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Research Report RESEARCH REPORT Daily Mortality and Fine and Ultrafine Particles in Erfurt, Germany Part I: Role of Particle Number and Particle Number 98 November 2000 Mass H-Erich Wichmann, Claudia Spix, Thomas Tuch, Gabriele Wölke, Final Version Annette Peters, Joachim Heinrich, Wolfgang G Kreyling, and Joachim Heyder Includes a Commentary by the Institute’s Health Review Committee HEALTH The Health Effects Institute, established EFFECTS in 1980, is an independent and unbiased INSTITUTE source of information on the health effects of motor vehicle emissions. HEI supports research on all major pollutants, including regulated pollutants (such as carbon monoxide, ozone, nitrogen dioxide, and particulate matter) and unregulated pollutants (such as diesel engine exhaust, methanol, and aldehydes). To date, HEI has supported more than 200 projects at institutions in North America and Europe and has published over 100 research reports. Typically, HEI receives half its funds from the US Environmental Protection Agency and half from 28 manufacturers and marketers of motor vehicles and engines in the United States. Occasionally, funds from other public and private organizations either support special projects or provide resources for a portion of an HEI study. Regardless of funding sources, HEI exercises complete autonomy in setting its research priorities and in reaching its conclusions. An independent Board of Directors governs HEI. The Institute’s Health Research and Health Review Committees serve complementary scientific purposes and draw distinguished scientists as members. The results of HEI-funded studies are made available as Research Reports, which contain both the Investigators’ Report and the Health Review Committee’s evaluation of the work’s scientific quality and regulatory relevance. STATEMENT Synopsis of Research Report 98, Part 1 Daily Mortality and Fine and Ultrafine Particles in Erfurt, Germany Part I: Role of Particle Number and Particle Mass INTRODUCTION The statistical methods were Poisson regression with Epidemiologic studies have shown an association a generalized additive model to smooth time trends, between airborne particles and mortality data, but weather, and other variables. uncertainty persists as to which aspects of the particle mixture are the driving force underlying observed RESULTS AND INTERPRETATION associations. Further, only a small number of studies The authors evaluated whether human deaths were have investigated the role of ultrafine particles (parti- associated in time with levels of outdoor particles cles less than 0.1 µm in diameter). Although ultrafine (that is, whether the measured day-to-day changes in particles contribute little to mass concentration, they air pollution related to the day-to-day changes in are present in urban air in high numbers and may be deaths). If air pollution and adverse health outcomes important in terms of health effects. One hypothesis is are closely linked in time, then a daily average value that these particles may be particularly toxic because of air pollution will be associated with a daily mea- their small size allows them to deposit efficiently sure of health. This relation was estimated in the cur- deep in the lungs and that the higher number of rent study by relative risk, the relative increase in ultrafine particles, and therefore their greater total deaths given the range of particulate pollutants. particle surface area, may increase their toxicologic Timing of effect was evaluated by examining pol- effects. However, the few epidemiologic studies that lutant levels on the current day (lag 0), the prior day have tried to isolate effects of ultrafine particles have (lag 1), 2 days prior to death (lag 2), and so on, up to 5 evaluated respiratory disease, not deaths. days prior to death (lag 5). A lag is the assumed time period between exposure and effect and can be repre- APPROACH sented by the best single day or an average of the effect Dr H-Erich Wichmann and colleagues at the over multiple days. Currently, no biological evidence National Research Center for Environment and Health supports a particular lag. Although many investiga- (GSF) in Neuherberg, Germany, prospectively studied tors of time-series studies have used the best lag the association of daily mortality data with the approach, this method can bias the results toward number and mass concentrations of ultrafine and fine finding positive or negative statistically significant particles in Erfurt, Germany. Using a time-series associations. approach, they looked at short-term changes in par- This study was the first to show that ultrafine parti- ticle concentration and the concurrent deaths due to cles are associated with human mortality. The investi- cardiovascular and respiratory causes. Concentrations gators found comparable effects for ultrafine and fine were measured at one monitoring site, which was particles and have reported a suggestion of a delayed close to a road, and mortality was analyzed for 3.5 effect for ultrafine particles versus an immediate years. Because Erfurt had a population of roughly effect for fine particles. The HEI Health Review Com- 200,000 people, the number of deaths was small mittee agreed with the investigators’ conclusions that (average 5 to 6 deaths per day). The analytic technique associations between mortality and ultrafine and fine that the investigators developed to gather air pollu- particles were observed; however, the Committee did tion data, especially monitoring of the ultrafine frac- not agree that a consistent pattern indicating either a tion, was unique in the sharp detail of the size ranges. delayed or an immediate effect existed. This Statement, prepared by the Health Effects Institute, summarizes Part I of a research project sponsored by HEI from August 1995 to August 1999 and conducted by Dr H-Erich Wichmann of the GSF Institute of Epidemiology, Neuherberg, Germany. The following Research Report con- tains both the detailed Investigators’ Report and a Commentary on Part I prepared by the Institute’s Health Review Committee. Research Report 98, Part I This study is a major contribution to our knowledge (specifically regarding interpretations of timing of of actual airborne particle levels, and it has provided effect). Although the results associate the ultrafine the first evidence that ultrafine particles as well as fraction with human deaths, no clear pattern of asso- fine particles are associated with mortality. Despite ciations indicates temporal differences between the unique analytic technique developed by the inves- ultrafine and fine particles. tigators, important limitations to the results remain Copyright © 2000 Health Effects Institute, Cambridge MA. Printed at Flagship Press, North Andover MA. Library of Congress Catalog Number for the HEI Report Series: WA 754 R432. The paper in this publication meets the minimum standard requirements of the ANSI Standard Z39.48-1984 (Permanence of Paper) effec- tive with Report Number 21, December 1988, and with Report Numbers 25, 26, 32, 51, 65 Parts IV, VIII, and IX, and 91 excepted. These excepted Reports are printed on acid-free coated paper. CONTENTS Research Report 98 Daily Mortality and Fine and Ultrafine Particles in Erfurt, Germany Part I: Role of Particle Number and Particle Mass H-Erich Wichmann, Claudia Spix, Thomas Tuch, Gabriele Wölke, Annette Peters, Joachim Heinrich, Wolfgang G Kreyling, and Joachim Heyder GSF–Forschungszentrum für Umwelt und Gesundheit and Ludwig Maximilian University, Neuherberg, Germany HEI STATEMENT This Statement is a nontechnical summary of the Investigators’ Report and the Health Review Committee’s Commentary. PREFACE Background . 1 Continuing Research . 2 Research Program from HEI RFA 94-2 . 2 References . 3 INVESTIGATORS’ REPORT When an HEI-funded study is completed, the investigators submit a final report. The Investigators’ Report is first examined by three outside technical reviewers and a biostatistician. The report and the reviewers’ comments are then evaluated by members of the HEI Health Review Committee, who had no role in selecting or managing the project. During the review process, the investigators have an opportunity to exchange comments with the Review Committee and, if necessary, revise the report. Abstract . 5 Implications of Findings . 66 Introduction . 6 Acknowledgments. 67 Specific Aims . 7 References . 67 Definitions . 8 Appendix A. Assigning the Causes of Death to Methods . 8 Categories. 73 Study Design . 8 Appendix B. Comparison of the Distribution of the Study Period and Study Area . 8 Underlying Causes of Death . 74 Data. 9 Appendix C. Comparison of Prevalent Diseases Mortality Data . 15 and Underlying Causes of Death. 75 Analytical Methods . 18 Appendix D. Properties of the Particle Data . 77 Results . 22 Appendix E. Diagnostics of Confounder Data Description . 22 Model . 80 Regression Analysis. 36 Appendix F. Further Subgroup Results . 82 Summary of the Regression Results . 51 Confounder Models Differ by Subgroup. 82 Discussion and Synthesis . 55 Delays Differ by Subgroup . 82 Ambient Air Pollution in Erfurt . 55 Appendices Available on Request . 84 Health Effects of Particles . 57 About the Authors. 84 Gaseous Pollutant Effects . 62 Abbreviations and Other Terms . 86 Limitations. 65 Conclusions . 66 Continued Research Report 98, Part I COMMENTARY Health Review Committee The Commentary about the Investigators’ Report is prepared by the HEI Health Review Committee and staff. Its purpose is to place the study into a broader scientific context,
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