2019 Report on Air Pollution and Health Research


compiled by 
Utah Physicians for a Healthy Environment

In 2019 the medical research on air pollution strengthened and expanded our understanding of just how hazardous it is to public health and the damage it is doing to individual lives.  Several well-respected studies were truly alarming.  Today we highlight what we feel are the most important ones.

The authors of two new studies describe the impacts of air pollution in nearly the exact terms that UPHE has been using for several years.  Air pollution is the world’s fifth leading risk factor for death.  Tissue damage may result directly from pollutant toxicity because fine and ultrafine particles can gain access to organs, or indirectly through systemic inflammatory processes.  It can harm any organ in the body.  Air pollution is a danger to everyone’s health, but some people are more susceptible than others, either because of genetics, socioeconomics, race, or ethnicity. 

Public health is damaged at levels far below those previously considered to be safe.1,2

The relationship between particulate pollution and death has been repeatedly studied for at least three decades.  Almost from the beginning studies have yielded consistently alarming, but slightly different statistics.   This year a meta-analysis of all the important previous studies has allowed us to narrow those differences, and has provided even more solid evidence that increases of just 1 ug/m3 of PM2.5 chronic exposure increases community deaths rates about 1%.3  Acute spikes of PM2.5 will add additional mortality, as will ozone.  This study adds strong confirmation to the statement UPHE has made for several years that between 1,000 and 2,000 people die prematurely every year in Utah because of our air pollution.

A new BYU study4 significantly strengthens the contention that UPHE has been making for more than a decade–that our air pollution shortens the life span of Utah residents an average of two years, and nearly one in four residents lose 5 years of more.  The same study estimates that air pollution costs our economy about $1.8 billion a year, although other national studies found that number to be even higher, i.e. $7.4 billion.5,6,7,8

Of the two high volume pollutants–ozone and particulate matter–ozone has historically been considered the “weaker sister.” Nonetheless, ozone has been associated with almost all the health consequences of particulate matter, if only to a slightly lesser extent.  Ozone is a powerful oxidizing agent and has been proven to cause a decrease in lung function and damage to lung tissue.  But a new study shows that the lung is exquisitely sensitive to even small increments of ozone.  Researchers followed nearly 7,000 patients and found emphysematous destruction of lung tissue and loss of lung function (measured by CAT scans and spirometry) in both smokers and non-smokers at this shocking rate: Just 3 ppb increase in ozone exposure over ten years caused as much lung damage as smoking a pack a day of cigarettes for 29 years.9

Short term exposure to PM2.5 and risk of hospital admission were found for several prevalent but rarely studied diseases, such as septicemia (blood infections), fluid and electrolyte disorders, and acute and unspecified renal failure. Positive associations were also found between risk of hospital admission and cardiovascular and respiratory diseases, Parkinson’s disease, diabetes, phlebitis, thrombophlebitis, and thromboembolism.10

We have seen the emergence of studies proving that particulate matter is embedded in the critical organs of virtually all humans.  Pollution particles contaminate human brain tissue, at the rate of millions per gram of brain tissue.  Other studies have found the particles embedded in the lining of blood vessels and even the placentas of pregnant mothers.  This year researchers studied dozens of people at autopsy who had been residents of Mexico City.  The average age was 25, the youngest was only three years old.  Astonishingly, they found between 2 billion and 22 billion nanoparticles of air pollution embedded in the heart, per gram of heart tissue, in all patients, even the children.  Those people who had lived in highly polluted Mexico City had between 2 and 10 ten times as many pollution particles as those that lived in less polluted environments.11   The clinical significance of this finding is almost undoubtedly impaired performance of the heart’s pumping mechanism and disruption of the electrical impulses that control heart rate and rhythm.

Many other studies have shown that air pollution does indeed impair the normal electrical signaling of the heart.  That is one way that air pollution causes sudden death.  This study suggests that damage to the heart’s electrical activity begins in infancy.12   Even newborns exposed to more air pollution have higher blood pressure.13

Published in one of the most prestigious medical journals, this study of 4.5 million US veterans found that 99% of the deaths related to air pollution occur in populations where the air pollution meets the EPA’s standards.  This puts a definitive stamp on the concept that there is no safe level of air pollution, and that those standards, which are supposed to be updated every 5 years, are far too lax.  Also, nine causes of death related to air pollution were identified, including causes not previous connected to air pollution—kidney disease, dementia, and type II diabetes.14

A new study demonstrates that the benefits of cleaner air occur almost immediately.  Respiratory symptoms, hospitalizations, school absenteeism, and mortality start to drop within a few weeks, although they may not drop back to normal.  And there is additional benefit to making already clean air even cleaner.15

For several years numerous studies have shown the toxicity of air pollution to brain function and development, even changing brain architecture.  New studies provide more detail.  A critical area of the brain for memory, the hippocampus, is smaller in adults exposed to more air pollution.16  Air pollution changes the physical development of the brain in utero, including reducing the size of certain parts of the brain like the corpus callosum, the bridge between both hemispheres.  This abnormality is associated with behavioral disorders.17  Another new study provided more evidence that air pollution, prenatal or during infancy, is associated with increased risk of autism.18  

Numerous other studies showed the clinical consequences of air pollution showing impaired memory.  For example, for every 2.81 μg/m3 of PM2.5, the annual decline rate in a certain type of memory capability was accelerated by 19.3%.19 Chronic exposure to more HAPs (hazardous air pollutants) was found to be associated with worse academic performance among school children in reading, math, and science through the third grade.20

One study focused on particulate pollution associated with Mountain Top Removal mining, something that is directly relevant to Utah given the close proximity of the Kennecott mine to our largest population center.  The study found that air pollution from mining contributes to dramatically increased risk for dementia related mortality.21

Previous studies have shown that air pollution can acutely reduce the performance of children in school.   A new study also shows the reverse.  Reducing air pollution in school classrooms improves test scores substantially.  One study found that even from a baseline of low level pollution (well below the EPA’s annual standard) a classroom air purifier capable of reducing PM 2.5 90%, improved students’ test scores more than reducing class size by 30%, i.e. a 0.20 standard deviation improvement in Math and English scores.22

There were many new studies showing that air pollution is associated with virtually every type of mental illness, like depression, behavioral disorders, unethical behavior, violent crime, and increased rates of hospitalizations and emergency room visits for mental illness for pediatric, adolescent and adult patients.23,24,25  Several studies have even shown that pollution decreases stock market returns by decreasing mood and trading activity among brokers.26

Numerous new studies added confirmation to the already substantial research showing the multiple ways that air pollution can harm pregnancy and fetal development, including increasing the incidence of hypertensive disorders,27 gestational diabetes, 28 premature rupture of membranes (a disorder that puts both the baby and mother at risk for infection), for premature birth,29 and still birth.30

Significant progress was made in the past year showing that air pollution increases the risk for metabolic and endocrine diseases, like diabetes, both type I and type II, and impaired thyroid function.31,32,33,34,35Thyroid function is critical to good health at any age, and especially critical for normal fetal development, especially brain development.  New studies show that air pollution impairs thyroid function in pregnant mothers and in turn impairs fetal thyroid development, which may contribute to the well established connection between air pollution and low birth weight.36,37,38 

More studies that show air pollution is associated with higher rates of lung, breast, and nasopharyngeal cancer.39,40,41,42 About 30% of lung cancer is now attributable to air pollution.43

By promoting inflammation, particulate pollution was found to contribute to rheumatoid and osteoarthritis, higher levels of auto antibodies, severe bone density decrease, bone demineralization, cartilage wear, and structure damages.44,45,46,47

We have seen numerous studies showing that air pollution exposure early in life (in utero and infancy) can have lasting impacts on health, like heart and lung function, that don’t show up for decades.  A new study expanded that concept finding that early life exposure is even associated with higher rates of arthritis in adulthood, especially rheumatoid arthritis.48

Sleep disorders are increasingly recognized as very common, as well as very important contributors to overall poor health.  This year more evidence was published that air pollution is associated with sleep disorders, especially sleep apnea.49,50

The length of chromosome end caps, called telomeres, is a marker of aging at the molecular level.  Another study was published showing that air pollution exposure during pregnancy was associated with shorter telomeres measured at the age of eight.51


1. Air pollution kills 1,000 to 2,000 Utah residents every year, from at least nine different causes of death.  Shortens life span in Utah an average of two years, some as much as five years.

2. Costs to the economy are between $2 billion and $7.4 billion.

3. Because cleaner air has such a profound benefit to brain function, classroom air purifiers are the most cost effective way of improving public education.

4. Extremely small increases in ozone damage lung tissue and function as much as smoking does.  

5. Just 3 ppb increase in ozone exposure over ten years caused as much lung damage as smoking a pack a day of cigarettes for 29 years.

6. Particulate pollution provokes disease by contaminating all major organs, like the heart, lungs, brain, kidneys, blood vessels, placenta.  For example, between 2 billion and 22 billion nanoparticles per gram of heart tissue.

7. 99% of air pollution deaths occur where the air pollution meets the EPA’s standards.  All air pollution matters.

8. Cleaning up the air has almost immediate health benefits.


1. It’s time for free public transit:  like Kansas City, Oslo, Amsterdam, Winnipeg, Melbourne, Athens, Geneva, Scotland, Pittsburgh, Philadelphia

2. Emissions testing of all commercial diesel trucks and heavy equipment, on road and off.

3. Room air purifiers in all school class rooms.

4. Repeal the Port 


1. Schraufnagel D, et al.  Air Pollution and Noncommunicable Diseases.  Chest.  February 2019Volume 155, Issue 2, Pages 409–416

2. Michael Brauer M, et al.  Mortality–Air Pollution Associations in Low-Exposure Environments (MAPLE): Phase 1.  Health Effects Institute.  Research Report 203, November 2019

3. Pope CA, et al.  Fine particulate air pollution and human mortality: 25+ years of cohort studies.  Environmental Research.  Available online 14 November 2019, 108924

4. https://pws.byu.edu/ben-abbott-lab/human-health-and-economic-costs-of-air-pollution-in-utah

5. Landrigan, P. J. et al. The Lancet Commission on pollution and health. The Lancet 0, (2017).

6. Caiazzo, F., Ashok, A., Waitz, I. A., Yim, S. H. L. & Barrett, S. R. H. Air pollution and early deaths in the United States. Part I: Quantifying the impact of major sectors in 2005. Atmos. Environ. 79, 198–208 (2013).

7. Goodkind, A. L., Tessum, C. W., Coggins, J. S., Hill, J. D. & Marshall, J. D. Fine-scale damage estimates of particulate matter air pollution reveal opportunities for location-specific mitigation of emissions. Proc. Natl. Acad. Sci. 201816102 (2019) doi:10.1073/pnas.1816102116.

8. Bennett, J. E. et al. Particulate matter air pollution and national and county life expectancy loss in the USA: A spatiotemporal analysis. PLOS Med. 16, e1002856 (2019).

9. Wang M, et al.   Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function. JAMA, 2019; 322 (6): 546 DOI: 10.1001/jama.2019.10255

10. Mahase E.  Study links air pollution to several new causes of hospital admissions.BMJ. 2019 Nov 28;367:l6741. doi: 10.1136/bmj.l6741.

11. Calderón-Garcidueñas L, et al.  Combustion- and friction-derived magnetic air pollution nanoparticles in human hearts.  Environmental Research.  Volume 176, September 2019, 108567

12. Cowell WJ, et al.  Prenatal Exposure to PM2.5 and Cardiac Vagal Tone during Infancy: Findings from a Multiethnic Birth Cohort. Environmental Health Perspectives, 2019; 127 (10): 107007 DOI: 10.1289/EHP4434

13. Madhloum N. et al.  Neonatal blood pressure in association with prenatal air pollution exposure, traffic, and land use indicators: An ENVIRONAGE birth cohort study.  Environ Int. 2019 Jun 18;130:104853. doi: 10.1016/j.envint.2019.05.047. [Epub ahead of print]

14. Bowe B, et al.  Burden of Cause-Specific Mortality Associated With PM2.5 Air Pollution in the United States.  JAMA Network Open.  November 20, 2019

15. Schraufnagel D, et al.  Health Benefits of Air Pollution Reduction.  Annals of the American Thoracic Society.  Vol. 16, No. 12 | Dec 01, 2019

16. Hedges DW, et al.  Association between Exposure to Air Pollution and Hippocampal Volume in Adults in the UK Biobank.  Neurotoxicology. 2019 Jun 17. pii: S0161-813X(19)30053-1. doi: 10.1016/j.neuro.2019.06.005. [Epub ahead of print]

17. Mortamais M, et al.  Effects of prenatal exposure to particulate matter air pollution on corpus callosum and behavioral problems in children.  Environ Res. 2019 Sep 7;178:108734. doi: 10.1016/j.envres.2019.108734. [Epub ahead of print]

18. Jo H, et al.  Sex-specific associations of autism spectrum disorder with residential air pollution exposure in a large Southern California pregnancy cohort.  Environ Pollut. 2019 Nov;254(Pt A):113010. doi: 10.1016/j.envpol.2019.113010. Epub 2019 Aug 5.

19. Younan D, et al.  Particulate matter and episodic memory decline mediated by early neuroanatomic biomarkers of Alzheimer’s disease.  Brain, awz348,  https://doi.org/10.1093/brain/awz348. Published: 20 November 2019

20. Grineski S, et al.  Hazardous air pollutants are associated with worse performance in reading, math, and science among US primary schoolchildren.  Environ Res. 2019 Nov 15:108925. doi: 10.1016/j.envres.2019.108925. [Epub ahead of print]

21. Salm AK, et al.  Increased Dementia Mortality in West Virginia Counties with Mountaintop Removal Mining?  Int J Environ Res Public Health. 2019 Nov 4;16(21). pii: E4278. doi: 10.3390/ijerph16214278.  PMID: 31689936 [PubMed – in process]

22. https://www.edworkingpapers.com/ai20-188

23. Brokamp C, et al.  Psychiatric Emergency Department Utilization and Fine Particulate Matter: A CaseCrossover Study.  Environ Health Perspect. 2019 Sep;127(9):97006. doi: 10.1289/EHP4815. Epub 2019 Sep 25.  PMID: 31553231 [PubMed – in process] Free Article

24. Bernardini F, et al.  Air pollutants and daily number of admissions to psychiatric emergency services: evidence for detrimental mental health effects of ozone. Epidemiol Psychiatr Sci. 2019 Nov 6:1-7. doi: 10.1017/S2045796019000623. [Epub ahead of print]  PMID: 31690359 [PubMed – as supplied by publisher]

25. Burkhardt J, et al.  The effect of pollution on crime: Evidence from data on particulate matter and ozone. Journal of Environmental Economics and Management, 2019; 102267 DOI: 10.1016/j.jeem.2019.102267

26. Wu Q, et al.  Air pollution, stock returns, and trading activities in China.  Pacific-Basin Finance Journal.  Volume 51, October 2018, Pages 342-365

27. Sun M, et al. The correlation between PM<sub>2.5</sub> exposure and hypertensive disorders in pregnancy: A Meta-analysis.  Sci Total Environ. 2019 Nov 2;703:134985. doi: 10.1016/j.scitotenv.2019.134985. [Epub ahead of print]

28. Hu CY, et al.   Human epidemiological evidence about the association between air pollution exposure and gestational diabetes mellitus: Systematic review and meta-analysis.  Environ Res. 2019 Oct 21;180:108843. doi: 10.1016/j.envres.2019.108843. [Epub ahead of print]

29. Wang K, et al.  Maternal exposure to ambient fine particulate matter and risk of premature rupture of membranes in Wuhan, Central China: a cohort study.  Environ Health . 2019 Nov 14;18(1):96. doi: 10.1186/s12940-019-0534-y.

30. Smith RB, et al.  Impacts of air pollution and noise on risk of preterm birth and stillbirth in London.  Environ Int. 2019 Nov 26;134:105290. doi: 10.1016/j.envint.2019.105290. [Epub ahead of print]

31. Holliday KM, et al.  Air pollution-associated changes in biomarkers of diabetes risk.  Environ Epidemiol. 2019 Aug 13;3(4):e059. doi: 10.1097/EE9.0000000000000059. eCollection 2019 Aug. 

32. Hendryx M, et al.  Exposure to heavy metals from point pollution sources and risk of incident type 2 diabetes among women: a prospective cohort analysis.  Int J Environ Health Res. 2019 Sep 19:1-12. doi: 10.1080/09603123.2019.1668545. [Epub ahead of print]

33. Kim JS, et al.  Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study.  Environ Int. 2019 Oct 14;133(Pt A):105180. doi: 10.1016/j.envint.2019.105180. [Epub ahead of print]

34. Yang BY, et al.  Ambient air pollution and diabetes: A systematic review and meta-analysis.  Environ Res. 2019 Oct 12;180:108817. doi: 10.1016/j.envres.2019.108817. [Epub ahead of print]

35. Yu Y, et al.  Air pollution, noise exposure, and metabolic syndrome – A cohort study in elderly MexicanAmericans in Sacramento area.  Environ Int. 2019 Nov 25;134:105269. doi: 10.1016/j.envint.2019.105269. [Epub ahead of print]

36. Howe CG, et al.  Association of Prenatal Exposure to Ambient and Traffic-Related Air Pollution With Newborn Thyroid Function: Findings From the Children’s Health Study. JAMA Network Open, 2018 DOI: 10.1001/jamanetworkopen.2018.2172

37. Wang X, et al.  Evaluation of maternal exposure to PM2.5 and its components on maternal and neonatal thyroid function and birth weight: a cohort study.  Thyroid. 2019 Jul 12. doi: 10.1089/thy.2018.0780. [Epub ahead of print]

38. Ghassabian A, et al.  Association of Exposure to Ambient Air Pollution With Thyroid Function During Pregnancy.  JAMA Netw Open. 2019 Oct 2;2(10):e1912902. doi: 10.1001/jamanetworkopen.2019.12902.

39. White AJ, et al.  Air Pollution, Clustering of Particulate Matter Components, and Breast Cancer in the Sister Study: A U.S.-Wide Cohort.   Environ Health Perspect. 2019 Oct;127(10):107002. doi: 10.1289/EHP5131. Epub 2019 Oct 9.

40. Huang HC, et al.  Association between coarse particulate matter (PM10-2.5) and nasopharyngeal carcinoma among Taiwanese men.  J Investig Med. 2019 Oct 16. pii: jim-2019-001119. doi: 10.1136/jim2019-001119. [Epub ahead of print]

41. Goldberg MS, et al.  Associations between incident breast cancer and ambient concentrations of nitrogen dioxide from a national land use regression model in the Canadian National Breast Screening Study. Environ Int. 2019 Oct 21;133(Pt B):105182. doi: 10.1016/j.envint.2019.105182. [Epub ahead of print]

42. Santibáñez-Andrade M, et al.  Deciphering the Code between Air Pollution and Disease: The Effect of Particulate Matter on Cancer Hallmarks.  Int J Mol Sci. 2019 Dec 24;21(1). pii: E136. doi: 10.3390/ijms21010136.

43. Zhang Z, et al.  Association between particulate matter air pollution and lung cancer.  Thorax. 2019 Nov 14. pii: thoraxjnl-2019-213722. doi: 10.1136/thoraxjnl-2019-213722. [Epub ahead of print]

44. Peng K, et al.  Particulate matter exposure aggravates osteoarthritis severity.Clin Sci (Lond). 2019 Oct 18. pii: CS20190458. doi: 10.1042/CS20190458. [Epub ahead of print].  PMID: 31696218 [PubMed – as supplied by publisher]

45. Alex AM, et al.  Exposure to ambient air pollution and autoantibody status in rheumatoid arthritis.  Clin Rheumatol. 2019 Nov 15. doi: 10.1007/s10067-019-04813-w. [Epub ahead of print]

46. Yamamoto SS, et al.  Household air pollution and arthritis in low-and middle-income countries: Crosssectional evidence from the World Health Organization’s study on Global Ageing and Adult Health.PLoS One. 2019 Dec 27;14(12):e0226738. doi: 10.1371/journal.pone.0226738. eCollection 2019.

47. Ranzani OT, et al.  Association of Ambient and Household Air Pollution With Bone Mineral Content Among Adults in Peri-urban South India.  JAMA Netw Open. 2020 Jan 3;3(1):e1918504. doi: 10.1001/jamanetworkopen.2019.18504.

48. Shepherd A, et al.  Arthritis diagnosis and early-life exposure to air pollution.  Environ Pollut. 2019 Oct;253:1030-1037. doi: 10.1016/j.envpol.2019.07.054. Epub 2019 Jul 13.

49. Tang M, et al.  The association of short-term effects of air pollution and sleep disorders among elderly residents in China.  Sci Total Environ. 2019 Nov 19:134846. doi: 10.1016/j.scitotenv.2019.134846. [Epub ahead of print]

50. Yu H, et al.  The Association between Air Pollution and Sleep Duration: A Cohort Study of Freshmen at a University in Beijing, China.  Int J Environ Res Public Health. 2019 Sep 11;16(18). pii: E3362. doi: 10.3390/ijerph16183362.

51. Clemente DBP, et al.  Prenatal and Childhood Traffic-Related Air Pollution Exposure and Telomere Length in European Children: The HELIX Project.  Environ Health Perspect. 2019 Aug;127(8):87001. doi: 10.1289/EHP4148. Epub 2019 Aug 8.