may 30, 2003 american lung association of pennsylvania 1 health effects of diesel exhaust kevin m....
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May 30, 2003American Lung Association of
Pennsylvania1
Health Effects of Diesel ExhaustKevin M. Stewart
Director of Environmental Health
American Lung Association of Pennsylvania
May 30, 2003American Lung Association of
Pennsylvania2
Outline
Diesel Exhaust Composition Diesel Exhaust Health Effects
Overview Specifics, notably cancer Populations at Risk
Key Steps / Conclusion
May 30, 2003American Lung Association of
Pennsylvania4
Composition of Diesel Exhaust Complex mixture of thousands of
chemicals Gases and fine particles Over forty air contaminants
recognized as toxicants,
carcinogens, reproductive
and developmental hazards,
endocrine disruptors
May 30, 2003American Lung Association of
Pennsylvania5
Composition of Diesel Exhaust Gas phase
Oxygen Carbon dioxideNitrogen Carbon monoxideWater vaporNitrogen Oxides (especially NO)Sulfur Compounds
(especially Sulfur Oxides)Volatile Organic CompoundsLow MW Hydrocarbons…
May 30, 2003American Lung Association of
Pennsylvania6
Composition of Diesel Exhaust
Gas phase components of toxicological significance
Aldehydes (formaldehyde, acetaldehyde, acrolein)
Benzene1,3-butadienenitrosaminespolycyclic aromatic hydrocarbons (PAHs)nitro-PAHs
May 30, 2003American Lung Association of
Pennsylvania7
Composition of Diesel Exhaust Particulate phase
Mostly elemental carbon (soot) About 20% to 40% adsorbed organic
compounds Also sulfate, nitrate, metals, other trace elements The most toxicologically relevant adsorbed
compounds (less than 1% of PM by mass):
- PAHs
- Nitro-PAHs
- Oxidized PAH derivatives 92% of mass is in particles smaller than 1 micron
May 30, 2003American Lung Association of
Pennsylvania8
Substances in Diesel Exhaust Listed by the California Air Resources Board as Toxic Air Contaminantsacetaldehyde cobalt compounds nickel
acrolein cresol isomers 4-nitrobiphenyl
aniline cyanide compounds phenol
antimony compounds dibutylphthalate phosphorus
arsenic dioxins and dibenzofurans POM, including PAHs
benzene ethyl benzene and their derivatives
beryllium compounds formaldehyde propionaldehyde
biphenyl hexane selenium compounds
bis[2-ethylhexyl]phthalate lead (inorganic) styrene
1,3-butadiene manganese compounds toluene
cadmium mercury compounds xylene isomers, mixtures
chlorine methanol o-xylenes
chlorobenzene methyl ethyl ketone m-xylenes
chromium compounds naphthalene p-xylenes
May 30, 2003American Lung Association of
Pennsylvania9
Diesel Emissions Inventory
Nationwide, 2001 data show diesel emissions at ~ 4% of PM2.5 inventory. (~11% excluding natural and
miscellaneous sources) Urban Centers
Diesel PM estimated up to 10% to 36% in some western cities.
Nitrogen Oxides – nearly one third! Over decades, nonroad diesel has over-
taken decreasing onroad diesel emissions. Recent diesel emissions trends have been
relatively stagnant.
May 30, 2003American Lung Association of
Pennsylvania10
Estimating Exposure to Diesel Exhaust
Use of particulate phase as surrogate for all: Typical indoor level about half of higher risk areas Near-highway exposures up to about 5 times
average outdoor levels On school buses, average PM2.5 concentrations
often 5 to 10 times higher than ambient, especially when buses are queued and idling.
PM10 concentrations average ~ 2 mcg/m3 but has been detected at 125 mcg/m3 above background (w/ windows closed) following an urban transit bus
May 30, 2003American Lung Association of
Pennsylvania12
Weight of Evidence Approach to Understanding Risk biological plausibility supporting evidence from animal studies,
genotoxicity consistency of response broad-based evidence upward trend in exposure-response detectable association at environmental levels effects remain after adjusting for potential bias strong association for highest exposure groups confounding cannot explain association
May 30, 2003American Lung Association of
Pennsylvania13
Diesel Exhaust is a “Quadruple Whammy”
for Public Health Carcinogens Toxins Fine Particulate Matter Nitrogen oxides
May 30, 2003American Lung Association of
Pennsylvania14
Whammies 1 and 2 Carcinogens
Lung Bladder
Toxins Nervous Endocrine Reproductive Immune Developmental Liver Kidney
May 30, 2003American Lung Association of
Pennsylvania15
Whammy 3 Fine Particulate Matter
Premature death Increase respiratory illnesses Exacerbate asthma
Symptom days Attacks ER visits Hospitalization
May 30, 2003American Lung Association of
Pennsylvania16
Whammy 4 Nitrogen oxides
Ozone precursor … Increase in respiratory illnesses Decrease in lung function growth
May 30, 2003American Lung Association of
Pennsylvania18
Specific Highlights Diesel emissions are a significant source of the fine
particulate matter that may be responsible for about
50,000 premature deaths in the U. S. every year. Nationwide, expected lifetime cancers from diesel
particulate in the U. S. population have been
conservatively estimated at about 125,000. EPA has estimated that the diesel engine and fuel rule
approved in February of 2001 will prevent 8,300
premature deaths, 360,000 asthma attacks, and
1.5 million lost work days annually.
May 30, 2003American Lung Association of
Pennsylvania19
Specific Highlights
STAPPA and ALAPCO estimated in 2002 that if EPA
were to adopt and implement a NONROAD heavy duty
diesel rule consistent with those organizations’
recommendations: Approximately 8,500 premature deaths per year could be
avoided. In 2030 the total annual monetized health-related
benefits associated with reductions in particulate
matter emissions reductions would be more than
$67 billion (1999 dollars).
May 30, 2003American Lung Association of
Pennsylvania20
Non-cancer Health Effects from Short-term Exposure
Acute irritation Respiratory symptoms (e.g., cough) Neurophysiological symptoms (e.g., nausea) Compromised pulmonary function Increase in biochemical markers associated with
allergy Asthma exacerbation Insufficient data for specifying “guidance” level
May 30, 2003American Lung Association of
Pennsylvania21
Non-cancer Health Effects from Long-term Exposure
Greater cough and phlegm Asthma induction Animals also show decreased resistance to
infection, increased chronic lung inflammation and tissue changes
Insufficient human data for specifying “guidance” level, but US EPA has set Reference
Concentration at 5 micrograms/m3
May 30, 2003American Lung Association of
Pennsylvania23
Estimated Cancers from Diesel ParticulateState and Territorial Air Pollution
Program Administrators
and Association of Local Air Pollution Control Officials
(STAPPA/ALAPCO)
Cancer Risk from Diesel Particulate: National and
Metropolitan Area Estimates for the United States,
March 15, 2000.
May 30, 2003American Lung Association of
Pennsylvania24
Estimated Cancers from Diesel Particulate
ENTIRE UNITED STATES 125,110 20 Largest Metropolitan AreasMetropolitan Area CancersLos Angeles 16,250New York 10,360Chicago 4,535Washington/Baltimore 3,750San Francisco 3,510Philadelphia 3,085Boston 2,900Detroit 2,810Dallas/Fort Worth 2,470
- continued
May 30, 2003American Lung Association of
Pennsylvania25
Estimated Cancers from Diesel Particulate
20 Largest Metropolitan Areas - continuedMetropolitan Area CancersHouston 2,270Atlanta 1,930Miami/Fort Lauderdale 1,880Seattle 1,765Phoenix 1,510Cleveland 1,500Minneapolis 1,460San Diego 1,430St. Louis 1,320Denver 1,220Pittsburgh 1,210
May 30, 2003American Lung Association of
Pennsylvania26
Cancer Risk Assessments of Diesel Exhaust ORGANIZATION YEAR
CONCLUSIONNational Institute for Occupational Safety and Health 1988
potential occupational carcinogenInternational Agency for Research on Cancer (WHO) 1989
probable human carcinogenState of California 1990
known to cause cancerHealth Effects Institute 1995& World Health Organization 1996
consistency in showing weak association between exposure to diesel exhaust and lung cancer
May 30, 2003American Lung Association of
Pennsylvania27
Cancer Risk Assessments of Diesel Exhaust ORGANIZATION YEAR
CONCLUSIONCalifornia EPA (Staff Recommendation) 1998
“may cause an increase in the likelihood of cancer”California Air Resources Board 1998
diesel particulate emissions are a toxic air contaminantNational Toxicology Program 1998
“diesel exhaust particulate is reasonably anticipated to be a human carcinogen”
U.S. Environmental Protection Agency 2002 likely to be carcinogenic to humans by inhalation at environmental levels of exposure
May 30, 2003American Lung Association of
Pennsylvania28
Carcinogenic Potential of Diesel Emissions
Known carcinogens in vapor phase Benzene Formaldehyde 1,3-butadiene Ethylene dibromide
Adsorbed onto particles 3 PAHs (including BAP) classified as
probably carcinogenic to humans At least 16 hydrocarbons classified as
possibly carcinogenic to humans These do not account for all of the cancer risk associated with diesel exhaust.
May 30, 2003American Lung Association of
Pennsylvania29
Carcinogenic Potential of Diesel Emissions
Meta-analysis by California Office of Environmental Health Hazard Assessment on diesel exhaust and lung cancer: Clear positive relationship between
occupational diesel exhaust and lung cancer
Cigarette smoking removed as confounder
Consistent with causal relationship Association with 40% increase in
relative risk
May 30, 2003American Lung Association of
Pennsylvania30
Carcinogenic Potential of Diesel Emissions
A similar meta-analysis on dieselexhaust and bladder cancer (January,2001 by Boffetta and Silverman inEpidemiology): Found an increased risk of between
18% and 76% among occupationallyexposed individuals (bus and truckdrivers, railroad and shipyardworkers)
May 30, 2003American Lung Association of
Pennsylvania31
Carcinogenic Potential of Diesel Emissions
People are exposed to hundreds of times theamount of carcinogens the Clean Air Actrecognizes as a reasonable precaution (one-in-a-million): In 1996 the national average lifetime cancer
risk from breathing outdoor hazardous
pollutants was 1 in 2,100. Mobile sources: 93% of this risk Diesel emissions: 89% of the risk:
28% from on-road sources (e.g., trucks) 60% from nonroad sources (industrial,
construction and farm equipment)
May 30, 2003American Lung Association of
Pennsylvania32
Populations at Risk (1998 data)
State Population Emphysema Chronic Bronchitis
Adult Asthma (>= 18 yr) Pediatric Asthma (< 18 yr)
NJ 8,095,542 91,513 277,593
210,480 105,914
PA 12,002,329 137,136 415,982
315,416 151,857
DE 744,066 8,461 25,666
19,460 9,557
MD 5,130,072 57,572 174,642
132,420 68,593
May 30, 2003American Lung Association of
Pennsylvania33
Populations at Risk (1998 data) (continued)
State Population Under 14 Years 65 Years and Over
NJ 8,095,542 1,680,818 1,106,028
PA 12,002,329 2,358,803 1,905,327
DE 744,066 150,327 96,809
MD 5,130,072 1,083,642 591,273
May 30, 2003American Lung Association of
Pennsylvania34
The American Lung Association’sRecommended Key Steps
Implement the clean air standards for trucks and buses and fuels – completely and on time.
Adopt strong equivalent standards for all nonroad diesel equipment.
Close the loophole for diesel electric generators.
Implement retrofit programs now.
May 30, 2003American Lung Association of
Pennsylvania35
Conclusion
Approximately one in ten Americans has a chronic
lung disease and is at risk from air pollution. Infants,
children, and the elderly are at increased risk, too.
These are not faceless statistics, but people close to you:
Your friends, your coworkers. Your parents, your children.
Your aunt with emphysema struggling to breathe.
Your coworker who can't make it in for that important task.
Your child taking that frightening trip to the emergency room.
Maybe even yourself.
May 30, 2003American Lung Association of
Pennsylvania36
Remember:
When You Can’t Breathe, Nothing Else Matters.
May 30, 2003American Lung Association of
Pennsylvania37
Additional Materials
(Not part of presentation, but for use in responding to questions, if necessary)
May 30, 2003American Lung Association of
Pennsylvania38
Factors Affecting Composition of Diesel Emissions Engine types (light-duty to heavy-duty as
they appear in passenger vehicles to
off-road vehicles, in locomotives to
electric generators) Engine operating conditions
(idle, accelerate, decelerate) Fuel formulations
(e.g., sulfur or aromatic content)
May 30, 2003American Lung Association of
Pennsylvania39
Factors Affecting Fate of Diesel Emissions Dilution Chemical & physical changes
Example: Diesel exhaust “aging” results in secondary PM formed from gas phase components
Transport Weather (sunlight, temperature,
humidity, precipitation) Other (interacting) pollutants Interactions with ground-level
environment
May 30, 2003American Lung Association of
Pennsylvania40
Example of Study from Current Research
Study in April 3, 2002 issue of Immunotherapy Weekly presented at annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI).
Prior evidence showed that Diesel Exhaust Particulate (DEP ) could increase immune system response and airway inflammation associated with various allergens.
This study examined hospital emergency room visits and inpatient admissions between 1995 to 2000. Asthma exacerbations for children under 18 years old increased 1.4 times in the fall compared with the spring, significantly correlated with higher levels of DEP.
May 30, 2003American Lung Association of
Pennsylvania41
Reproductive and Developmental Effects Some possibilities in animal
studies Neurobehavioral and
neurophysiological effects in
neonatal rodents Organ systems not yet evaluated
May 30, 2003American Lung Association of
Pennsylvania42
Immunological Effects Several observed effects in
immune system biochemical
mediators, inflammation,
cytological changes Diesel exhaust as potentiator for
known allergens Insufficient data to determine
reference level
May 30, 2003American Lung Association of
Pennsylvania43
Genotoxic Effects of Diesel Particulates or Extracts
Mutagenic in several mammalian cell systems Aberrations in chromosomes or cell division Free radical inhibition of antioxidant enzymes Separately, substances in diesel exhaust have
been identified as genotoxic Questions remain about the level of
bioavailability
May 30, 2003American Lung Association of
Pennsylvania44
Carcinogenic Potential of Diesel Emissions
Lifetime lung cancer risks per microgram of diesel exhaust:
Cancer risk per microgram of diesel exhaust particulate per cubic meter of air: Scenarios range on the order of 100 to 1000 per million population after 70 years
of exposure.
May 30, 2003American Lung Association of
Pennsylvania45
Major Report on Particulate Air Pollution:March 6, 2002 of JAMA “Lung Cancer, Cardiopulmonary Mortality, and
Long-term Exposure to Fine Particulate Air Pollution” by Pope, C. A., et al.
Prospective mortality study of 500,000 adults in 156 cities, followed over the years 1982-98.
Conclusion: “Each 10-µg/m3 elevation in fine particulate air pollution was associated with approximately a 4%, 6%, and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality, respectively.”
May 30, 2003American Lung Association of
Pennsylvania46
Important Public Health News from Last Year Dec. 21, 2000: EPA issues rule for
diesel fuel and heavy duty diesel vehicles.
Feb. 28, 2001: EPA agrees to enforce rule.
May 3, 2002: Ruling by U. S. Circuit Court of Appeals for the District of Columbia Circuit upholds the rule.
May 30, 2003American Lung Association of
Pennsylvania47
Important Public Health News from Last Year Rule to take effect in 2007. EPA estimates that annually the rule will
prevent 8,300 premature deaths, more than 9,500 hospitalizations, 5,500 cases of chronic bronchitis, 17,600 cases of acute bronchitis in children, 360,000 fewer asthma attacks, and more than 1.5 million lost workdays. The rule also will prevent cancers from diesel exhaust, which EPA has found to be a likely carcinogen in humans.
May 30, 2003American Lung Association of
Pennsylvania48
References
… where you can find links to this same information – and more:
The 1998 California Environmental Protection Agency’s Office of Environmental Health Hazard Assessment (OEHHA) Report www.arb.ca.gov/regact/diesltac/diesltac.htm
The 2000 US EPA Review Draft www.epa.gov/ncea/dieslexh.htm
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