us six cities and relevance for clean air policy in ireland

US Six Cities and Relevance for Clean Air Policy in Ireland

Clean Air Conference 2015 September 28, 2015

Wood Quay Venue, Dublin

Douglas W. Dockery Professor of Environmental Epidemiology

Harvard School of Public Health

Dublin Coal Ban On September 1, 1990, the

marketing, sale, and distribution of bituminous coals was banned within the city of Dublin (Air Pollution Act, 1987).

0

20

40

60

80

100

120

140

µg/m

3Dublin Black Smoke

Ban on Coal Sales

14.6 µg/m3

50.2 µg/m3

Bans on Coal Sales

September 1, 1990 -Dublin October 1, 1995 -Cork October 1, 1998 -Limerick -Dundalk -Drogheda -Wexford -Arklow

98th percentiles of Daily Black Smoke Concentrations in Major Urban Areas

Air Quality in Ireland 2010; Key Indicators of Ambient Air Quality

DUBLIN CORK

1990 Ban 1995 Ban 1998 Ban

What are the effects of repeated, long term exposures to Fine Particles?

Satellite-Derived PM2.5: 2001–2006 Average

Von Donkelaar et al Envir Hlth Pers 2010;118:847

Six Cities Adult Mortality Study Random sample of

8411 adults in six cities Dirty: Steubenville,

OH & St. Louis, MI Moderate: Watertown,

MA & Harriman, TN Clean: Topeka, KS &

Portage, WI Enrolled 1974-77 14-16 years of

mortality follow-up

Dockery et al, NEJM 1993;329:1753

Follow-up

Six Cities Adult Mortality Study Random sample of

8411 adults in six cities Dirty: Steubenville,

OH & St. Louis, MI Moderate: Watertown,

MA & Harriman, TN Clean: Topeka, KS &

Portage, WI Enrolled 1974-77 14-16 years of

mortality follow-up

Dockery et al, NEJM 1993;329:1753

Six Cities Adult Mortality

0.7

0.8

0.9

1.0

1.1

1.2

1.3

1.4

0 10 20 30 40

PM2.5 (µg/m3)

Mor

talit

y Ri

sk R

atio

Steubenville

Topeka Watertown

Kingston St. Louis

Portage

EPA NAAQS

Six Cities Mortality Follow-up 1974 to 1989 follow-up

Annual returned postcards and National Death Index

1,364 deaths 104,243 person

years

PM2.5 measurements 1979-1986

1990 to 1998 follow-up National Death Index

search 1,368 deaths

54,735 person years

PM2.5 estimated from

PM10 1990-1998

Laden et al, AJRCCM 2006;54:709

Six Cities Cohort Follow-up

Laden et al, AJRCCM 2006;54:709

0.7

0.8

0.9

1.0

1.1

1.2

1.3

1.4

0 5 10 15 20 25 30 35

PM2.5 (µg/m3)

Mor

talit

y R

isk

Rat

io Steubenville

Topeka

Watertown

Kingston

St. Louis Portage

Improved air quality leads to reduced mortality

Can we see effect of air pollution controls in US?

Age-adjusted death rates: United States, 1960-2005

600

800

1,000

1,200

1,400

Rat

e pe

r 100

,000

pop

ulat

ion

1970 1980 1990

Age-adjusted

1960 0

2000 2005

County life expectancies at birth for white males and females;1997–2001

CJL Murray et al, Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med. 2006 Sep;3(9):e260

Trends in the Levels of the Six Criteria Pollutants Relative to U.S. National Standards: 1980 - 2006

51 Metropolitan areas (dots); Study Counties (shaded gray)

Life Expectancy vs PM2.5 1978-82

71

72

73

74

75

76

77

78

79

80

81

5 10 15 20 25 30 35PM2.5 (µg/m3)

Life

Exp

ecta

ncy

Steubenville

Topeka

Boston

EPA NAAQS

Pope, Ezzati, Dockery. NEJM 2009; 360:376


71

72

73

74

75

76

77

78

79

80

81

5 10 15 20 25 30 35PM2.5 (µg/m3)

Life

Exp

ecta

ncy

Topeka

Boston

Steubenville

EPA NAAQS



71

72

73

74

75

76

77

78

79

80

81

5 10 15 20 25 30PM2.5 (µg/m3)

Life

Exp

ecta

ncy

Topeka



71

72

73

74

75

76

77

78

79

80

81

5 10 15 20 25 30PM2.5 (µg/m3)

Life

Exp

ecta

ncy

Pope, Ezzati, Dockery (NEJM 2009)

EPA NAAQS

Health benefits below current NAAQS

CAFE Stage I Limit Value

CAFE Stage II Limit Value

71

72

73

74

75

76

77

78

79

80

81

5 10 15 20 25 30

Life

Exp

ecta

ncy

PM2.5 (µg/m3)

Coleraine St PM2.5 9.7 µg/m3

↓

2012 Life Expectancy 80.9 year

1990 Life Expectancy 74.8 year

What would these results say about air pollution in Ireland?

PM2.5 in 1990?

Black Smoke Before and After Bans

Goodman et al, JAWMA 2009

71

72

73

74

75

76

77

78

79

80

81

5 10 15 20 25 30 35

Life

Exp

ecta

ncy

PM2.5 (µg/m3)

CORK Black Smoke

Pre-Ban 32.4 µg/m3

↓ ↑

Post-Ban 17.2 µg/m3

3.8 yr

Implications of US data for Cork?

65

67

69

71

73

75

77

79

81

0 10 20 30 40 50

Life

Exp

ecta

ncy

PM2.5 (µg/m3)

1984-90 50.2 µg/m3

↑ 1990-96 14.6 µg/m3 9.0 yr

Implications of US data for Dublin?

0 2 4 6 8 10

Galway

Celbridge

Leixlip

Naas

Waterford

Limerick

Dundalk

Drogheda

Arklow

Cork

Dublin

20

00

Ban

19

98

Ban

19

95

Ban

19

90

Ban

Estimated Extra Years Life Expectancy

Implications of US data?

Median 3.5 yrs

How big is 3.5 year increase in life expectancy? 68 year old nonsmoking male

Additional life expectancy 15.5 years

Additional 3.5 years life expectancy 19.0 years

+

How big is 3.5 year increase in life expectancy in population of Ireland? Tobacco Smoking

6.8 years reduced life expectancy for average smoker (Streppel et al, Tob Cont 2007)

31% Current Smoking in Ireland(2009) (Special Eurobarometer 332) 6.8 yr among 31% of population

2.1 yr longer life expectancy in population Diabetes

7.8 years for men, 8.4 years for women (Fromer et al, Arch Int Med 2007)

4.7% Diabetes Mielitus in Ireland (2005) (Institute of Public Health in Ireland, 2006.)

8 yr among 4.7% of population 0.4 yr longer life expectancy in population

Fine particle air pollution Median 3.5 years for reduction in Black Smoke due to ban 100% of population affected

3.5 yr longer life expectancy in population

Conclusions PM2.5 associated significant life

shortening (mortality) Improved air quality leads to

measurably improved public health Benefits at all levels of air pollution Even in clean communities

Ireland likely has substantially longer life expectancy due to ban on coal sales