2019 Report on Air Pollution and Health Research

AIR POLLUTION AND HEALTH:
SUMMARY OF THE 2019 MEDICAL 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.

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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.^{31,32,33,34,35}Thyroid 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

2019 RESEARCH HIGHLIGHTS

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.

WHAT WE SHOULD DO NEXT

REFERENCES

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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

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