Table 1: PM2.5 health endpoints and associated concentration-response functions Concentration-response function (95%CI) Health outcomes Australian UK Europe US EPA WHO Recommended Long-term outcomes (annual average concentration) Mortality All cause n/a1 1.06 (1.04-1.11) per 10 µg/m3 1.06 (1.00-1.15) per 10 µg/m3 to be used in a sensitivity analysis. () () Age: 30+ years. 1.05 per 10 µg/m3 (95%CI not provided) Pooled estimate from () () Age: 30+years. 1.06 (1.04-1.08) per 10 µg/m3 () () All ICD9 Age: 30+years. 1.14 (1.04-1.24) per 10 µg/m3 () () Age: 30+ years 1.07 (1.04-1.11) per 10 µg/m3 () () Age: 30+years. Recommended CRF: 1.06 per 10 µg/m3 () () Cardiopulmonary n/a 1.09 (1.03-1.16) per 10 µg/m3 () () Age: 30+ years. n/a 1.14 (1.11-1.17 per 10 µg/m3 () () ICD9: 401-440, Age: 30+ years. n/a Recommended CRF: 1.14 per 10 µg/m3 () () Ischaemic heart disease n/a n/a n/a 1.24 (1.19-1.28) per 10 µg/m3 () () ICD9: 410-414 Age: 30+ years. n/a Recommended CRF: 1.24 per 10 µg/m3 () () 1.17
Lung cancer n/a 1.08 (1.01-1.16) per 10 µg/m3 () () Age: 30+ years. n/a 1.14 (1.06-1.123) per 10 µg/m3 () () ICD9: 162 Age: 30+ years. n/a Recommended CRF: 1.14 per 10 µg/m3 () () Infant (<12 months of age) n/a n/a n/a 1.07 (0.93-1.24) for 10 µg/m3 () () All ICD9 Age: <12 months n/a Recommended CRF: 1.07 for 10 µg/m3 () () Life expectancy lost (years of life lost; YOLL) n/a 6 months of life expectancy lost in the UK at current levels of anthropogenic PM2.5 (~9 µg/m3) () 6.02E-04 YOLL/ (person/year/µg/m3) () () n/a n/a Recommended CRF: 6.02E-04 YOLL/ (person/year/µg/m3) () () Morbidity Incidence of chronic obstructive pulmonary disease (COPD) or chronic bronchitis n/a n/a Chronic bronchitis: 1.181 (0.98-3.25) per 45 µg/m3 OR 1.141 (0.996-1.30) per 10 µg/m3 () () Adults (27+ years) COPD: 1.81 (0.98-3.25) per 10 µg/m3 () () Age: >26 years Chronic bronchitis: 1.34 (0.94-1.99) per 10 µg/m3 () () ?Age Recommended CRF for COPD: 1.81 (0.98-3.25) per 10 µg/m3 () () Age: >26 years Chronic bronchitis:
with cough or sputum on most days for at least three months of the year for at least two years. No CRF recommended. Incidence of asthma Ever had wheezing: No effect. Ever had asthma: No effect. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly. PM2.5 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Recent symptoms (in last 12 months) No effect for asthma exacerbation, wheeze, cough or shortness of breath. () Melbourne N=1,446 Mean age: 37 years. 12-month average. n/a n/a n/a n/a Recommended CRF only for rhinitis (). No effect for other symptoms in Australian 6-cities study ().
litres) Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly. PM2.5 over lifetime. Age: mean age10.0 years. 2,860 children. No effect in Australian 6-cities study (). Change in forced vital capacity (FVC; litres) No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly. PM2.5 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Airway inflammation No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly. PM2.5 over lifetime. Age: mean age10.0 years. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study ().
() 24-hour average. Lag 01. Age: All ages. All year. Low heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: <800; ICD10: A-R, Z35.5, Z35.8 () ?ICD codes ?All ages Cardiovascular 1.0439 increase per 1 unit bsp () Pooled CRF from 4 cities (Sydney, Perth, Melbourne, Brisbane) ICD9: 390-459 ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 Age: All ages. Lag 1 24-hour bsp. 1.5% (0.7-2.3%) per 1.4% (0.7-2.2%) per 10 µg/m3 () 9 studies ICD9: 390-459 All ages. n/a 0.85% (0.46 to 1.25%) per 10 µg/m3 () () ICD10: I01-I59 Ages: All ages. 1.00507 (0.98808- 1.02236) per 10 µg/m3 () () 1 study only ICD9: 390-459 Age: All ages. Recommended CRF: 1.5% per 3.78 µg/m3 (). (0.7-
cities - Brisbane, Melbourne, Perth Sydney. ICD9: 390-459; ICD10: I00–I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 Cardiac 5.1% (3.5-6.7% per 10 µg/m3 () () Pooled estimate from 3 cities - Sydney, Melbourne, Perth. lCD9: 390-429; ICDI0: I00-I52, I97.0, I97.1, I98.1 Age: All ages. 1-hour maximum. 15-64 years: No effect 65+ years: 1.9% (1.0-2.7%) per 3.78 µg/m3 () 24-hour average. Lag 01. n/a n/a n/a n/a Recommended CRF: 65+ years: 1.9% (1.0-2.7%) increase per 3.78 µg/m3 (). May use the CRF from Simpson et al () in a sensitivity analysis.
effect. () 24-hour average. Lag 01. Low heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 437; ICD10: I46-I49 No effect in Australian 4-cities meta-analysis (). Myocardial infarction 15-64 years: No effect. 65+ years: 2.7% (1.3-4.2%) per 3.78 µg/m3 () 24-hour average. Lag 01. Low heterogeneity for 65+ years. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. lCD9: 410; ICDI0: I21, I22 n/a n/a n/a n/a Recommended CRF: 65+ years: 2.7% (1.3-4.2%) increase per 3.78 µg/m3 (). Respiratory 1.0401 increase per 1 unit bsp () n/a n/a No effect. () () ICD9: 490-492, 480-487 0-14 years: No effect. 15-64 years: No effect. 65+ years: Recommend CRF: CRFs from Australian 4-cities meta-analysis (). 466,
Respiratory disease n/a n/a n/a 1.00046 per 1 µg/m3 () () Age: All ages. 24-hour average. Atlanta. ICD9: 491-493, 786.07, 786.09, 496, 460-465, 460.0, 477, 466.1, 466.11, 466.19 n/a No CRF recommended. May use CRF from Tolbert () in a sensitivity analysis as the CRF is close to being statistically significant. Note that respiratory disease ICD codes include asthma. Cardiovascular disease n/a n/a n/a 1.00046 per 1 µg/m3 () () All ages. 24-hour average. Atlanta. ICD9: 410-414, 433-437, 440, 443-445, 451-453 n/a No CRF recommended. May use CRF from Tolbert () in a sensitivity analysis as the CRF is close to being statistically significant. Incidence of myocardial infarction (heart attacks) Non-fatal heart attacks (24-hr PM) n/a n/a n/a 1.62 (1.13-2.34) per 20 µg/m3 () () Age: 18+ years n/a Recommended CRF: 1.62 per 20 µg/m3 ()
ICD9: 410 Lung function Change in forced expiratory volume in 1 second (FEV1; litres) No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean age 10.0 years. 270 children with current asthma. n/a n/a n/a -1.9% (-3.1 to -0.6%) per 10 µg/m3 () Children No CRF recommended. No effect in Australian 6-cities study (). Change in peak expiratory flow rate (PEF; litres per minute) No effect of bsp. () Brisbane and Ipswich Mixed-models Age: All (n=53) History of allergy to pollen or fungi on skin prick testing No effect. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study ().
Age: mean age 10.0 years. 270 children with current asthma. Minor morbidity Asthma exacerbation n/a n/a n/a n/a (not reported in Abt Associates 2011 or in USEPA 2006) Pooled estimate from Vedal 1998 and Ostro 2001 () Age: 6-18 years n/a No CRF recommended. Increased airway n/a n/a n/a n/a n/a No CRF recommended. Restricted activity days (RAD)2 n/a n/a 0.475% per 1 μg/m3 () () Age: 15-64 years. In a sensitivity analysis, all ages used. n/a n/a Recommended CRF: 0.475% (0.417-0.533%) per 1 μg/m3 PM2.5 () () Minor restricted activity days n/a n/a 0.74% (0.60-0.88%) per 1 μg/m3 1.0769 per 10 n/a Recommended CRF: 1.0769 responsiveness
(MRAD)3 () () Age: 18-64 years. μg/m3 () () Age: 18-64 years. (1.0622-1.0918) per 10 μg/m3 () () Work lost days (WLD)2 n/a n/a 0.46% (0.39-0.53%) per 1 μg/m3 () () CAFE CBA 2005 Age: 15-64 years. 1.0471 per 10 μg/m3 () () Age: 18-64 years. n/a Recommended CRF: 1.0471 (1.0397-1.0545) per 10 μg/m3 () () Acute bronchitis (incidence, 8-12 years) n/a n/a n/a 1.5 (0.91-2.47) per 14.9 µg/m3 () () Annual average. n/a Recommended CRF: 1.5 per 14.9 µg/m3 () () Lower respiratory symptoms n/a n/a n/a 1.33 (1.11-1.58) per 15 µg/m3 () () Age: 7-14 years. n/a Recommended CRF: 1.33 per 15 µg/m3 () () Acute respiratory symptoms n/a n/a n/a n/a n/a No CRF recommended. Wheeze No effect. Rodriguez 2007 Age: 0-5 years. Perth. 1-hour maximum. n/a n/a Only for children () () n/a No CRF recommended. No effect in Australian 6-cities American
No effect. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. study (). Cough 1.006 (1.000-1.012) per ?1µg/m3 () Age: 0-5 years. Perth. 1-hour maximum. No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. n/a n/a Only for children. () () n/a No CRF recommended. No effect in Australian 6-cities study (). Shortness of breath No effect. () n/a n/a Only for children. n/a No CRF recommended. American American
Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. () () No effect in Australian 6-cities study (). Bronchodilator use No effect. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Upper respiratory symptoms Runny/blocked nose: No effect. () Age: 0-5 years. Perth. 1-hour maximum. n/a n/a Only for children. () () n/a No CRF recommended. Only Australian study did not show any adverse effects. Increased respiratory symptoms Any day symptoms: No effect on any day symptoms - cough, wheeze, shortness of breath, runny nose, eye n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). American
() () ICD9: All Age: 30+ years () ?ICD codes ?Age 1 µg/m3 (). Cardiopulmonary n/a n/a n/a n/a n/a No CRF recommended. Ischaemic heart disease n/a n/a n/a n/a n/a No CRF recommended. Lung cancer n/a n/a n/a n/a n/a No CRF recommended. Infant all cause (<12 months age) n/a n/a 4% (2-7%) per 10 µg/m3 () () ICD9: All Age: <12 months n/a n/a Recommended CRF: 4% (2-7%) per 10 µg/m3 (). Life expectancy (Years of life lost; YOLL) n/a 2-6 months per death brought forward. () 2.69E-04 YOLL / (person/yr/µg/m3) () Applies CRF from Pope 1995 to whole population. n/a n/a Recommended CRF: 2.69E-04 YOLL / (person/yr/µg/m3) (). Morbidity Incidence of chronic n/a n/a Chronic bronchitis: n/a Chronic bronchitis: No CRF
obstructive pulmonary disease (COPD) or chronic bronchitis 1.15 (0.99-1.33) per 20 µg/m3 () () () Adults (27+ years) with cough or sputum on most days for at least three months of the year for at least two years. 1.29 (0.96-1.83) per 10 µg/m3 () () ?Age recommended for chronic bronchitis. Both the reported CRFs are statistically May be used in a sensitivity analysis. Incidence of asthma Ever had wheezing: No effect Ever had asthma: No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly PM10 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Recent symptoms (in last 12 months) Nigh cough: 1.34 (1.19-1.53) per 10 µg/m3 Chest colds: 1.43 (1.12-1.82) per 10 n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities
µg/m3 () Children in school years 3-5. Illawarra/Hunter. Annual mean PM10. No effect or protective effects for wheeze, wheeze after exercise, current asthma, use of bronchodilators, cough, visit to doctor/hospital, rhinitis and itchy rash in various single pollutant and 2-pollutant models. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly PM10 over lifetime. Age: mean age10.0 years. 2,860 children. study (). May use the CRFs from the study by Lewis et al () in a sensitivity analysis. Lung function growth n/a n/a n/a n/a n/a No CRF recommended.
Change in forced expiratory volume in 1 second (FEV1; litres) No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly PM10 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Change in forced vital capacity (FVC; litres) No effect () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly PM10 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Airway inflammation 1.04 (1.01-1.06) per 1 µg/m3 in single pollutant model. Estimates are similar in 2-pollutant models with PM2.5, NO2, SO2 and CO () n/a n/a n/a n/a Recommended CRF: 1.04 per 1 µg/m3 ().
Short-term outcomes (daily average concentration) Mortality Non-trauma All ages: No effect () Pooled CRF from 3 cities - Brisbane, Sydney, Melbourne. ICD9: <800 ICD10: A-R, Z35.5, Z35.8 1.3% (0.4-2.3%) per 10 µg/m3 () Sydney Age: All ages. 24-hour average ICD9: <800; ICD10: A-R, Z35.5, Z35.8 All ages: No effect () 24-hour average Lag 01 All year High heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: <800; ICD10: 0.074% per 1 µg/m3 () CRF is a WHO summary finding based on 17 international studies ICD: All Age: All ages. 1.0105 per 10 µg/m3 () () ?ICD ?Age n/a 1.0074 per 10 µg/m3 () ?ICD ?Age 1.006 (1.004-1.008) per 10 µg/m3 () 33 studies ICD9: <800 Age: All ages. No CRF recommended. No effect in 2 Australian (; ). CRF from Morgan et al () or WHO () may be used in a sensitivity analysis. analyses
(excluding G45.3), G46, M30, M31, R58 Respiratory No effect () Sydney Age: All ages. 24-hour average ICD9: 460-519; ICD10: J00-J99 (excluding J95.4 to J95.9), R09.1, R09.8 All ages: No effect () 24-hour average. Lag 01 Age: All ages. All year High heterogeneity Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 460-519; ICD10: J00-J99 (excluding J95.4 to J95.9), R09.1, R09.8 n/a n/a n/a 1.013 (1.005-1.020) per 10 µg/m3 () 18 studies ICD9: 460-519 Age: All ages. No CRF recommended. No effect in Australian 4-cities meta-analysis () and in study by Morgan et al (). CRF from WHO () may be used in a sensitivity analysis. Hospitalisation
Cardiovascular 15-64 years: No effect 65+ years: No effect () 24-hour average Lag 01 Low heterogeneity Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 390-459; ICD10: I00–I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 1.22% (0.41 to 2.03%) per 10 µg/m3 () Sydney Age: All ages. 24-hour average ICD9: 390-459; ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, 0.8 per 10 µg/m3 (no 95%CI provided) () (based on COMEAP 1998) No effect () CRF not intended for health risk assessment purposes. 6 studies ICD9: 390-459 Age: All ages. 0.6% (0.3-0.9%) per 10 µg/m3 () ICD9: 390-429 Age: All ages. n/a n/a No CRF recommended. No effect in Australian 4-cities meta-analysis (). CRF from the study by Morgan et al () may be used in a sensitivity analysis.
65+ years: No effect () 24-hour average Lag 01 Low heterogeneity Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. lCD9: 410; ICDI0: I21, I22 No effect in Australian 4-cities meta-analysis (). Respiratory 0 year: 2.3% increase per 7.53 µg/m3 1-4 years: 2.3% (0.9-3.8%) increase per 7.53 µg/m3 5-14 years: 2.3% (0.2-4.4%) increase per 7.53 µg/m3 15-64 years: No effect 65+ years: No effect () 24-hour average. Lag 01. Low heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 460-519; ICD10: J00-J99 0.080% per 1µg/m3 () CRF is a WHO summary finding based on 6 cities All respiratory causes Age: All ages. 1.14% (0.62-1.67%) per 10µg/m3 () Age: All ages. ICD9: 460-519 n/a 1.0080 per 10 µg/m3 () ?ICD ?Age 0-14 years: 1.010 (0.998-1.021) per 10 µg/m3 3 studies 14-64years: 1.008 (1.001-1.015) per 10 µg/m3 3 studies 65+ years: 1.007 (1.002-1.013) per 10 µg/m3 8 studies () ICD9: 460-519 Age: All ages. Recommended CRF: CRFs from the Australian 4-cities meta-analysis (). May use CRF from the study by Morgan et al () in a sensitivity analysis. This CRF is for all ages but from one location only.
Lung function Change in forced expiratory volume in 1 second (FEV1; litres) No effect in single pollutant models, but significant effects in 2-pollutant models with 1-hour SO2 and 24-hour SO2 With 1-hour SO2: -0.0041 (-0.0076 to -0.0006) per 1 µg/m3 24-hour average Lag 2 With 24-hour SO2: -0.0043 (-0.0078 to -0.0008) per 1 µg/m3 24-hour average Lag 2 () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean age 10.0 years. 270 children with current asthma. n/a n/a n/a -1.2% (-2.3 to per 10 µg/m3 () () Children ?Age -1.0% (95%CI not available) per 10 µg/m3 () () Adults ?Age Recommended CRF: -0.0043 (-0.0078 to -0.0008) per 1 µg/m3 ().
Change in peak expiratory flow rate (PEF; litres per minute) No effect () Sydney 125 children with a history of wheezing in previous 12 months. Age: mean age about 9.6 years. No effect () Sydney 32 children (mean age about 9.2 years) with a history of wheezing in previous 12 months. -0.0036 (-0.0067 to -0.0005) per 1 µg/m3 () Brisbane and Ipswich Mixed-models 4-day lag Age: All ages. 53 people with history of allergy to pollen or fungi on skin prick testing. No effect in single n/a n/a n/a -0.13% (-0.17 to -0.09%) per 10 µg/m3 () ?Age Change in peak expiratory flow relative to mean. Recommended CRF: -0.8187 (-1.3325 to -0.3048) per 1 µg/m3 (). Note inconsistencies in CRFs from Australian single site studies.
Minor morbidity Asthma exacerbation n/a n/a n/a 1.05 (0.95-1.16) per 10 µg/m3 () () () Asthmatic children Age: 5-13 years At least one asthma symptom: wheeze, cough, chest tightness, shortness of breath. n/a No CRF recommended. CRF from Yu et al () was not statistically significant. Restricted activity days (RAD)2 n/a n/a n/a n/a n/a No CRF recommended. Minor restricted activity days (MRAD)3 n/a n/a n/a n/a n/a No CRF recommended. Work lost days (WLD)2 n/a n/a n/a n/a n/a No CRF recommended. Acute bronchitis (incidence) n/a n/a n/a n/a n/a No CRF recommended. Lower respiratory symptoms No effect on wheezing. () 148 children (mean age about 9.6 0-15 years: 0.330% (0.134-0.526%) per 1 µg/m3 15+ years: No effect. 5-14 years: 1.004 (1.002-1.006) per 10 µg/m3 () () n/a 1.0324 per 10 µg/m3 () ?Age Recommended CRFs: 5-14 years: 1.004 (1.002-1.006) per 10 µg/m3 () from a
years) with a history of wheezing in previous 12 months. Sydney. Wheezing: 3.149 (1.495-6.631) per 10 µg/m3 () 32 children (mean age about 9.2 years) with a history of wheezing in previous 12 months. Sydney. () () () CRFs for those with asthma. NOT included in impact assessment in the UK because of doubts about the transferability of the data and lack of UK studies. () CRF from All children. Lower respiratory symptoms include wheeze, chest tightness, shortness of breath, cough. 20+ years: 1.017 (1.002-1.032) per 10 µg/m3 () () CRF from of five panel studies. Symptomatic adults only: wheeze, chest tightness, phlegm, shortness of breath, cough. meta-analysis. 20+ years: 1.017 (1.002-1.032) per 10 µg/m3 () from a meta-analysis. Australian studies are single site studies CRFs are for individual symptoms. Acute respiratory symptoms n/a n/a 1.0049 per 1 µg/m3 () () All ages Whole population. Only for sensitivity analysis Presence of any n/a n/a No CRF recommended. CRF from Krupnick et al () may be used in a sensitivity analysis. Note that CRF is statistically marginally analysis
Age: mean 10.0 years. 270 children with current asthma. Shortness of breath Day SOB: No effect Night SOB: 1.0417 (1.0031-1.0819) per 1 μg/m3 in model with CO 8-hour average 24-hour average Lag 2 () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. n/a n/a n/a n/a Recommended CRF: 1.0417 (1.0031-1.0819) per 1 μg/m3 (). Bronchodilator use (people with asthma) No effect. () 148 children (mean age about 9.6 years) with a history of wheezing in previous 12 months. Sydney. No effect 0-15 years: 0.230% (0.073-0.3876%) per 1µg/m3 15+ years: 0.180% (0.004-0.357%) per 1µg/m3 () () () 5-14 years : No effect 20+ years: No effect () () () People with asthma. n/a 1.0305 per 10 µg/m3 () ?Age 5-15 years: No effect 31 studies Symptomatic No CRF recommended. No effect in Australian 6-cities study (). Inconsistent CRFs reported. There is generally a lack of pollutant
() Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney Age: mean 10.0 years 270 children with current asthma CRFs for those with asthma. NOT included in impact assessment in the UK because of doubts about the transferability of the data and lack of UK studies. children. 16-70 years: No effect 3 studies Symptomatic adults. () an effect. Upper respiratory symptoms n/a n/a n/a 1.0367 per 10 µg/m3 () () Asthmatics 9-11 years. At least one of the following symptoms: runny/stuffy nose, wet cough, burning, aching or red eyes. n/a No CRF recommended. The CRF from Pope et al () may be used in a sensitivity analysis. Increased respiratory symptoms Any day symptoms: With 1-hour SO2: 1.0257 per 1 μg/m3 (Any cough, wheeze, shortness of breath, runny nose, eye irritation, fever) Recommended CRF: Use CRFs from Australian study ().
Concentration-response function (95%CI) Health outcomes Australian UK Europe US EPA WHO Recommended Long-term outcomes(annual average concentration) Mortality All cause n/a1 n/a n/a No effect () () Age: 30-99 years. Annual 1-hour average. n/a No CRF recommended. Cardiopulmonary n/a n/a n/a Cardiovascular disease: No effect () () Age: 30-99 years. Annual 1-hour average. n/a No CRF recommended. Ischaemic heart disease n/a n/a n/a n/a n/a No CRF recommended. Lung cancer n/a n/a n/a n/a n/a No CRF recommended. Respiratory n/a n/a n/a 1.040 (1.013-1.067) per 10 ppb () () ICD9: 460-519 Age: 30-99 years. Annual 1-hour average. n/a No CRF recommended. Insufficient evidence - only 1 study.
Adjusted for PM2.5. Infant (<12 months age) n/a n/a n/a n/a n/a No CRF recommended. Life expectancy lost (years of life lost) n/a n/a n/a n/a n/a No CRF recommended. Morbidity Incidence of chronic obstructive pulmonary disease (COPD) or chronic bronchitis n/a n/a n/a n/a n/a No CRF recommended. Incidence of asthma Ever had wheezing: Protective effect in single and models with PM, NO2, SO2 and CO. Ever had asthma: Protective effect in single and models with PM, NO2, SO2 and CO. () Six cities – Adelaide, Brisbane, Canberra, n/a n/a 2.8% (0.1-5.6%) per 1 ppb () () Age: Non-asthmatic males 27+ years. Annual average ozone. n/a No CRF recommended. No effect in Australian 6-cities study (). Study by McDonnell et al () may be used in a sensitivity analysis. pollutant pollutant
Melbourne, Perth, Sydney. Average hourly O3 over lifetime. Age: mean age10.0 years. 2,860 children. Recent symptoms (in last 12 months) Cough: 1.14 ( 1.01-1.29) per 3.12 ppb in single model. 1.26 (1.06-1.50) per 3.12 ppb in model with CO. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly O3 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a Recommended CRF: Cough: 1.26 per 3.12 ppb in 2-pollutant model with CO (). Lung function growth n/a n/a n/a n/a n/a No CRF recommended. Change in forced expiratory volume in No effect. () n/a n/a n/a n/a. No CRF recommended. pollutant
1 second (FEV1; litres) Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly O3 over lifetime. Age: mean age10.0 years. 2,860 children. No effect in Australian 6-cities study (). Change in forced vital capacity (FVC; litres) No effect. ()] Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Average hourly O3 over lifetime. Age: mean age10.0 years. 2,860 children. n/a n/a n/a n/a. No CRF recommended. No effect in Australian 6-cities study (). Airway inflammation Protective effect in single and models with PM, NO2, SO2 and CO () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, n/a n/a n/a n/a. No CRF recommended. No effect in Australian 6-cities study (). pollutant
Sydney. Average hourly O3 over lifetime. Age: mean age10.0 years. 2,860 children. Birth outcomes Birth defects Pulmonary artery & valves: 2.96% (1.34- 7.52%) per 5 ppb () Brisbane. Birth addresses <6km of air monitoring station. n/a n/a n/a n/a No CRF recommended. Only 1 Australian study. Prematurity 1.26 (1.10-1.45) per 7.1 ppb () CRF not linear. Brisbane. Preterm: <37 weeks 1st trimester exposure. 1.604 (1.268-2.030) per 1 ppb 1st month gestation for women living n/a n/a n/a n/a No CRF recommended. Only 2 Australian studies are available and evidence is conflicting regarding CRF.
4-hour maximum Lag 0 1.0004 per 1 ppb 1-hour maximum Lag 0 () Pooled CRF from 4 cities - Sydney, Perth, Melbourne, Brisbane. ICD9: <800 ICD10: A-R, Z35.5, Z35.8 Age: All ages. 1.4% (0.3-2.4%) per 9.83 ppb () 1-hour maximum. Lag 01. Age: All ages. All year. No heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: <800; ICD10: A-R, Z35.5, Z35.8 () Age: All ages. 1.027 (1.013-1.039) per 50 µg/m3 () 8-hour average. Age: All ages. All non-trauma deaths. Meta-analysis of 5 European cities. () () WHO Daily maximum average O3. Assuming linearity without threshold. 0.3% (0.1-0.4%) change per 10 µg/m3 () () 8-hour maximum average. n/a () Meta-analysis of 6 studies. µg/m3 () () WHO Daily maximum average. All ages. 1.003 (1.001-1.004) per 10 µg/m3 (8-hour average). Estimate revised for possible publication bias 1.002 () 0.3-0.5% increase in daily mortality per 10 µg/m3 8-hour average O3 above 70 µg/m3. () per 9.83 ppb (). Cardiovascular 1.0008 per 1 ppb 0.4% (0.3-0.5%) change per 10 n/a n/a 1.004 (1.003, 1.005) per 10 µg/m3 Recommended CRF: 2.1% 2.4%)
(4-hour maximum) (lag0) 1.0006 per 1 ppb 1-hour maximum Lag 0 Pooled CRF from 4 cities - Sydney, Perth, Melbourne, Brisbane. ICD9: 390-459; ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 Age: All ages. () 2.1% (1.1-3.1%) per 9.83 ppb () 1-hour maximum. Lag 01. Age: All ages. All year. No heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. µg/m3 () 8-hour average No evidence of publication bias. CRF not intended for health risk assessment purposes. Estimate revised for possible publication bias 1.004 () 8-hour average. per 9.83 ppb (). Note that CRFs from Simpson et al () are very close to being statistically significant.
Lag 01 Age: All ages. All year. No heterogeneity. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 460-519; ICD10: J00-J99 (excluding J95.4 to J95.9), R09.1, R09.8 Hospitalisation Cardiovascular 15-64 years: No effect 65+ years: No effect () 1-hour maximum. Lag 01. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 390-459 ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 No effect. () 8-hour average. No evidence of publication bias. CRF not intended for health risk assessment purposes. No strong evidence of association between daily O3 and cardiovascular disease admissions. () n/a n/a Insufficient studies for meta-analysis () No CRF recommended. No effect in Australian () and in COMEAP study (). analysis
Cardiac All ages: No effect. 15-64 years: 1.0009 (1.0001-1.0017) per 1 ppb. 4-hour average. Lag 3. Pooled estimate from 4 cities - Sydney, Brisbane, Melbourne, Perth. lCD9: 390-429 ICDI0: I00-I52, I97.0, I97.1, I98.1 () 15-64 years: No effect. 65+ years: No effect. () 1-hour maximum. Lag 01. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth, Sydney. Low heterogeneity. lCD9: 390-429; ICDI0: I00-I52, I97.0, I97.1, I98.1 n/a n/a n/a n/a No CRF recommended. No effect in more recent Australian meta-analysis (). CRF for 15-64 years from Simpson et al () may be used in a sensitivity analysis. Cardiac failure 15-64 years: No effect. n/a n/a n/a n/a No CRF recommended.
cities - Brisbane, Melbourne, Perth Sydney. Low heterogeneity. ICD9: 437; ICD10: I46-I49 Myocardial infarction 15-64 years: No effect. 65+ years: No effect. () 1-hour maximum. Lag 01. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. High heterogeneity. in 65+ years lCD9: 410; ICDI0: I21, I22 n/a n/a n/a n/a No CRF recommended. No effect in the EPHC study (). Respiratory 65+ years: No effect. () 1-hour maximum. lCD9: 460-519 ICD10: J00-J99 (excluding R09.1, R09.8. Pooled from 4 cities - All ages: 3.5% per 50 µg/m3 15-64 years: 1.031 (1.013-1.049) per 50 µg/m3 () Whole population. 8-hour average. Meta-analysis of 4 European cities. ICD9: 460-519 Various age groups analysed: effect close to significant for 65+ years only. 65+ years: No effect. (). () 8-hour average. Meta-analysis of 5 n/a Pooled analysis of a number of studies – unable to locate CRF. () n/a All ages: 5% increase per 25 µg/m3 (8-hour average) and 30 µg/m3 1-hour average () 0-14 years: Insufficient numbers No CRF recommended. Results are inconsistent. The Brisbane CRFs () and the 4-cities meta-analysis () may be used in a sensitivity analysis.
Brisbane, Sydney, Melbourne, Perth. All ages: 1.023 (1.003-1.043) per 1 pphm 0-4 years: Protective effect. 1-hour maximum Lag 0 5-14 years: No effect. 1-hour maximum Lag 0 15-64 years: 1.045 (1.013-1.079) per 1 pphm 8-hour average Lag 2 65+ years: 1.054 (1.016-1.094) per 1 pphm 8-hour average Lag 3 () Brisbane ICD9: 460-519 All ages: No effect 0-14 years: No effect. 65+ years: No effect. Perth. European cities. for meta-analysis 15-64 years: 1.001 (0.991-1.012) per 10 µg/m3 65+ years: 1.005 (0.998-1.012) per 10 µg/m3 () 8-hour average.
High heterogeneity for 15-64 years only. Meta-analysis of 4 cities - Brisbane, Melbourne, Perth Sydney. ICD9: 466, 480-486 ICD10: J12-J17, J18.0, J18.1, Jl8.8, JI8.9, J20, J21 Emergency department visits Asthma 1-4 years: 2.3% (1.4-3.2%) per 13.6 ppb 5-9 years: 2.1% (0.7-3.5%) per 13.6 ppb 10-14 years: No effect. 1-14 years: 1.8% (1.1-2.5%) per 13.6 ppb () 1-hour maximum. Lag 01. Greater significant effects in warm months but not cool months. ICD9: 493 Children n/a n/a 1.022 (0.996-1.049) per 25 ppb () () () Pooled results from 3 cities and 2 studies. 8-hour maximum. Age: 0-99 years. n/a Recommended CRF: 1-14 years: 1.8% (1.1-2.5%) per 13.6 ppb ().
Sydney 1-15 years Non-linear significant response for Western & South/South Eastern regions (No CRFs available). No effect of O3 for Inner Melbourne or Eastern Melbourne regions. () ICD10: J45, J46 Melbourne. Respiratory disease n/a n/a n/a n/a n/a No CRF recommended. Cardiovascular disease n/a n/a n/a n/a n/a No CRF recommended. Incidence of myocardial infarction (heart attacks) Non-fatal heart attacks n/a n/a n/a n/a n/a No CRF recommended. Lung function Change in forced expiratory volume in 1 second (FEV1; No effect of 1-hour maximum, 4-hour average and 8-hour n/a n/a n/a n/a Lung function deficits seen in No CRF recommended.
litres) average on PEF either in all year analysis or in warm season only analysis () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney Age: mean 10.0 years (n=270) 270 children with current asthma exercising children exposed to daily maximum 8-hour average of 160 µg/m3. () 10% change in FEV1 at 160µg/m3 (8-hour average) and 350µg/m3 average). 5% change in FEV1 at 120µg/m3 (8-hour average) and 250µg/m3 (1-hour average) () Controlled exposure studies. No effect in Australian 6-cities study (). Change in peak expiratory flow rate (PEF; litres per minute) Average change in PEF: -0.8823 l/min ( -0.0542 to -1.7104 l/min) per 1 pphm () Mean daytime ozone. 148 children with history of wheezing in last 12 months. Mean age: 9.6 years. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study ().
Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. Minor morbidity Asthma exacerbation (asthmatics) n/a n/a However, CRF from Whittemore and Korn 1980 used in health risk assessment n/a 1.0018 per 1 ppb () () Asthmatics of all ages 1-hour maximum n/a Recommended CRF: 1.0018 (1.0004-1.0032) per 1 ppb () () Asthma/ respiratory exacerbations (whole population) n/a n/a No effect. (; )) () Whole population of children aged 5-14 years France. 8-hour daily maximum . n/a n/a 25% increased symptoms in adults or asthmatics per 100 µg/m3 (8-hour average) and 200 µg/m3 (1-hour average). () No CRF recommended. CRF from European Commission () is not statistically significant and CRFs from WHO () do not have associated confidence limits. Increased airway n/a n/a n/a n/a n/a No CRF recommended.
Restricted activity days (RAD)2 n/a n/a n/a n/a n/a No CRF recommended. Minor restricted activity days (MRAD)3 n/a 1.48% per 10 µg/m3 8-hour average 0.11% per 1 µg/m3 () in () () Age: Adults. 1-hour maximum O3 adjusted for PM2.5 in study. 1.48% (0.57-2.38%) per 10 µg/m3 8-hour average 0.11% per 1 µg/m3 1-hour maximum (). () Age: 18+ years. Whole population. O3 adjusted for PM2.5 in study. 1.0022 per 1 ppb (Ostro and Rothschild 1989) () () 1-hour maximum. Age: 18-65 years. O3 adjusted for PM2.5 in study. n/a Recommended CRF: 1.0022 (1.0009-1.0035) per 1 ppb (Ostro and Rothschild 1989) () () Work lost days (WLD)2 n/a n/a n/a n/a Pooled estimate from 2 studies – unable to locate CRF. () n/a No CRF recommended. Acute bronchitis n/a n/a n/a n/a n/a No CRF recommended. Upper respiratory illness n/a n/a n/a n/a n/a No CRF recommended. Lower respiratory symptoms n/a n/a n/a n/a n/a No CRF recommended.
Acute respiratory symptoms No effect on cough, wheeze, runny/blocked nose. (Rodriguez et al, 2007) Perth. n/a Presence of any 19 acute respiratory symptoms: 1.0055 per 10 ppb () (). () Presence of any 19 acute respiratory symptoms: 1.0001 per 1 ppb () () Age: 18-65 years. Whole population. 1-hour maximum. n/a No CRF recommended. CRF by Krupnick et al () may be used in a sensitivity analysis. This endpoint not used by US EPA in its most recent analysis (). Wheeze No effect. (Rodriguez et al, 2007) Perth. Evening wheeze: No effect () 148 children. Mean age 9.6 years. Sydney. Day wheeze: No effect of 1-hour maximum, 4-hour average or 8-hour average in either all year analysis or n/a n/a n/a n/a No CRF recommended. No effects have been shown in Australian studies including the 6-cities study ().
warm season only analysis except for protective effect for 8-hour average in all year analysis. Night symptoms: Protective effects for 1-hour maximum, 4-hour average and 8-hour average in both all year analysis and warm season only analysis () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney Age: mean 10.0 years 270 children with current asthma Cough No effect. (Rodriguez et al, 2007) Perth Evening dry/wet cough: No effect. () n/a Incidence night cough: No effect (Just et al. 2002) () Based on 1 study (82 children aged years with doctor n/a n/a No CRF recommended. No effects have been shown in Australian studies including the 6-cities study ().
of 1-hour maximum, 4-hour average and 8-hour average in either all year analysis or in warm season only analysis Night use: No effect of 1-hour maximum, 4-hour average and 8-hour average in either all year analysis or in warm season only analysis () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. using as upper limit for sensitivity analyses only, as based on 1 study (82 children aged years with doctor diagnosed asthma taking daily asthma medications) only with high odds ratios. Odds ratios based on days when children not taking corticosteroids. () Adults 20+ years: No effect. (; ). () Adults with asthma. 8-hour maximum moving average. Upper respiratory symptoms n/a n/a n/a n/a n/a No CRF recommended. Increased respiratory symptoms Day symptoms: No effect of 1-hour maximum, 4-hour average or 8-hour n/a n/a n/a n/a No CRF recommended. No effects shown in
Life expectancy lost (years of life lost; YOLL) n/a n/a n/a n/a n/a No CRF recommended. Morbidity Incidence of chronic obstructive pulmonary disease (COPD) or chronic bronchitis n/a n/a n/a n/a n/a No CRF recommended. Incidence of asthma Ever had wheezing: No effect in single model. Largest effect in model with PM2.5: 1.15 per 4.31 ppb Ever had asthma: No effect in single model. Largest effect in model with CO: 1.27 per 4.31 ppb () Six cities – Adelaide, Brisbane, Canberra, n/a n/a n/a Results inconsistent. () n/a Recommended CRF for asthma incidence: 1.27 (1.04-1.56) per 4.31 ppb (in 2-pollutant model with CO) (). pollutant pollutant
Melbourne, Perth, Sydney. Average hourly NO2 over lifetime. Age: mean age10.0 years. 2,860 children. Recent symptoms (in last 12 months) Wheeze: 1.25 (1.07-1.46) per 4.31 ppb in 2-pollutant model with PM2.5 Wheeze after exercise: 1.43 (1.05-1.96) per 4.31 ppb in 2-pollutant model with CO Current asthma: 1.51 (1.08-2.12) per 4.31 ppb in 2-pollutant model with CO Visit to doctor/hospital: 1.51 (1.04-2.19) per 4.31 ppb in 2-pollutant model with O3 Use of bronchodilators: 1.35 n/a n/a n/a n/a Recommended CRFs: Wheeze: 1.25 (1.07-1.46) per 4.31 ppb in 2-pollutant model with PM2.5 Wheeze after exercise: 1.43 (1.05-1.96) per 4.31 ppb in 2-pollutant model with CO Current asthma: 1.51 (1.08-2.12) per 4.31 ppb in 2-pollutant model with CO Visit to doctor/hospital: 1.51 (1.04-2.19) per 4.31 ppb in 2-pollutant model with O3 Use of
Cardiovascular 1.0018 per 1 ppb () Pooled CRF from 4 cities. ICD9: 390-459; ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 Age: All 1.6% (0.4-2.8%) per 8.98 ppb () 1-hour maximum Lag 01 Age: All ages All year No heterogeneity. Meta-analysis of 5 cities-Brisbane, Canberra, Melbourne, Perth, Sydney. ICD9: 390-459 ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 1.0% (0.8-1.3%) per 10 ug/m3 () Moderate evidence of publication bias. CRF not intended for health risk assessment purposes. n/a n/a Suggestive but not sufficient to infer a causal relationship as it is difficult to attribute effects to NO2 alone. However, estimates were robust to adjustment for () n/a Recommended CRF: 1.6% per 8.98 ppb ().
Hospitalisation Cardiovascular n/a for all cardiovascular disease Four cities study. () No effect () Brisbane ICD9: 390-459 Age: All Heart disease: 7.52% (5.21-9.88%) per 17 ppb () Sydney Age: All ICD9: 410, 413, 427, 428 24-hour average 15-64 years: 1.3% (0.3-2.3%) per 8.98 ppb 65+ years: 2.6% (1.8-3.3%) per 8.98 ppb () 1-hour maximum Lag 01 () n/a n/a n/a n/a Recommended CRF: 1.3% per 8.98 ppb in 15-64 years; 2.6% (1.8-3.3%) per 8.98 ppb in 65+ years ().
Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney Low heterogeneity ICD9: 390-459; ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 Cardiac 1.0022 per 1 ppb () Pooled estimate from 4 cities (Sydney, Perth, Melbourne, Brisbane) lCD9: 390-429 ICDI0: I00-I52, I97.0, I97.1, I98.1 Age: All 1-hour maximum 15-64 years: 1.2% (0.0-2.4%) per 8.98 ppb 65+ years: 3.3% (2.4-4.3%) per 8.98 1.3% (1.0-1.7%) per 10 ug/m3 () No evidence of publication bias. CRF not intended for health risk assessment purposes. n/a n/a Inadequate evidence for causal relationship, but generally positive associations seen with cardiovascular disease hospitalisations or emergency department presentations. () n/a Recommended CRF: 15-64 years: 1.2% (0.0-2.4%) per 8.98 ppb in 15-64 years; 3.3% (2.4-4.3%) per 8.98 ppb in 15-64 years (). Chosen as it is a more recent study. In a sensitivity analysis use the following CRFs: 1.0022 per 1 ppb (). This study applies to all ages.
ppb () 1-hour maximum Lag 01 Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney Low heterogeneity lCD9: 390-429; ICDI0: I00-I52, I97.0, I97.1, I98.1 Cardiac failure 15-64 years: No effect 65+ years: 7.5% (5.3-9.7%) per 8.98 ppb () 1-hour maximum Lag 01 Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney Low heterogeneity ICD9: 428; ICD10: I50 1.3% (0.4-2.3%) change per 10 ug/m3 () Weak evidence of publication bias. CRF not intended for health risk assessment purposes. n/a n/a n/a Recommended CRF: 7.5% per 8.98 ppb in 65+ years (). Cerebrovascular Stroke: 15-64 years: No effect 0.4% (0.0-0.8%) per 10 ug/m3 () n/a n/a n/a No CRF recommended.
65+ years: 2.7% (1.5-4.0%) per 8.98 ppb () 1-hour maximum Lag 01 Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney. Low heterogeneity. lCD9: 410-413; ICDI0: I20-I22, I24, I25.2 Arrhythmia 15-64 years: 3.4% (0.7-6.3%) per 8.98 ppb 65+ years: No effect () 1-hour maximum Lag 01 Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney. Low heterogeneity. ICD9: 437; ICD10: I46-I49 n/a n/a n/a n/a Recommended CRF: 3.4% per 8.98 ppb in 15-64 years (). Myocardial infarction 15-64 years: No effect n/a n/a n/a n/a Recommended CRF: 4.8%
65+ years: 4.8% (2.3-7.4%) per 8.98 ppb () 1-hour maximum Lag 01 Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney. Low heterogeneity. lCD9: 410; ICDI0: I21, I22 per 8.98 ppb in 65+ years (). Respiratory 65+ years: 1.0016 (1.0006-1.0026) per 1 ppb Pooled estimate from 4 cities - Sydney, Perth, Melbourne, Brisbane. lCD9: 460-519 ICDI0: J00-J99 (excluding R09.1, R09.8 1-hour maximum 1-4 years: 3.6% (1.5-5.7%) per 9.0 ppb 5-14 years: 4.0% No effect () (), Pooled CRF from 5 cities. 2.5% (95%CI not available) per 10 ug/m3 () () ICD9: 460-519 n/a n/a Consistent evidence of positive associations. () n/a Recommended CRF: 1-4 years: 3.6% (1.5-5.7%) per 9.0 ppb; 5-14 years: 4.0% (1.1-7.1%) per 9.0 ppb; 15-64 years: 1.6% per 9.0 ppb (). 65+ years: 1.0016 (1.0006-1.0026) per 1 ppb ()
(1.1-7.1%) per 9.0 ppb 15-64 years: 1.6% (0.5-2.8%) per 9.0 ppb 65+ years: No effect. () Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney. Low heterogeneity. lCD9: 460-519; ICDI0: J00-J99 (excluding R09.1, R09.8 1-hour maximum Asthma 1-14 years: 5.29% (1.07-9.68%) per 29 ppb () Sydney ICD9: 493 1-hour maximum No effect () Pooled CRF from 4 cities (Sydney, Perth, Melbourne, 2.6% (0.6-4.9%) per 50 ug/m3 () () Pooled CRF from 4 cities. 24-hour average ?Age n/a n/a Consistent evidence of positive associations, particularly for asthma. () 0-29 years: 1.0243 (1.0084-1.0405) per 10 ppb 30-99 years: 1.0141 (1.0042-1.0241) per n/a No CRF recommended. 2 Australian studies have shown no effects. May use either Morgan et al () CRF in a sensitivity analysis. Note the restricted age group.
Brisbane) lCD9: 493; ICDI0: J45, J46, J44.8 1-hour maximum 1-4 years: No effect 5-14 years: No effect 15-64 years: No effect 65+ years: No effect () Meta-analysis of 5 cities - Brisbane, Canberra, Melbourne, Perth, Sydney. Moderate heterogeneity Brisbane, Canberra, Melbourne, Perth, Sydney. lCD9: 493; ICDI0: J45, J46, J44.8 1-hour maximum 10 ppb () () () ICD9: 493 All ages Chronic obstructive pulmonary disease (COPD) 65+ years: 1.0019 (1.0005-1.0033) per 1 ppb () Pooled estimate from 4 cities - Sydney, Perth, Melbourne, 1.9% (0.2-4.7%) per 50 ug/m3 () () Pooled CRF from 6 cities n/a Pooled CRF from 2 analyses shown below (pooled CRF not available) LA County: 1.0182 (1.0144-1.0219) per 10 ppb n/a No CRF recommended. No effect in the meta-analysis (). May use the CRF
Lag 2 daily 1-hour maximum. Single model: 2.3% (1.4, 3.2%) per 9.5 ppb Two model with PM2.5: 1.1% (0.6-1.6%) per 9.5 ppb () Sydney Age: 1-14 years 1-hour maximum 1.21 (1.03–1.43) per 1ppb () Perth Age: 0-4 years 24-hour average 24 ppb () 1.08 (1.00-1.17) per 34 ppb () 1.047 (1.011-1.085) per 20 ppb () 1-hour maximum () () ICD9: 493 Age: All to all ages. Cardiovascular disease n/a n/a n/a n/a n/a No CRF recommended. Respiratory disease n/a n/a n/a No CRF Consistent evidence of positive associations. () n/a No CRF recommended. Incidence of myocardial infarction (heart attacks)
8-hour maximum Increased airway n/a n/a n/a n/a Increases observed in healthy adults with 1.5-2.0ppm and in asthmatics with 0.3ppm (30 minutes) or 0.1ppm (60 minutes). () n/a () Chamber studies of bronchial in asthmatics-effects seen > 200 µg/m3 (1-hour average). No CRF recommended. Restricted activity days (RAD)2 n/a n/a n/a n/a n/a No CRF recommended. Minor restricted activity days (MRAD)3 n/a n/a n/a n/a n/a No CRF recommended. Work lost days (WLD)2 n/a n/a n/a n/a n/a No CRF recommended. Acute bronchitis (incidence, 8-12 years) n/a n/a n/a n/a n/a No CRF recommended. Lower respiratory symptoms n/a n/a n/a n/a n/a No CRF recommended. Acute respiratory symptoms n/a n/a n/a n/a n/a No CRF recommended. Wheeze No effect. () n/a n/a n/a n/a Recommended CRF in sensitivity
Age: 0-5 years Perth 24-hour average No effect. () 148 children (mean age about 9.6 years) with a history of wheezing in previous 12 months Sydney. 1-hour maximum Day wheeze: 1.0356 per 1 ppb Lag 0 Day wheeze: No effect in 2-pollutant model with O3 Night wheeze: No effect 24-hour average Day wheeze: 1.0722 per 1 ppb in 2-pollutant model with O3 Lag 0 Night wheeze: 1.0640 per 1 ppb analysis: 24-hour average Day wheeze: 1.0722 per 1 ppb in 2-pollutant model with O3 (). Note inconsistency of results between single and models. Also note that two other Australian studies have not shown any effects.
Night wheeze: No effect in 2-pollutant model with O3 () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. Cough 1.028 (1.002-1.055) per ?1 ppm () Age: 0-5 years Perth 24-hour mean Not clear from the paper the metric for NO2 concentration used in the calculation of CRF. Wet cough: 1.05 (1.00-1.10) per 8.2 ppb Dry cough: No effect. () 148 children (mean age about 9.6 n/a n/a (0.94-1.46) for a 10 ppb () () () Age: 7-14 years Lag 0-4 days n/a Recommended CRF in sensitivity analysis: 24-hour average Night cough: 1.0447 (1.0015-1.0898) per 1 ppb in 2-pollutant model with O3 (). Note inconsistency of results between single and models.
Mortality All cause n/a1 n/a n/a n/a Evidence is inadequate to confer causal relationship. () n/a No CRF recommended. Infant (<12 months of age) n/a n/a n/a n/a n/a No CRF recommended. Life expectancy lost (years of life lost; YOLL) n/a n/a n/a n/a n/a No CRF recommended. Morbidity Incidence of chronic obstructive pulmonary disease (COPD) or chronic bronchitis n/a n/a n/a n/a n/a No CRF recommended. Incidence of asthma Ever had wheezing: No effect in single pollutant model and protective effects in 2-pollutant models with CO. Ever had asthma: No effect in single pollutant model and n/a n/a n/a n/a No CRF recommended. No effects in Australian 6-cities study ().
2,860 children Change in forced vital capacity (FVC; litres) No effect in single pollutant model -8.92 mls (-16.0 to -1.84 mls) per 0.74 ppb in 2-pollutant model with NO2 () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney Average hourly SO2 over lifetime Age: mean age10.0 years 2,860 children n/a n/a n/a n/a Recommended CRF: -8.92 mls (-16.0 to -1.84 mls) per 0.74 ppb in model with NO2 (). Airway inflammation Protective effect in single and models with PM, NO2, O3 and CO () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney Average hourly SO2 over lifetime n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study ().
station () Sydney 1-hour maximum Low birth weight Not assessed () Sydney Not assessed () Brisbane n/a n/a n/a n/a No CRF recommended. Short-term outcomes (daily average concentration) Mortality Non-trauma Not assessed in 4 cities study () Brisbane, Melbourne, Perth, Sydney No effect. () 1-hour maximum. Lag 01 Age: All ages. All year. Moderate heterogeneity. Meta-analysis of 2 1.029 (1.035-1.023) per 50 ug/m3 () 24-hour average. APHEA estimates for 7 western European cities. n/a Non-trauma mortality: range per 10 ppb () 24-hour average. Effects reduced when co-pollutants added to model. n/a Various studies showed increased mortality with levels between 5-10 ug/m3 24-hour average. () () No CRF recommended. No effect in Australian 2-cities study (). May use CRF from COMEAP () or Hu et al () in a sensitivity analysis.
ICD9: 390-459; ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 for 5 western European cities. Respiratory Not assessed in 4 cities study () Brisbane, Melbourne, Perth, Sydney. No effect. () 1-hour maximum. Lag 01. Age: All ages. All year. Moderate heterogeneity. Meta-analysis of 2 cities – Brisbane, Sydney ICD9: 460-519; ICD10: J00-J99 (excluding J95.4 to J95.9), R09.1, R09.8. 1.05 (1.03-1.07) per 50 ug/m3 () 24-hour average. APHEA estimates for 5 western European cities. n/a n/a n/a No CRF recommended. No effect in Australian 2-cities meta-analysis (). May use the CRF from COMEAP () in a sensitivity analysis. Hospitalisation
Cardiovascular Not assessed in 4 cities study () 15-64 years: No effect 65+ years: No effect () 1-hour maximum Lag 01 Meta-analysis of 2 cities - Brisbane, Sydney. Low heterogeneity. ICD9: 390-459; ICD10: I00-I99 (excluding I67.3, I68.0, I88, I97.8, I97.9, I98.0), G45 (excluding G45.3), G46, M30, M31, R58 0.6% ( 0.1-1.2%) per 10 ug/m3 () Random effects estimate. 24-hour average. Weak evidence of publication bias. CRF not intended for health risk assessment. n/a n/a Some evidence from epidemiological studies but inconsistent toxicological studies, and effect estimate not robust to co-pollutant adjustment. () n/a However, cited Hong Kong study which showed no evidence of threshold for effect at 5-40ug/m3 24-hour average. () () No CRF recommended. No effect in Australian 2-cities meta-analysis (). May use the CRF from COMEAP () in a sensitivity analysis. Cardiac Not assessed in 4 cities study () 15-64 years: No effect 65+ years: No effect () 1-hour maximum. Lag 01. 2.4% (1.6-3.3%) per 10 ug/m3 () Random effects estimate. 24-hour average. No evidence of publication bias. CRF not intended for health risk n/a n/a n/a No CRF recommended. No effect in Australian 2-cities meta-analysis (). May use the CRF from COMEAP () in a sensitivity
Meta-analysis of 2 cities - Brisbane, Sydney. Low to moderate heterogeneity. ICD9: 428; ICD10: I50 publication bias. CRF not intended for health risk assessment. Cerebrovascular Not assessed in 4 cities study () Stroke: 15-64 years: No effect 65+ years: No effect () 1-hour maximum. Lag 01. Meta-analysis of 2 cities - Brisbane, Sydney. Low heterogeneity. ICD9: 430-438; ICD10: I60-I66, I67 (excluding I67.0, I67.3), I68 (excluding I68.0), I69, G45 (excluding G45.3), G46 No effect () Random effects. estimate 24-hour average. No evidence of publication bias. CRF not intended for health risk assessment. n/a n/a n/a No CRF recommended. No effect in Australian 2-cities meta-analysis (). Arrhythmia 15-64 years: No effect 65+ years: No effect n/a n/a n/a n/a No CRF recommended.
() 1-hour maximum. Lag 01. Meta-analysis of 2 cities - Brisbane, Sydney. Low heterogeneity. ICD9: 437; ICD10: I46-I49 No effect in Australian 2-cities meta-analysis (). Myocardial infarction 15-64 years: No effect. 65+ years: No effect. () 1-hour maximum. Lag 01. Meta-analysis of 2 cities - Brisbane, Sydney. Moderate to high heterogeneity. lCD9: 410; ICDI0: I21, I22 n/a n/a n/a n/a No CRF recommended. No effect in Australian 2-cities meta-analysis (). Respiratory Not assessed in 4 cities study () 0 years: No effect 1-4 years: No effect 5-14 years: No effect 15-64 years: No 65+ years: 1.020 (1.005-1.046) per 50 ug/m3 15-64 years: No effect. () Based on APHEA estimates for 5 western European 0.5% per 10 ug/m3 () n/a Effect ranges from -5 to +20% risk per 10 ppb increase in SO2 (24-hour average), with effects observed at levels of 4 ppb, but marked increases in n/a Recommended CRF: For 65+ years age-group, 2.8% (1.0-4.7%) per 5.4 ppb from Australian study (). No CRF recommended for all
Cough Day cough: No effect of 1-hour maximum or average in models with PM10. Night cough: No effect of 1-hour maximum or average in models with PM10. () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study (). Shortness of breath 1-hour maximum Day SOB: No effect in 2-pollutant. models with PM10 Night SOB: No effect in 2-pollutant models with PM10. 24-hour average Day SOB: No effect in 2-pollutant n/a n/a n/a n/a No CRF recommended. No effect in Australian 6-cities study ().
Upper respiratory symptoms n/a n/a n/a n/a n/a No CRF recommended. Increased respiratory symptoms No effect on any night symptoms (cough, wheeze, shortness of breath) in 2-pollutant models with PM10 No effect on any day symptoms (cough, wheeze, shortness of breath, runny nose, eye irritation, fever) in models with PM10 () Six cities – Adelaide, Brisbane, Canberra, Melbourne, Perth, Sydney. Age: mean 10.0 years. 270 children with current asthma. No CRF recommended. No effect in Australian 6-cities study (). General practitioner consultation for asthma n/a n/a n/a n/a n/a No CRF recommended.
Wong, C. M., R. W. Atkinson, et al. (2002). "A tale of two cities: effects of air pollution on hospital admissions in Hong Kong and London compared." Environmental Health Perspectives 110(1): 67-77. Table 6: Sources of health data Type of health data Data custodian Years of available data Variables in dataset Process for accessing data Time frame for accessing data Mortality ABS (aggregate and coded data available to SLA level (lowest geographic idenitifier)).* Individual State Registrars of Births, Deaths and Marriages (unit record data available but not coded). ABS: 2002-2012 (last 10 years). Some data back to 1968 but would incorporate ICD8, ICD9 and ICD10 coding. Variables include : age or DOB, gender, underlying cause of death (ABS), multiple causes of death (ABS), SLA (geographic identifier), ICD codes. National Information Referral Service (NIRS) 1300 135 070 or complete Inquiry form located at Specify requirements and work is quoted. Minimum charge of $650 for 3 hrs. State level data available free of charge at: OpenDocument Up to 1 month. Hospitalisation National Hospital Morbidity Database (NHMD) administered by AIHW. State health agencies, eg. NSW Admitted Patient Data by State; annual frequency of reporting (Australian Institute of Health and Welfare). AIHW, Head, Hospitals Data Unit, 02 6244 1157; hospitaldata@aihw.gov.au Apply in writing to NSW 2 weeks to a few
NSW Ministry of Health. Data - 1988/89-current (June 2011) Data to SLA & postcode levels. Other geographic level may be available on request. Variables include: age, DOB, gender, postcode, primary diagnosis, additional diagnoses, readmission within 28 days, date of admission and date of separation, length of stay, ICD codes, other demographic & hospital data. Chief Health Officer whereupon data needs will be assessed. Data Custodian: Director Demand & Performance Evaluation Branch, NSW Ministry of Health Tel: 02 9391 9590. months, depending on nature of request. Emergency department (ED) visits State health agencies, for example, NSW Ministry of Health. ED visit data for asthma available for NSW, Victoria & WA, but method of data collection differs (). For example, NSW Emergency Department Database; July 1996-year to date (2012). Data to SLA & postcode levels. Other geographic level may be available on request. Age, DOB, gender, postcode, arrival date and time, triage date and time, diagnosis- ICD9 and ICD 10, type of visit, mode of separation, other demographic data. Apply in writing to NSW Chief Health Officer whereupon data needs will be assessed. Data Custodian: Director Demand & Performance Evaluation Branch, NSW Ministry of Health Tel: 02 9391 9590 2 weeks to a few months, depending on nature of request. Perinatal State health agencies, for example, NSW Ministry of Health. For example, Perinatal Data Collection (PDC), encompasses all live births >20 weeks gestation or ≥400 grams birth weight. Data to SLA & postcode levels of mother’s residence. Other geographic level may be available on request. Apply in writing to NSW Chief Health Officer whereupon data needs will be assessed 2 weeks to a few months, depending on nature of request.
1987-1988; 1989 (missing); 1990-current (2009). Variables include: mother’s demographic details, baby’s DOB, gender; date of last menstrual period, birth order, gestational age, birth weight, APGAR scores (1 & 5 minutes), mother’s smoking status, diabetes status. Other details related to pregnancy. Data Custodian: Manager, Surveillance Methods Centre for Epidemiology & Research, NSW Ministry of Health Tel: 02 9391 9223 Chronic obstructive pulmonary disease (COPD) incidence No geographic based data for COPD incidence. Data available for hospital separations for COPD. Data on COPD mortality and estimates (). Prevalence of COPD in 2007-08 National Health Survey estimated at 5.3%, but is likely to be an (). COPD (Stage 2) prevalence from BOLD study (Sydney) 9.4% (). Prevalence in Australia BOLD study (Stage 2 or higher) 7.5% in 40 years+