM, Stieb DM, Vedal S, Wyzga RE (2010) Is the Air Pollution Health Research Community Prepared to Support a Multipollutant Air Quality Management Framework. Inhal Toxicol 22(sup1):1–19. https://doi.org/10.3109/08958371003793846
Mostofsky E, Schwartz J, Coull BA, Koutrakis P, Wellenius GA, Suh HH, Gold DR, Mittleman MA (2012) Modeling the Association between Particle Constituents of Air Pollution and Health Outcomes. Am J Epidemiol 176(4):317–326. https://doi.org/10.1093/aje/kws018
National Research Council (2004) Air Quality Management in the United States. https://www.nap.edu/catalog/10728/air-quality-management-in-the-united-states
Ostro B, Feng W-Y, Broadwin R, Green S, Lipsett M (2007) The Effects of Components of Fine Particulate Air Pollution on Mortality in California: Results from CALFINE. Environ Health Perspect 115(1):13–19. https://doi.org/10.1289/ehp.9281
Ostro B, Roth L, Malig B, Marty M (2009) The Effects of Fine Particle Components on Respiratory Hospital Admissions in Children. Environ Health Perspect 117(3):475–480. https://doi.org/10.1289/ehp.11848
Peng RD, Bell ML, Geyh AS, McDermott A, Zeger SL, Samet JM, Dominici F (2009) Emergency Admissions for Cardiovascular and Respiratory Diseases and the Chemical Composition of Fine Particle Air Pollution. Environ Health Perspect 117(6):957–963. https://doi.org/10.1289/ehp.0800185
Pirani M, Best N, Blangiardo M, Liverani S, Atkinson RW, Fuller GW (2015) Analysing the Health Effects of Simultaneous Exposure to Physical and Chemical Properties of Airborne Particles. Environ Int 79:56–64. https://doi.org/10.1016/j.envint.2015.02.010
Pope CAIII, Dockery DW (2006) Health Effects of Fine Particulate Air Pollution: Lines That Connect. J Air Waste Manage Assoc 56(6):709–742. https://doi.org/10.1080/10473289.2006.10464485
Roberts S, Martin MA (2006) Investigating the Mixture of Air Pollutants Associated with Adverse Health Outcomes. Atmos Environ 40(5):984–991. https://doi.org/10.1016/j.atmosenv.2005.10.022
Robinson E, Robbins RC (1970) Gaseous Nitrogen Compound Pollutants from Urban and Natural Sources. J Air Pollut Control Assoc 20(5):303–306. https://doi.org/10.1080/00022470.1970.10469405
Sarnat SE, Suh HH, Coull BA, Schwartz J, Stone PH, Gold DR (2006) Ambient Particulate Air Pollution and Cardiac Arrhythmia in a Panel of Older Adults in Steubenville, Ohio. Occup Environ Med 63(10):700–706. https://doi.org/10.1136/oem.2006.027292
Schwartz J (2000) Assessing Confounding, Effect Modification, and Thresholds in the Association between Ambient Particles and Daily Deaths. Environ Health Perspect 108(6):563–568
Schwartz J, Morris R (1995) Air Pollution and Hospital Admissions for Cardiovascular Disease in Detroit, Michigan. Am J Epidemiol 142(1):23–35. https://doi.org/10.1093/oxfordjournals.aje.a117541
Song X-H, Polissar AV, Hopke PK (2001) Sources of Fine Particle Composition in the Northeastern US. Atmos Environ 35(31):5277–5286. https://doi.org/10.1016/S1352-2310(01)00338-7
Srebot V, Gianicolo EAL, Rainaldi G, Trivella MG, Sicari R (2009) Ozone and Cardiovascular Injury. Cardiovasc Ultrasound 7:30. https://doi.org/10.1186/1476-7120-7-30
Stieb DM, Burnett RT, Smith-Doiron M, Brion O, Shin HH, Economou V (2008) A New Multipollutant, No-Threshold Air Quality Health Index Based on Short-Term Associations Observed in Daily Time-Series Analyses. J Air Waste Manage Assoc 58(3):435–450. https://doi.org/10.3155/1047-3289.58.3.435
US Census Bureau (2010) 2010 Geographic Terms and Concepts - Census Divisions and Census Regions. 2010. http://www2.census.gov/geo/docs/maps-data/maps/reg_div.txt
US EPA AirData (2016) Download Files | AirData | US EPA. 2016. http://aqsdr1.epa.gov/aqsweb/aqstmp/airdata/download_files.html#Daily
US EPA, OAR (2016) Multi-Pollutant Planning and Control Strategies.” Overviews and Factsheets. 2016. https://www.epa.gov/air-quality-management-process/multi-pollutant-planning-and-control-strategies
Valavanidis A, Loridas S, Vlahogianni T, Fiotakis K (2009) Influence of Ozone on Traffic-Related Particulate Matter on the Generation of Hydroxyl Radicals through a Heterogeneous Synergistic Effect. J Hazard Mater 162(2):886–892. https://doi.org/10.1016/j.jhazmat.2008.05.124
Vincent R, Bjarnason SG, Adamson IY, Hedgecock C, Kumarathasan P, Guénette J, Potvin M, Goegan P, Bouthillier L (1997) Acute Pulmonary Toxicity of Urban Particulate Matter and Ozone. Am J Pathol 151(6):1563–1570
World Health Organization (2003) “Health Aspects of Air Pollution with Particulate Matter, Ozone and Nitrogen Dioxide: Report on a WHO Working Group, Bonn, Germany 13-15 January 2003.” http://www.who.int/iris/handle/10665/107478
World Health Organization (2006) Air Quality Guidelines: Global Update 2005: Particulate Matter, Ozone, Nitrogen Dioxide, and Sulfur Dioxide. World Health Organization
Zanobetti A, Franklin M, Koutrakis P, Schwartz J (2009) Fine Particulate Air Pollution and Its Components in Association with Cause-Specific Emergency Admissions. Environ Health 8(1):58. https://doi.org/10.1186/1476-069X-8-58
Acknowledgements
This work was supported by the No. RD835871 awarded by the U.S. Environmental Protection Agency to Yale University. The views expressed in this document are solely those of The SEARCH Center and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Peng serves on the Health Review Committee of the Health Effects Institute.
Electronic supplementary material
ESM 1
(DOCX 2646 kb)
Rights and permissions
About this article
Cite this article
Liu, J.C., Peng, R.D. Health effect of mixtures of ozone, nitrogen dioxide, and fine particulates in 85 US counties. Air Qual Atmos Health 11, 311–324 (2018). https://doi.org/10.1007/s11869-017-0544-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11869-017-0544-2