Skip to main content
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2002 Feb;110(Suppl 1):95–102. doi: 10.1289/ehp.02110s195

Use of an index to reflect the aggregate burden of long-term exposure to criteria air pollutants in the United States.

Amy D Kyle 1, Tracey J Woodruff 1, Patricia A Buffler 1, Devra L Davis 1
PMCID: PMC1241151  PMID: 11834467

Abstract

Air pollution control in the United States for five common pollutants--particulate matter, ground-level ozone, sulfur dioxide, nitrogen dioxide, and carbon monoxide--is based partly on the attainment of ambient air quality standards that represent a level of air pollution regarded as safe. Regulatory and health agencies often focus on whether standards for short periods are attained; the number of days that standards are exceeded is used to track progress. Efforts to explain air pollution to the public often incorporate an air quality index that represents daily concentrations of pollutants. While effects of short-term exposures have been emphasized, research shows that long-term exposures to lower concentrations of air pollutants can also result in adverse health effects. We developed an aggregate index that represents long-term exposure to these pollutants, using 1995 monitoring data for metropolitan areas obtained from the U.S. Environmental Protection Agency's Aerometric Information Retrieval System. We compared the ranking of metropolitan areas under the proposed aggregate index with the ranking of areas by the number of days that short-term standards were exceeded. The geographic areas with the highest burden of long-term exposures are not, in all cases, the same as those with the most days that exceeded a short-term standard. We believe that an aggregate index of long-term air pollution offers an informative addition to the principal approaches currently used to describe air pollution exposures; further work on an aggregate index representing long-term exposure to air pollutants is warranted.

Full Text

The Full Text of this article is available as a PDF (554.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbey D. E., Burchette R. J., Knutsen S. F., McDonnell W. F., Lebowitz M. D., Enright P. L. Long-term particulate and other air pollutants and lung function in nonsmokers. Am J Respir Crit Care Med. 1998 Jul;158(1):289–298. doi: 10.1164/ajrccm.158.1.9710101. [DOI] [PubMed] [Google Scholar]
  2. Abbey D. E., Hwang B. L., Burchette R. J., Vancuren T., Mills P. K. Estimated long-term ambient concentrations of PM10 and development of respiratory symptoms in a nonsmoking population. Arch Environ Health. 1995 Mar-Apr;50(2):139–152. doi: 10.1080/00039896.1995.9940891. [DOI] [PubMed] [Google Scholar]
  3. Abbey D. E., Nishino N., McDonnell W. F., Burchette R. J., Knutsen S. F., Lawrence Beeson W., Yang J. X. Long-term inhalable particles and other air pollutants related to mortality in nonsmokers. Am J Respir Crit Care Med. 1999 Feb;159(2):373–382. doi: 10.1164/ajrccm.159.2.9806020. [DOI] [PubMed] [Google Scholar]
  4. Abbey D. E., Ostro B. E., Petersen F., Burchette R. J. Chronic respiratory symptoms associated with estimated long-term ambient concentrations of fine particulates less than 2.5 microns in aerodynamic diameter (PM2.5) and other air pollutants. J Expo Anal Environ Epidemiol. 1995 Apr-Jun;5(2):137–159. [PubMed] [Google Scholar]
  5. Ackermann-Liebrich U., Leuenberger P., Schwartz J., Schindler C., Monn C., Bolognini G., Bongard J. P., Brändli O., Domenighetti G., Elsasser S. Lung function and long term exposure to air pollutants in Switzerland. Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) Team. Am J Respir Crit Care Med. 1997 Jan;155(1):122–129. doi: 10.1164/ajrccm.155.1.9001300. [DOI] [PubMed] [Google Scholar]
  6. Bates D. V., Sizto R. Relationship between air pollutant levels and hospital admissions in Southern Ontario. Can J Public Health. 1983 Mar-Apr;74(2):117–122. [PubMed] [Google Scholar]
  7. Bates D. V., Sizto R. The Ontario Air Pollution Study: identification of the causative agent. Environ Health Perspect. 1989 Feb;79:69–72. doi: 10.1289/ehp.897969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Borja-Aburto V. H., Loomis D. P., Bangdiwala S. I., Shy C. M., Rascon-Pacheco R. A. Ozone, suspended particulates, and daily mortality in Mexico City. Am J Epidemiol. 1997 Feb 1;145(3):258–268. doi: 10.1093/oxfordjournals.aje.a009099. [DOI] [PubMed] [Google Scholar]
  9. Braga A. L., Saldiva P. H., Pereira L. A., Menezes J. J., Conceiço G. M., Lin C. A., Zanobetti A., Schwartz J., Dockery D. W. Health effects of air pollution exposure on children and adolescents in São Paulo, Brazil. Pediatr Pulmonol. 2001 Feb;31(2):106–113. doi: 10.1002/1099-0496(200102)31:2<106::aid-ppul1017>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  10. Braun-Fahrländer C., Ackermann-Liebrich U., Schwartz J., Gnehm H. P., Rutishauser M., Wanner H. U. Air pollution and respiratory symptoms in preschool children. Am Rev Respir Dis. 1992 Jan;145(1):42–47. doi: 10.1164/ajrccm/145.1.42. [DOI] [PubMed] [Google Scholar]
  11. Bromberg P. A., Koren H. S. Ozone-induced human respiratory dysfunction and disease. Toxicol Lett. 1995 Dec;82-83:307–316. doi: 10.1016/0378-4274(95)03565-6. [DOI] [PubMed] [Google Scholar]
  12. Burnett R. T., Brook J. R., Yung W. T., Dales R. E., Krewski D. Association between ozone and hospitalization for respiratory diseases in 16 Canadian cities. Environ Res. 1997 Jan;72(1):24–31. doi: 10.1006/enrs.1996.3685. [DOI] [PubMed] [Google Scholar]
  13. Burnett R. T., Cakmak S., Brook J. R. The effect of the urban ambient air pollution mix on daily mortality rates in 11 Canadian cities. Can J Public Health. 1998 May-Jun;89(3):152–156. doi: 10.1007/BF03404464. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Burnett R. T., Dales R. E., Brook J. R., Raizenne M. E., Krewski D. Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 Canadian cities. Epidemiology. 1997 Mar;8(2):162–167. doi: 10.1097/00001648-199703000-00007. [DOI] [PubMed] [Google Scholar]
  15. Delfino R. J., Murphy-Moulton A. M., Becklake M. R. Emergency room visits for respiratory illnesses among the elderly in Montreal: association with low level ozone exposure. Environ Res. 1998 Feb;76(2):67–77. doi: 10.1006/enrs.1997.3794. [DOI] [PubMed] [Google Scholar]
  16. Delfino R. J., Murphy-Moulton A. M., Burnett R. T., Brook J. R., Becklake M. R. Effects of air pollution on emergency room visits for respiratory illnesses in Montreal, Quebec. Am J Respir Crit Care Med. 1997 Feb;155(2):568–576. doi: 10.1164/ajrccm.155.2.9032196. [DOI] [PubMed] [Google Scholar]
  17. Detels R., Tashkin D. P., Sayre J. W., Rokaw S. N., Massey F. J., Jr, Coulson A. H., Wegman D. H. The UCLA population studies of CORD: X. A cohort study of changes in respiratory function associated with chronic exposure to SOx, NOx, and hydrocarbons. Am J Public Health. 1991 Mar;81(3):350–359. doi: 10.2105/ajph.81.3.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Dockery D. W., Cunningham J., Damokosh A. I., Neas L. M., Spengler J. D., Koutrakis P., Ware J. H., Raizenne M., Speizer F. E. Health effects of acid aerosols on North American children: respiratory symptoms. Environ Health Perspect. 1996 May;104(5):500–505. doi: 10.1289/ehp.96104500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Dockery D. W., Pope C. A., 3rd, Xu X., Spengler J. D., Ware J. H., Fay M. E., Ferris B. G., Jr, Speizer F. E. An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993 Dec 9;329(24):1753–1759. doi: 10.1056/NEJM199312093292401. [DOI] [PubMed] [Google Scholar]
  20. Dockery D. W., Speizer F. E., Stram D. O., Ware J. H., Spengler J. D., Ferris B. G., Jr Effects of inhalable particles on respiratory health of children. Am Rev Respir Dis. 1989 Mar;139(3):587–594. doi: 10.1164/ajrccm/139.3.587. [DOI] [PubMed] [Google Scholar]
  21. Goldberg M. S., Burnett R. T., Bailar J. C., 3rd, Brook J., Bonvalot Y., Tamblyn R., Singh R., Valois M. F. The association between daily mortality and ambient air particle pollution in Montreal, Quebec. 1. Nonaccidental mortality. Environ Res. 2001 May;86(1):12–25. doi: 10.1006/enrs.2001.4242. [DOI] [PubMed] [Google Scholar]
  22. Goldsmith J. R., Friger M. D., Abramson M. Associations between health and air pollution in time-series analyses. Arch Environ Health. 1996 Sep-Oct;51(5):359–367. doi: 10.1080/00039896.1996.9934423. [DOI] [PubMed] [Google Scholar]
  23. Greer J. R., Abbey D. E., Burchette R. J. Asthma related to occupational and ambient air pollutants in nonsmokers. J Occup Med. 1993 Sep;35(9):909–915. doi: 10.1097/00043764-199309000-00014. [DOI] [PubMed] [Google Scholar]
  24. Harkema J. R., Plopper C. G., Hyde D. M., St George J. A., Wilson D. W., Dungworth D. L. Response of the macaque nasal epithelium to ambient levels of ozone. A morphologic and morphometric study of the transitional and respiratory epithelium. Am J Pathol. 1987 Jul;128(1):29–44. [PMC free article] [PubMed] [Google Scholar]
  25. Hirsch T., Weiland S. K., von Mutius E., Safeca A. F., Gräfe H., Csaplovics E., Duhme H., Keil U., Leupold W. Inner city air pollution and respiratory health and atopy in children. Eur Respir J. 1999 Sep;14(3):669–677. doi: 10.1034/j.1399-3003.1999.14c29.x. [DOI] [PubMed] [Google Scholar]
  26. Hoek G., Brunekreef B., Verhoeff A., van Wijnen J., Fischer P. Daily mortality and air pollution in The Netherlands. J Air Waste Manag Assoc. 2000 Aug;50(8):1380–1389. doi: 10.1080/10473289.2000.10464182. [DOI] [PubMed] [Google Scholar]
  27. Ito K., Thurston G. D. Daily PM10/mortality associations: an investigations of at-risk subpopulations. J Expo Anal Environ Epidemiol. 1996 Jan-Mar;6(1):79–95. [PubMed] [Google Scholar]
  28. Ito K., Thurston G. D., Hayes C., Lippmann M. Associations of London, England, daily mortality with particulate matter, sulfur dioxide, and acidic aerosol pollution. Arch Environ Health. 1993 Jul-Aug;48(4):213–220. doi: 10.1080/00039896.1993.9940362. [DOI] [PubMed] [Google Scholar]
  29. Katsouyanni K., Zmirou D., Spix C., Sunyer J., Schouten J. P., Ponka A., Anderson H. R., Le Moullec Y., Wojtyniak B., Vigotti M. A. Short-term effects of air pollution on health: a European approach using epidemiologic time series data. The APHEA Project. Air Pollution Health Effects--A European Approach. Public Health Rev. 1997;25(1):7–28. [PubMed] [Google Scholar]
  30. Künzli N., Lurmann F., Segal M., Ngo L., Balmes J., Tager I. B. Association between lifetime ambient ozone exposure and pulmonary function in college freshmen--results of a pilot study. Environ Res. 1997 Jan;72(1):8–23. doi: 10.1006/enrs.1996.3687. [DOI] [PubMed] [Google Scholar]
  31. Last J. A., Sun W. M., Witschi H. Ozone, NO, and NO2: oxidant air pollutants and more. Environ Health Perspect. 1994 Dec;102 (Suppl 10):179–184. doi: 10.1289/ehp.94102s10179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Linn W. S., Szlachcic Y., Gong H., Jr, Kinney P. L., Berhane K. T. Air pollution and daily hospital admissions in metropolitan Los Angeles. Environ Health Perspect. 2000 May;108(5):427–434. doi: 10.1289/ehp.00108427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Lipfert F. W., Hammerstrom T. Temporal patterns in air pollution and hospital admissions. Environ Res. 1992 Dec;59(2):374–399. doi: 10.1016/s0013-9351(05)80043-x. [DOI] [PubMed] [Google Scholar]
  34. McConnell R., Berhane K., Gilliland F., London S. J., Vora H., Avol E., Gauderman W. J., Margolis H. G., Lurmann F., Thomas D. C. Air pollution and bronchitic symptoms in Southern California children with asthma. Environ Health Perspect. 1999 Sep;107(9):757–760. doi: 10.1289/ehp.99107757. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Morris R. D., Naumova E. N., Munasinghe R. L. Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities. Am J Public Health. 1995 Oct;85(10):1361–1365. doi: 10.2105/ajph.85.10.1361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Oehme F. W., Coppock R. W., Mostrom M. S., Khan A. A. A review of the toxicology of air pollutants: toxicology of chemical mixtures. Vet Hum Toxicol. 1996 Oct;38(5):371–377. [PubMed] [Google Scholar]
  37. Ostro B. Fine particulate air pollution and mortality in two Southern California counties. Environ Res. 1995 Aug;70(2):98–104. doi: 10.1006/enrs.1995.1053. [DOI] [PubMed] [Google Scholar]
  38. Peters J. M., Avol E., Navidi W., London S. J., Gauderman W. J., Lurmann F., Linn W. S., Margolis H., Rappaport E., Gong H. A study of twelve Southern California communities with differing levels and types of air pollution. I. Prevalence of respiratory morbidity. Am J Respir Crit Care Med. 1999 Mar;159(3):760–767. doi: 10.1164/ajrccm.159.3.9804143. [DOI] [PubMed] [Google Scholar]
  39. Pope C. A., 3rd, Bates D. V., Raizenne M. E. Health effects of particulate air pollution: time for reassessment? Environ Health Perspect. 1995 May;103(5):472–480. doi: 10.1289/ehp.95103472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Pope C. A., 3rd, Dockery D. W. Acute health effects of PM10 pollution on symptomatic and asymptomatic children. Am Rev Respir Dis. 1992 May;145(5):1123–1128. doi: 10.1164/ajrccm/145.5.1123. [DOI] [PubMed] [Google Scholar]
  41. Pope C. A., 3rd Particulate pollution and health: a review of the Utah valley experience. J Expo Anal Environ Epidemiol. 1996 Jan-Mar;6(1):23–34. [PubMed] [Google Scholar]
  42. Pope C. A., 3rd Respiratory hospital admissions associated with PM10 pollution in Utah, Salt Lake, and Cache Valleys. Arch Environ Health. 1991 Mar-Apr;46(2):90–97. doi: 10.1080/00039896.1991.9937434. [DOI] [PubMed] [Google Scholar]
  43. Pope C. A., 3rd, Schwartz J., Ransom M. R. Daily mortality and PM10 pollution in Utah Valley. Arch Environ Health. 1992 May-Jun;47(3):211–217. doi: 10.1080/00039896.1992.9938351. [DOI] [PubMed] [Google Scholar]
  44. Pope C. A., 3rd, Thun M. J., Namboodiri M. M., Dockery D. W., Evans J. S., Speizer F. E., Heath C. W., Jr Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):669–674. doi: 10.1164/ajrccm/151.3_Pt_1.669. [DOI] [PubMed] [Google Scholar]
  45. Ramadour M., Burel C., Lanteaume A., Vervloet D., Charpin D., Brisse F., Dutau H., Charpin D. Prevalence of asthma and rhinitis in relation to long-term exposure to gaseous air pollutants. Allergy. 2000 Dec;55(12):1163–1169. doi: 10.1034/j.1398-9995.2000.00637.x. [DOI] [PubMed] [Google Scholar]
  46. Ritz B., Yu F., Chapa G., Fruin S. Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993. Epidemiology. 2000 Sep;11(5):502–511. doi: 10.1097/00001648-200009000-00004. [DOI] [PubMed] [Google Scholar]
  47. Ritz B., Yu F. The effect of ambient carbon monoxide on low birth weight among children born in southern California between 1989 and 1993. Environ Health Perspect. 1999 Jan;107(1):17–25. doi: 10.1289/ehp.9910717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Rogers J. F., Thompson S. J., Addy C. L., McKeown R. E., Cowen D. J., Decouflé P. Association of very low birth weight with exposures to environmental sulfur dioxide and total suspended particulates. Am J Epidemiol. 2000 Mar 15;151(6):602–613. doi: 10.1093/oxfordjournals.aje.a010248. [DOI] [PubMed] [Google Scholar]
  49. Romieu I., Meneses F., Ruiz S., Sienra J. J., Huerta J., White M. C., Etzel R. A. Effects of air pollution on the respiratory health of asthmatic children living in Mexico City. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):300–307. doi: 10.1164/ajrccm.154.2.8756798. [DOI] [PubMed] [Google Scholar]
  50. Schmitzberger R., Rhomberg K., Büchele H., Puchegger R., Schmitzberger-Natzmer D., Kemmler G., Panosch B. Effects of air pollution on the respiratory tract of children. Pediatr Pulmonol. 1993 Feb;15(2):68–74. doi: 10.1002/ppul.1950150203. [DOI] [PubMed] [Google Scholar]
  51. Schwartz J., Dockery D. W. Increased mortality in Philadelphia associated with daily air pollution concentrations. Am Rev Respir Dis. 1992 Mar;145(3):600–604. doi: 10.1164/ajrccm/145.3.600. [DOI] [PubMed] [Google Scholar]
  52. Schwartz J., Dockery D. W. Particulate air pollution and daily mortality in Steubenville, Ohio. Am J Epidemiol. 1992 Jan 1;135(1):12–25. doi: 10.1093/oxfordjournals.aje.a116195. [DOI] [PubMed] [Google Scholar]
  53. Schwartz J. Lung function and chronic exposure to air pollution: a cross-sectional analysis of NHANES II. Environ Res. 1989 Dec;50(2):309–321. doi: 10.1016/s0013-9351(89)80012-x. [DOI] [PubMed] [Google Scholar]
  54. Schwartz J. PM10, ozone, and hospital admissions for the elderly in Minneapolis-St. Paul, Minnesota. Arch Environ Health. 1994 Sep-Oct;49(5):366–374. doi: 10.1080/00039896.1994.9954989. [DOI] [PubMed] [Google Scholar]
  55. Schwartz J. Particulate air pollution and chronic respiratory disease. Environ Res. 1993 Jul;62(1):7–13. doi: 10.1006/enrs.1993.1083. [DOI] [PubMed] [Google Scholar]
  56. Spengler J. D., Koutrakis P., Dockery D. W., Raizenne M., Speizer F. E. Health effects of acid aerosols on North American children: air pollution exposures. Environ Health Perspect. 1996 May;104(5):492–499. doi: 10.1289/ehp.96104492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Studnicka M., Hackl E., Pischinger J., Fangmeyer C., Haschke N., Kühr J., Urbanek R., Neumann M., Frischer T. Traffic-related NO2 and the prevalence of asthma and respiratory symptoms in seven year olds. Eur Respir J. 1997 Oct;10(10):2275–2278. doi: 10.1183/09031936.97.10102275. [DOI] [PubMed] [Google Scholar]
  58. Thurston G. D., Ito K., Hayes C. G., Bates D. V., Lippmann M. Respiratory hospital admissions and summertime haze air pollution in Toronto, Ontario: consideration of the role of acid aerosols. Environ Res. 1994 May;65(2):271–290. doi: 10.1006/enrs.1994.1037. [DOI] [PubMed] [Google Scholar]
  59. Thurston G. D., Lippmann M., Scott M. B., Fine J. M. Summertime haze air pollution and children with asthma. Am J Respir Crit Care Med. 1997 Feb;155(2):654–660. doi: 10.1164/ajrccm.155.2.9032209. [DOI] [PubMed] [Google Scholar]
  60. Tolbert P. E., Mulholland J. A., MacIntosh D. L., Xu F., Daniels D., Devine O. J., Carlin B. P., Klein M., Dorley J., Butler A. J. Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia, USA. Am J Epidemiol. 2000 Apr 15;151(8):798–810. doi: 10.1093/oxfordjournals.aje.a010280. [DOI] [PubMed] [Google Scholar]
  61. Tseng R. Y., Li C. K., Spinks J. A. Particulate air pollution and hospitalization for asthma. Ann Allergy. 1992 May;68(5):425–432. [PubMed] [Google Scholar]
  62. Walters S., Phupinyokul M., Ayres J. Hospital admission rates for asthma and respiratory disease in the West Midlands: their relationship to air pollution levels. Thorax. 1995 Sep;50(9):948–954. doi: 10.1136/thx.50.9.948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Wang X., Ding H., Ryan L., Xu X. Association between air pollution and low birth weight: a community-based study. Environ Health Perspect. 1997 May;105(5):514–520. doi: 10.1289/ehp.97105514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Ware J. H., Ferris B. G., Jr, Dockery D. W., Spengler J. D., Stram D. O., Speizer F. E. Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children. Am Rev Respir Dis. 1986 May;133(5):834–842. [PubMed] [Google Scholar]
  65. Woodruff T. J., Grillo J., Schoendorf K. C. The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environ Health Perspect. 1997 Jun;105(6):608–612. doi: 10.1289/ehp.97105608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Zemp E., Elsasser S., Schindler C., Künzli N., Perruchoud A. P., Domenighetti G., Medici T., Ackermann-Liebrich U., Leuenberger P., Monn C. Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA study). The SAPALDIA Team. Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1257–1266. doi: 10.1164/ajrccm.159.4.9807052. [DOI] [PubMed] [Google Scholar]
  67. Zmirou D., Schwartz J., Saez M., Zanobetti A., Wojtyniak B., Touloumi G., Spix C., Ponce de León A., Le Moullec Y., Bacharova L. Time-series analysis of air pollution and cause-specific mortality. Epidemiology. 1998 Sep;9(5):495–503. [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES