Full Citation

Title: Air Pollution and Health—New Advances for an Old Public Health Problem

Citation Type: Journal Article

Publication Year: 2024

ISBN:

ISSN: 25743805

DOI: 10.1001/JAMANETWORKOPEN.2023.54551

NSFID:

PMCID:

PMID: 38427358

Abstract: The link between air pollution exposure and increased mortality and morbidity is firmly supported by a broad evidence base. The 2015 Global Burden of Diseases Study, a 195-country investigation, found fine particulate matter (ie, particles with an aerodynamic diameter 2.5 μm [PM 2.5 ]) to be the fifth ranking worldwide mortality risk factor, with an attributed 4.2 million premature deaths. 1 Yet these impacts are not equally distributed. Worsening air quality, in conjunction with population growth, has driven absolute increases in air pollution-associated illness in low-and middle-income nations. Furthermore, while air quality has improved in high-income nations, geographic disparities persist among economically and racially disparate communities where air pollution remains stubbornly elevated. 2 Prioritizing air quality improvements in the most affected areas will yield the greatest public health benefits, but quantifying the level of improvement needed is an evolving question. Improvement in air quality can be attributed to policies that set regulatory air pollution standards or guidelines protective of human health. Epidemiological data and evidence are used by environmental agencies, such as the World Health Organization, the US Environmental Protection Agency, and the European Union, to determine appropriate regulatory targets for criteria air pollutants, including PM 2.5 , ozone, and nitrogen dioxide (NO 2). However, the decision-making behind regulatory standards relies on up-to-date exposure and health information derived using appropriate methods. In the US, the Clean Air Act requires an independent review of the most relevant air pollution and health literature assessed through a weight-of-evidence approach. Weight-of-evidence relies on the examination of multiple evidentiary lines crossing different scientific disciplines, including epidemiological cohorts, animal-based toxicologic studies, and controlled human exposures or clinical findings, to determine causality. 3 The strength of this approach is to ensure that identified air pollution and health effects are not restricted to a single line of study and consider the full body of scientific inquiry. So, why should we pursue studies of air pollution and health when the existing literature is so robust? The identification of appropriate regulatory thresholds depends on up-to-date investigations that support, dispute, or identify new air pollution and health associations. This observational study by Ma and colleagues 4 evaluated the association between acute PM 2.5 and NO 2 air pollution exposure with 8.96 million mortality events in 4 separate global regions: Jiangsu, China; California, US; south-central Italy; and Germany. The findings in the study by Ma et al 4 confirm previously identified associations of increased mortality with greater PM 2.5 and NO 2 exposure. 5 Ma et al 4 also observed heterogeneity in the strength of associations of mortality with the highest air pollution risks identified in south-central Italy for PM 2.5 and Germany for NO 2. However, the novel aspect of their work was the methodological application of a 2-way interactive fixed-effect model used to infer the air pollution and mortality association. Ma et al 4 argued that this econometric-derived approach has advantages over more traditional time-series modeling by controlling for both measured and unmeasured time-varying spatial unit-specific confounders. Ma and colleagues 4 further compared their findings with a more familiar time-series model and demonstrated robustness in the air pollution and mortality association using both approaches. This methodological comparison not only validates prior air pollution and health studies that use time-series methods 6 but provides evidentiary rigor for the validity of both methods when reconsidering regulatory standards. While the study by Ma et al 4 presents an alternative statistical approach for estimating air pollution health effects, there are other noteworthy advances in the air pollution and health literature. First, there have been new developments in air pollution exposure modeling. Initial

Url: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815658

User Submitted?: No

Authors: Berman, Jesse D.

Periodical (Full): JAMA Network Open

Issue: 3

Volume: 7

Pages: e2354551-e2354551

Countries: