INSTITUTE OF OCCUPATIONAL MEDICINE www.iom-world.sg

Health Risks of Combustion Generated Particulate Matter, including Biomass

Combustion

Rob Aitken, Michael Riediker

NYP 15th Sept 2015

IOM Singapore

• Multidisciplinary research, consultancy, training, occupational and environmental health, hygiene, risk

• Core values

• Independence, Impartiality, Authority

• Deep insight for

• Problem definition & evaluation

• Practical solutions

• Charitable status - not for profit

• 140 staff, Edinburgh HQ, other UK offices, international activity

• Since 1st September 2012IOM Singapore30 Raffles Place#17-08 Chevron HouseSingapore 048622

www.iom-world.sg2

Air pollution

Going…. going… gone!!!

4

Early evidence of health effects

London fog of 1952: > 4000 deaths

Logan, Lancet 1:336-8;1953

Who died?

www.kcl.ac.uk

Components of air pollution

Air pollution

Gases

Co2, CO

NO, O3

SO2

Volatile organic

compounds

Quinones, PAH,

Benzenes, Toluenes

Particulates

Carbon, nitrates,

sulphates, metals

7

Plinius the older (1st AD):

"when well shafts have

been sunk deep, fumes

of sulfur or alum rush up

to meet the diggers and

kill them"

Paracelsus (16th AD):

"Silicosis is a consequence of bad substances present in the air of mines."

Air Pollution in historic times: Particles kill

Many examples from workplaces

• Coal dust – coalminers, – pneumoconiosis, COPD

• Quartz – stoneworkers - silicosis, COPD

• Asbestos – mesothelioma, cancer, asbestosis

Six cities study

Docherty and Pope (1993)• Prospective cohort mortality study involving

8,111 randomly selected residents of six U.S. cities. The objective was to estimate the effects of air pollution on mortality while controlling for other risk factors such as the individuals’ smoking status and age.

Dockery D, Pope CA et al. "An association between air pollution

and mortality in six U.S. cities." N Eng J Med. 1993;

392(24):1753-1759

Laden and Schwartz (2006)

• Death from cardiovascular disease was positively associated with average PM2.5 over the entire follow-up (RR=1.28)

• Death from lung cancer was positively associated with average PM2.5 over the entire follow-up period (RR=1.27)

• Death from non-malignant respiratory diseases was positively associated with average PM2.5 over the entire follow-up period (RR=1.08,

Laden and Schwartz “Reduction in Fine Particulate Air

Pollution and Mortality: Extended Follow-up of the Harvard Six

Cities Study,” in the American Journal of Respiratory & Critical

Care Medicine (2006; 173: 667-672.)

Roads:

- Engine exhaust

- Road, tire and brake wear

- Re-suspension of street dust

Sources of fine particles

10

Industry:

- Energy and heat production

- Exhaust from production process

Harbour:

- Ship diesel emissions

- Bulk ship unloading

- Ground transport

Forest fires:

- Illegal burning

- Accidents, lighting

- Draught – climate change

Short term effects

11Haze over Singapore, © Soham Banerjee, Flickr: soham_pablo, reproduced under Creatives Commons Attribution License 2.0.

Heart infarction

Stroke

Increased arrhythmia

Increased blood pressure

Asthma

Allergy exacerbation

12

Short-term effects of particles in populations

Heart Rate Variability Gold et al. Circulation 2000;101:1267-1273

ST-Segment depression Pekkanen et al. Circulation 2002;106:933-

938

Cardiac arrhythmia Peters et al. Epidemiology 2000;11:11-17

C-reactive protein Peters et al. Eur Heart J 2001;22:1198-1204

Plasma fibrinogen Pekkanen et al. Occup Environ Med 2000;57:818-822

Red blood cells Seaton et al. Thorax 1999;54:1027-1032

13

Chronic effects: atherosclerosis

from Künzli et al. EHP 2005;113(2):201-206

Geo-coded PM2.5

Carotid intima-media thickness

Population: long-term mortality related to PM

14

U.S. Cancer II study x): causes of mortality

All cardiovascular plus diabetes (+12% per 10 μg/m3 PM2.5)

Ischemic heart disease (+18%)

Dysrhythmia, heart failure and cardiac arrest (+13%)

Hypertensive disease (only smokers, +57%)

x) Prospective, 10-14 years follow-up, 1.2 million adults in all U.S. states, Pope et al. Circulation 2004;109:71-77.

Seaton hypothesis

Epidemiological studies have consistently shown an association between particulate air

pollution and not only exacerbations of illness in people with respiratory disease but also rises

in the numbers of deaths from cardiovascular and respiratory disease among older people…

We propose that the explanation lies in the nature of the urban particulate cloud, which may

contain up to 100000 nanometer-sized particles per mL, in what may be a gravimetric

concentration of only 100-200 μg/m3 of pollutant. We suggest that such ultra-fine particles are

able to provoke alveolar inflammation, with release of mediators capable, in susceptible

individuals, of causing exacerbations of lung disease and of increasing blood coagulability,

thus also explaining the observed increases in cardiovascular deaths associated with urban

pollution episodes. This hypothesis is testable both experimentally and epidemiologically.

Global burden of disease

Source – WHO Global Health Observatory Data

Repository

“In 2012, ambient air pollution was responsible

for 3.7 million deaths, representing 6.7% of the

total deaths. Worldwide, ambient air pollution is

estimated to cause about 16% of the lung

cancer deaths, 11% of chronic obstructive

pulmonary disease (COPD) deaths, more than

20% of ischaemic heart disease and stroke,

and about 13% of respiratory infection deaths”

3.7 million deaths, representing 6.7% of the total deaths

Global burden

Biomass burning

• Should we expect any difference?• High concentration PM2.5

• Ultrafine particles

• Similar composition

• Short term effects• Elevated hospital

admissions

• Increased myocardial infarction, stroke

• Long term effects• Increased COPD, ischemic

heart disease, cancer

Thank you for listening

Clear sky’s ahead?