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Nashville Air Pollution and Health Study

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Nashville Air Pollution and Health Study A summary Nashville Air Pollution and Health Study P. A. KENLINE, M.S., and C. J. CONLEE, B.S. EXTENSIVE air pollution and health in relation to quantity, composition, and the assess ANu study was conducted in Nashville, Tenn., factors affecting it; and (b) how to the in 1958 and 1959 by the Division of Air Pollu¬ health effects that might result from this con- tion, Public Health Service, and Vanderbilt tamination as they vary in geographic and tem- University School of Medicine, together with poral distribution and with the recognition that cooperating State, county, and local agencies. many other factors also might affect them. The The purpose was to investigate possible rela- large-scale investigation was undertaken pri- tions between air pollution and health and to marily to ascertain whether proper measure- gather information on a number of medical, ments and experimental procedures could be engineering, and meteorological phases of air designed to meet these objectives. Such a was a pollution. study prompted by and Conduct of need to assess the chronic or long-term health Objectives Study effects that may occur as the result of daily, and The study (1) was divided into two concur- often lifetime, exposure to air pollution. Nash¬ rent phases: medical and engineering. ville was selected because it was believed to Medical phase. Four separate but related have a chronic but relatively modest, air pollu¬ medical studies were conducted: a morbidity tion problem. In large measure, the pollu¬ survey, a mortality survey, a cardiorespiratory tion was caused by the combustion of coal. disease study, and an anthracosis study. Numerous scientific articles have been written To determine the possible relations between on various aspects and phases of this study. air pollution and health, the following objec¬ In this paper we have presented a bibliography tives were outlined. of all the published articles, together with a 1. Collect general and specific morbidity data brief outline of the study and a summary of on residents of Nashville and determine if there the important findings. is an association between morbid conditions and The multiple objectives of the Nashville study exposure to air pollutants. stemmed from two primary problems: (a) how 2. Determine mortality rates for specific to assess the atmosphericpollution of a commun- causes by census tracts and study relation be¬ ity most accurately, with reference to both tem- tween these death rates and demographic, social, poral variations and long-term averages, and and economic data. 3. Determine whether deaths from specific Mr. Kenline was chief and Mr. Conlee was sanitary causes vary significantly with residence in areas engineer, Aerometry Section, Division of Air Pollu¬ of relatively high or low atmospheric pollution tion, Public Health Service, Robert A. Taft Sanitary that have similar demographic, social, and eco¬ Engineering Center, Cincinnati, Ohio. Mr. Kenline nomic characteristics. is currently with the Career Development Program 4. Determine whether persons known to have of the Division of Air Pollution, and Mr. Conlee is specificcardiorespiratory disease show variation with the University of Washington, Seattle. in frequency or severity of attacks, depending Vol. 82, No. 1, January 1967 17 on diurnal or seasonal variation in exposure to 6. Determine the relations between air pollu¬ environmental air pollutants. tion concentrations at a selected station and 5. Determine whether the course of disease in meteorological parameters measured at the same persons known to have a specific cardiorespira¬ station and at different stations. tory disease differs according to their residence Sampling stations were established at 123 sites in areas of relatively high or low air pollution. in the Nashville area. Of these, 119 were within 6. Determine whether autopsies on residents an area about 9 miles in diameter, centered at a of Nashville showed a greater degree of anthra- downtown site. The sites, located on an equi- cosis than autopsies on nonresidents. lateraJ triangle grid pattern, were about 0.87 7. Determine whether the degree of anthra- mile apart. The remaining four control stations cosis in Nashville residents varies according to were located in the four cardinal compass direc- where they reside in the city. tions about 8 miles from the central station. 8. Determine whether anthracosis is com- The sampling network consisted of three gen- monly associated with any other pulmonary or eral types of stations (determinedby the amount cardiac pathology and whether anthracosis is and kind of aerometric and meteorological identified with any specific symptomatology. equipment) and several stations for specific A questionnaire designed to produce gen- measurements. The urban area was covered by eral and specific morbidity information was the three general types of stations in a reason- distributed to residents in approximately 5 ably uniform manner. A summarization of the percent of the occupied dwellings. A portion major aerometric measurements taken at the of the test group was examined medically to various stations follows: a check on of information. provide validity Number of stations Aerometric measurements Mortality data were obtained from Davidson death certificates from 1949 to 1956. ( Monthly dustfall. County 123_\ Monthly sulfur dioxide (lead peroxide Patients suffering from cardiorespiratory dis- \ candle method). eases were examinations given complete physical 24-hour daily soiling spot samples. after a detailed was obtained. The history pa¬ 36- 24-hour daily volumetric sulfur dioxide tients mailed report cards with appropriate in¬ (West-Gaeke method). formation at specified intervals after receiving 24-hour daily total wind movement. their examinations. 12 2-hour (high-pollution seasons) or The results of autopsies performed at Vander- 6 4-hour (low-pollution seasons) daily bilt University Hospital between 1953 and 1956 11- soiling spot samples, American Iron data for the anthracosis and Steel Institute (A.I.S.I.) method. provided study. 24-hour daily suspended particulate Engineering phase. A number of related ob¬ (high-volume samples). were interwoven into jectives the investigations __Continuous ambient temperature, rela- with the mission of providing air-quality data tive humidity, and wind speed and for use in medical studies. The following objec¬ direction. tives were outlined. __12 2-hour daily volumetric sulfur di¬ 1. Determine the representativeness of air- oxide (West-Gaeke method). quality data with respect to number and loca- ( Continuous sulfur dioxide (Thomas tion of sampling stations, sampling frequency, autometer). and time. Continuous nitrogen dioxide and oxi- sampling .{ dant (Kruger model 73 atmosphere 2. Evaluate analytical methods, equipment, analyzer). and procedures. Continuous carbon monoxide (Luft-type 3. Study and evaluate dispersion character¬ infrared analyzer). istics of pollutants. Special studies consisted of a sulfur dioxide 4. Determine public opinion on air pollution (S02) emission inventory, a study of dustfall as related to pollution levels and population measurement techniques, a public opinion sur¬ characteristics. vey, pollen measurements, pollution level fore- 5. Attempt to classify atmospheric stability casts, and automobile traffic counts. by use of radiosonde data. The numerous technical and scientific papers 18 Public Health Reports relating to air pollution in Nashville produced HE. "Morbidity in Kelation to Air Pollution" many important medical, aerometric, meteoro¬ (4). A method for studying the association of logical, and misceUaneous findings. air pollution and morbidity in an urban popula¬ tion and its limitations were discussed. Direct Medical Findings correlations of total morbidity and levels of Several relationships between air pollution pollution as measured by the soiling index and and health have been determined from the 24-hour S02 were observed among persons 55 studies of Zeidberg and associates. Their find¬ years old and older of the middle socioeconomic ings are presented in the following series of six class. Direct correlations for the same aero¬ papers on "The Nashville Air Pollution Study." metric parameters were also noted for cardio- I. "Sulfur Dioxide and Bronchial Asthma; vascular diseases but not for any other specific A Preliminary Report" (2). A group of 84 group of diseases. patients (49 adults and 35 children) with bron¬ Refinement of analyses to differentiate home chial asthma reported 3,647 asthmatic attacks and occupational environment influences on during 27,440 person-days of observation, or a morbidity revealed that white women keeping total attack rate of 0.133 per person-day. In house manifested direct correlations of pollu¬ adults, the asthmatic attack rate varied directly tion and total morbidity for all aerometric with the level of sulfation in their residential parameters, while white women who worked environment. Attack rates on days with the showed none. Nonwhite women tended to show highest and lowest S02 values were significantly direct correlations in both housekeeping and different. A 1-day lag showed even more sig- woridng groups. The effect of pollution on nificant differences. specific diseases of the respiratory, cardio- The influence of temperature, humidity, and vascular, or gastrointestinal systems could not barometric pressure on the asthmatic attack rate be demonstrated because such breakdowns pro¬ could not be demonstrated, but wind velocity duced numbers too
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