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Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
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OCR for page R1
EPIDEMIOLOGY
AND
AIR POLLU LION
Committee on the Epidemiology of Air Pollutants
Board on Toxicology and Environmental Health Herds
Commission on Life Sciences
National Research Council
NATIONAL ACADEMY PRESS
Washington, [).C. 1985
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NOTICE: The project that is the subject of this report was approved by
the Governing Board of the National Research Council, whose members
are drawn from the Councils of the National Academy of Sciences, the
National Academy of Engineering, and the Institute of Medicine. The
members of the committee responsible for the report were chosen for their
special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according
to procedures approved by a Report Review Committee consisting of
members of the National Academy of Sciences, the National Academy of
Engineering, and the Institute of Medicine.
The National Research Council was established by the National Academy
of Sciences in 1916 to associate the broad community of science and
technology with the Academy's purposes of furthering knowledge and of
advising the federal government. The Council operates in accordance with
general policies determined by the Academy under the authority of its
congressional charter of 1863, which establishes the Academy as a private,
nonprofit, self-governing membership corporation. The Council has become
the principal operating agency of both the National Academy of Sciences
and the National Academy of Engineering in the conduct of their services
lo the government, the public, and the scientific and engineering commu-
nities. It is administered jointly by both Academies and the Institute of
Medicine. The National Academy of Engineering and the Institute of
Medicine were established in 1964 and 1970, respectively, under the charter
of the National Academy of Sciences.
The study reported in this publication was conducted at the request of and
funded by the U.S. Environmental Protection Agency under Contract 68-
02-4073.
Illustrations: Cover, Dr. Clarence C. Gordon, (c) National Geographic
Society; page 20, Jodi Cobb, (c) National Geographic Society; page 36, Dr.
Arnold Brody, National Institute of Environmental Health Sciences; page
88, Dr. Clarence C. Gordon, (c) National Geographic Society; page 126,
.Jodi Cobb, (c) National Geographic Society; page 162, Martin Rodgers, (c)
National Geographic Society; page 190, Barrie Day School.
Available from: National Academy Press, 2101 Constitution Ave., N.W.,
Washington, D C. 20418.
· · 7
11
<-
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Commidee on the Epidemiology of Air Pollulan~
,NI.~LREEN M. HENDERSO.N, Chairman, Department of Epidemiology,
University of Washington, Seattle, Washington
rHILIF . LA.NDRIGA.N, c~o-v~ce-~na~rman, Environmental Sciences
Laboratory, Department of Community Medicine, Mt. Sinai Medical
Center, New York, New York
PAUL D. STOLLEY, Co-Vice-Chairman, Clinical Epidemiology Unit,
University of Pennsylvania, Philadelphia, Pennsylvania
JOHN C. BAILAR, III, Department of Biostatistics, Harvard School
of Public Health, Boston, Massachusetts, and Office of Disease
Prevention and Health Promotion, Department of Health and
Human Services, Washington, D.C.
DAVID V. BATES, Department of Health Care and Epidemiology,
University of British Columbia, Vancouver, British Columbia.
Canada
INGE F. GOLDSTEI.N, Division of Epidemiology, School of Public
Health, Columbia University, New York, New York
~ _ . . ~ ., . ~ .
ROGENE HENDERSON, Inhalation Toxicology Research Institute,
Lovelace Biomedical and Environmental Research Institute, A1-
buquerque, New Mexico
,~\RVIN S. LEGATOR, Division of Environmental Toxicology, De-
partment of Preventive Medicine and Community Health, Univer-
sity of Texas Medical Branch, Galveston, Texas
PAI: ~ J. LIOY, Institute of Environmental Medicine, New York
University Medical Center, New York, New York
SAMUTEL C. MORRIS, Department of Energy and Environment,
Brookhaven National Laboratory, Upton, New York
PAUL R. PORT.NEY, Resources for the Future, Washington, D.C.
CARL SHY, Department of Epidemiology, School of Public Health,
I:'niversity of North Carolina, Chapel Hill, North Carolina
JOHN D. SPENGLER, Department of Environmental Science and
Physiology, Hart ard School of Public Health, Boston, Massachusetts
BAILUS WALKER, Department of Public Health, The Commonwealth
of Massachusetts, Boston, Massachusetts
National Research Council Staff
PETER H. GA.., Project Director
DEN RA LEE DAVIS, Executive Director, BOTEHH
MARS ELLEN SCHECKE.NBACH, Staff Assistant
JA\IES LA.NEAR, Administrative Secretary
.N OR\! AN GROSSBLArr, Editor
BARBARA 1MANDULA, Consultant
. . .
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Board on Toxicology and Environmental Health Hazards
GERALD N. WOGA.N, Chairman, Department of Appliecl Biological
Sciences, Massachusetts Institute of Technology, Cambridge, Mas-
sachusetts
DONALD HORNIG, Co-Vice-Chairman, Harvard School of Public Health,
Boston, Massachusetts
PHILIP I. LANDRIGAN, Co-Vice-Chairman, Environmental Sciences
Laboratory, Department of Community Medicine, Mt. Sinai Medical
Center, New York, New York
JOHN Douse, Department of Pharmacology, University of Kansas
Medical Center, Kansas City, Kansas
HERMAN N. EISEN, Department of Biology and Center for Cancer
Research, Massachusetts Institute of Technology, Cambridge, Mas-
sachusetts
EMMANUTEL FARBER, Department of Pathology, University of To-
ronto, Toronto, Ontario, Canada
RICHARD MERRILL. School of Law, University of Virginia, Char-
lottesville, Virginia
EMIL PFITZER, Department of Toxicology and Pathology, Hoffmann-
La Roche Inc., Nutley, New Jersey
LIANE B. RUSSELL, Biology Division, Oak Ridge National Laboratory,
Oak Ridge, Tennessee
ELLEN SILBERGELD, Toxics Program, Environmental Defense Fund,
Washington, D.C.
PETER SPENCER, Institute of Neurotoxicology, Albert Einstein Col-
lege of Medicine, Bronx, New York
Ex Officio
RoY E. Al BERT, Institute of Environmental Medicine, New York
University Medical Center, New York, New York
GARY P. CARLSON, Department of Pharmacology and Toxicology,
, is, an,
Purdue University School of Pharmacy and Pharmacal Science,
Lafayette, Indiana
THOMAS CHALMERS, Mt. Sinai Medical Center, New York, New
York
ARTHUR B. DUBOIS, JOhn B. Pierce Foundation Laboratory, Yale
University, New Haven, Connecticut
ALAN M. GOLDBERG, School of Hygiene and Public Health, The
Johns Hopkins University, Baltimore, Maryland
MAUREEN M. HE.N DERSON, Department of Epidemiology, ~ Diversity
of Washington, Seattle, Washington
1V
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PC)GER (a. NfcC:~E~. L<~`elace Biomedical and Environmental
Research Insti~ure.,Nlbuquerque. O'er Mexico
DANIEL B. \'1EN'ZEL. Department of Pharmacology. Duke l~ni~ersity
Medical Center. Durham. North Carolina
NORTON NEL.~N, Institute of Environmental Medicine, Neu York
University Medical (:enter, iKe`` York. New York
Board Staff
DEBRA LEE Damp, Executive Director
`IACQU!ELIN'E PRI>;C,E, Staff Associate
v
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Acknowledgments
Many persons provided the Committee and staff with helpful information,
suggestions, and the benefits of their experience during preparation of this
report. We wish especially to express our gratitude for contributions made
by Edward Baker, Roger Detels, Jack Hackney, Car} Hayes, Kaye Kilburn,
Brian Leaderer, Samuel Marcus, lean McRae, Rene Mendes, Paul Morrow,
Marvin Schneiderman, Kirk Smith, and Warren Muir. We also wish tO
thank Barbara Manclula, who helped organize the project in its early stages
and contributed substantially to its completion; Danny Kao and Christopher
Wendel, who also helped finish it; Edna Paulson and Victor MiDer, of the
Toxicology Information Center, who provided continual access to the
literature; and Gunther Craun, of the Environmental Protection Agency
(EPA), our project officer. Devra Lee Davis, Executive Director of the
Board on Toxicology and Environmental Health Hazards, provided valuable
assistance in review throughout this project, and Alvin G. Lazen, Executive
Director of the Commission on Life Sciences, offered much helpful advice.
Without the support of Bernard Goldstein and Roger Cortesi of EPA, the
project would not have been possible. Without the editorial work of Norman
Grossblatt, it would have been a great deal more difficult to read about;
he edited the entire report with the utmost degree of efficiency and
professional judgment.
Finally, the extraordinary skis and unselfish dedication of.lames Lanear
and Mary Ellen Scheckenbach were evident to a] who witnessed or
. . .
participated.
V1
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Preface
The Committee on the Epidemiology of Air Pollutants dealt with a
difficult charge under severe time constraints. That it completer} itS task
well and on rime is a credit to both its members and its dedicated and
outstanding National Research Council scientific staff colleagues. Dr. Peter
Gann in particular assumed major responsibility for coordinating, translating,
and negotiating ideas, opinions, and insights among and between Committee
members, consultants, and responsible NRC executives.
The Committee's report is about epidemiology, but is not written for
epidemiologists. It is a written answer to a specific charge from EPA
administrators. In the Committee's view, the report to the EPA adminis-
trators is likely to be of interest to a much wider audience of federal and
state air pollution control program directors, as wed as to a variety of
scientists concerned with air and industrial pollution questions. These
scientists wiD mostly be in other scientific disciplines and have a need either
to work with epidemiologists or to use epidemiologic strategies.
The Committee members met and shared a wide variety of opinions
about the match between pertinent air pollution research questions and
current epidemiologic concepts and strategies. These individuals had been
chosen for their diversity of expertise, experience, and opinions, and they
devised a work plan that would use this diversity to full advantage.
The Committee established a common base of state-of-the-art knowledge
through the circulation and discussion of background papers prepared by
its own experts. It then implemented its functional plan that depended
upon meetings of small ad hoc working groups of members. These
interdisciplinary working groups developed conceptual and operational
approaches to assigned segments of the work at hand. The work was carried
out in three phases, which moved from the most general to the most specific
subject matter and from development of consensus to the preparation of
the first drafts of chapters of the report.
The composition and leadership of the groups were deliberately changed
as work progressed. Every effort was made to concentrate attention on
critical issues and ideas that had not been fully explored or reviewed in the
recent literature and to avoid either discussing or writing about subjects
for which good recent reviews were available. Some of the Committee's
working concepts and guidelines mentioned in the report itself are worth
highlighting here.
It concentrated on long-term respiratory morbidity in relation to ambient
air pollution. This was an expedient choice based on past and present
research priorities and without reference tO any changes in the relative
importance of short-term respiratory effects and short- and long-term effects
in other organ systems as smoking habits change. {t concerned itself more
. .
V11
OCR for page R8
with public than with personal health and more with morbidity than with
mortality. This was another decision taken tO expedite and focus the
Committee's effort It does not imply that clinical observations and mortality
data should be disregarded by future investigators.
The fu] Committee agreed upon the most important research questions
in air pollution and used them to test the practicality of its conclusions and
recommendations. Some of this work is included in the report to illustrate
ways in which epidemiologic methods can be applied to current air pollution
research questions.
The Committee's conceptual approach is a little different from the usual.
It used a working concept of ambient air as "the air breathed in 24 hours"
and ambient pollution as "the pollutants in breathed air." In its thinking,
it did not try to separate that part of the air breathed in and OUt each day
by an average man or woman that comes from indoor, outdoor, or
occupational sources. This definition accepted a very heterogeneous expo-
sure to pollutants, pollutant mixtures, and their concentrations. The
synergistic as weD as additive effects of mixtures of pollutants were an
important facet of this heterogeneity. Another working concept made
explicit by the Committee is that irritants like cigarette smoke reach the
lungs in the medium of breathed air, which can potentiate or reduce their
biological impact. A public health perspective is maintained throughout the
report with reference to attributable risk and to effects that are harder tO
distinguish among individuals than among populations. Finally, the Com-
mittee conducted itS own deliberations about research strategies and methods
keeping in mind total sources of bias in any epidemiologic air pollution
research project.
The report itself was prepared and edited by Committee members before
it was sent to consultants and reviewers. The distributed responsibilities
for writing put an additional burden on the entire staff of the Committee.
The report could not have been completed in time without their uniform
and continual responsiveness and patience.
. . .
VU1
Maureen Henderson
(,hairrn~lrl
Committee on the Epidemiology
of Air Pollutants
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Contents
Executive Summary
1
Introduction
Assessment of Health Effects
3 Exposure Assessment
Concepts and Strategies in Planning Epidemiologic
Studies on Air Pollution
The Application of Epidemiology to Selected
Research Questions
6 Conclusions and Recommendations
Appendix.N Morbidity and Mortality From Respiratory
Disease in the United States
1
21
37
89
127
165
191
202
Appendix B National Ambient Air Quality; Standards 204
Appendix C Pitfalls in Design. Analysis. and interpretation 205
1X
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