Skip to main content
PMC home page
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 1996 Aug;104(8):838–850. doi: 10.1289/ehp.96104838

Health and respirable particulate (PM10) air pollution: a causal or statistical association?

J F Gamble 1, R J Lewis 1
PMCID: PMC1469433  PMID: 8875158

Abstract

Numerous studies have reported weak but statistically significant acute health effects of particulate air pollution. The associations are observed at levels below the current U.S. standard of 150 micrograms/m3 (24 hr). Health effects include acute increased mortality from cardiopulmonary conditions and acute morbidity such as hospital admissions for related diseases. We reviewed recent epidemiology studies to evaluate whether criteria for causality are met, and we conclude that they are not. The weak associations are as likely to be due to confounding by weather, copollutants, or exposure misclassification as by ambient particulate matter (PM). The results from the same metropolitan areas are inconsistent, and PM explains such a small amount of the variability in mortality/morbidity that the association has little practical significance. Finally, experimental chamber studies of susceptible individuals exposed to PM concentrations well above 150 micrograms/m3 provide no evidence to support the morbidity/mortality findings. None of the criteria for establishing causality of the PM/mortality hypothesis are clearly met at ambient concentrations common in many U.S. cities.

Full text

PDF
840

Images in this article

838p838-a
on p.838
843Figure 1.
on p.843

Selected References

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

  1. Avol E. L., Linn W. S., Whynot J. D., Anderson K. R., Shamoo D. A., Valencia L. M., Little D. E., Hackney J. D. Respiratory dose-response study of normal and asthmatic volunteers exposed to sulfuric acid aerosol in the sub-micrometer size range. Toxicol Ind Health. 1988 Jun;4(2):173–184. doi: 10.1177/074823378800400203. [DOI] [PubMed] [Google Scholar]
  2. Avol E. L., Linn W. S., Wightman L. H., Whynot J. D., Anderson K. R., Hackney J. D. Short-term respiratory effects of sulfuric acid in fog: a laboratory study of healthy and asthmatic volunteers. JAPCA. 1988 Mar;38(3):258–263. doi: 10.1080/08940630.1988.10466375. [DOI] [PubMed] [Google Scholar]
  3. Banner A. S., Shah R. S., Addington W. W. Rapid prediction of need for hospitalization in acute asthma. JAMA. 1976 Mar 29;235(13):1337–1338. [PubMed] [Google Scholar]
  4. Bates D. V., Baker-Anderson M., Sizto R. Asthma attack periodicity: a study of hospital emergency visits in Vancouver. Environ Res. 1990 Feb;51(1):51–70. doi: 10.1016/s0013-9351(05)80182-3. [DOI] [PubMed] [Google Scholar]
  5. Bates D. V. Health indices of the adverse effects of air pollution: the question of coherence. Environ Res. 1992 Dec;59(2):336–349. doi: 10.1016/s0013-9351(05)80040-4. [DOI] [PubMed] [Google Scholar]
  6. Bates D. V., Sizto R. Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect. Environ Res. 1987 Aug;43(2):317–331. doi: 10.1016/s0013-9351(87)80032-4. [DOI] [PubMed] [Google Scholar]
  7. Brenner H., Savitz D. A., Jöckel K. H., Greenland S. Effects of nondifferential exposure misclassification in ecologic studies. Am J Epidemiol. 1992 Jan 1;135(1):85–95. doi: 10.1093/oxfordjournals.aje.a116205. [DOI] [PubMed] [Google Scholar]
  8. Bull G. M. The weather and deaths from pneumonia. Lancet. 1980 Jun 28;1(8183):1405–1408. doi: 10.1016/s0140-6736(80)92666-5. [DOI] [PubMed] [Google Scholar]
  9. Canny G. J., Reisman J., Healy R., Schwartz C., Petrou C., Rebuck A. S., Levison H. Acute asthma: observations regarding the management of a pediatric emergency room. Pediatrics. 1989 Apr;83(4):507–512. [PubMed] [Google Scholar]
  10. Cohen B. L. Invited commentary: in defense of ecologic studies for testing a linear-no threshold theory. Am J Epidemiol. 1994 Apr 15;139(8):765–771. doi: 10.1093/oxfordjournals.aje.a117071. [DOI] [PubMed] [Google Scholar]
  11. Derriennic F., Richardson S., Mollie A., Lellouch J. Short-term effects of sulphur dioxide pollution on mortality in two French cities. Int J Epidemiol. 1989 Mar;18(1):186–197. doi: 10.1093/ije/18.1.186. [DOI] [PubMed] [Google Scholar]
  12. Dockery D. W., Schwartz J. Particulate air pollution and mortality: more than the Philadelphia story. Epidemiology. 1995 Nov;6(6):629–632. [PubMed] [Google Scholar]
  13. Dockery D. W., Schwartz J., Spengler J. D. Air pollution and daily mortality: associations with particulates and acid aerosols. Environ Res. 1992 Dec;59(2):362–373. doi: 10.1016/s0013-9351(05)80042-8. [DOI] [PubMed] [Google Scholar]
  14. Dockery D. W., Spengler J. D. Personal exposure to respirable particulates and sulfates. J Air Pollut Control Assoc. 1981 Feb;31(2):153–159. doi: 10.1080/00022470.1981.10465205. [DOI] [PubMed] [Google Scholar]
  15. Dunnigan M. G., Harland W. A., Fyfe T. Seasonal incidence and mortality of ischaemic heart-disease. Lancet. 1970 Oct 17;2(7677):793–797. doi: 10.1016/s0140-6736(70)91460-1. [DOI] [PubMed] [Google Scholar]
  16. Fairley D. The relationship of daily mortality to suspended particulates in Santa Clara County, 1980-1986. Environ Health Perspect. 1990 Nov;89:159–168. doi: 10.1289/ehp.9089159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Fanta C. H., Rossing T. H., McFadden E. R., Jr Emergency room of treatment of asthma. Relationships among therapeutic combinations, severity of obstruction and time course of response. Am J Med. 1982 Mar;72(3):416–422. doi: 10.1016/0002-9343(82)90498-3. [DOI] [PubMed] [Google Scholar]
  18. Greenland S., Morgenstern H. Ecological bias, confounding, and effect modification. Int J Epidemiol. 1989 Mar;18(1):269–274. doi: 10.1093/ije/18.1.269. [DOI] [PubMed] [Google Scholar]
  19. HILL A. B. THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION? Proc R Soc Med. 1965 May;58:295–300. [PMC free article] [PubMed] [Google Scholar]
  20. Hillman D. R., Prentice L., Finucane K. E. The pattern of breathing in acute severe asthma. Am Rev Respir Dis. 1986 Apr;133(4):587–592. doi: 10.1164/arrd.1986.133.4.587. [DOI] [PubMed] [Google Scholar]
  21. Hoek G., Brunekreef B. Acute effects of a winter air pollution episode on pulmonary function and respiratory symptoms of children. Arch Environ Health. 1993 Sep-Oct;48(5):328–335. doi: 10.1080/00039896.1993.9936721. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. Kalkstein L. S. A new approach to evaluate the impact of climate on human mortality. Environ Health Perspect. 1991 Dec;96:145–150. doi: 10.1289/ehp.9196145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Khaw K. T. Temperature and cardiovascular mortality. Lancet. 1995 Feb 11;345(8946):337–338. doi: 10.1016/s0140-6736(95)90336-4. [DOI] [PubMed] [Google Scholar]
  25. Kleinman M. T., Bailey R. M., Whynot J. D., Anderson K. R., Linn W. S., Hackney J. D. Controlled exposure to a mixture of SO2, NO2, and particulate air pollutants: effects on human pulmonary function and respiratory symptoms. Arch Environ Health. 1985 Jul-Aug;40(4):197–201. doi: 10.1080/00039896.1985.10545917. [DOI] [PubMed] [Google Scholar]
  26. Kunst A. E., Looman C. W., Mackenbach J. P. Outdoor air temperature and mortality in The Netherlands: a time-series analysis. Am J Epidemiol. 1993 Feb 1;137(3):331–341. doi: 10.1093/oxfordjournals.aje.a116680. [DOI] [PubMed] [Google Scholar]
  27. Lebowitz M. D., Collins L., Holberg C. J. Time series analyses of respiratory responses to indoor and outdoor environmental phenomena. Environ Res. 1987 Aug;43(2):332–341. doi: 10.1016/s0013-9351(87)80033-6. [DOI] [PubMed] [Google Scholar]
  28. Lim T. K., Ang S. M., Rossing T. H., Ingenito E. P., Ingram R. H., Jr The effects of deep inhalation on maximal expiratory flow during intensive treatment of spontaneous asthmatic episodes. Am Rev Respir Dis. 1989 Aug;140(2):340–343. doi: 10.1164/ajrccm/140.2.340. [DOI] [PubMed] [Google Scholar]
  29. Linn W. S., Avol E. L., Anderson K. R., Shamoo D. A., Peng R. C., Hackney J. D. Effect of droplet size on respiratory responses to inhaled sulfuric acid in normal and asthmatic volunteers. Am Rev Respir Dis. 1989 Jul;140(1):161–166. doi: 10.1164/ajrccm/140.1.161. [DOI] [PubMed] [Google Scholar]
  30. 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]
  31. Mackenbach J. P., Looman C. W., Kunst A. E. Air pollution, lagged effects of temperature, and mortality: The Netherlands 1979-87. J Epidemiol Community Health. 1993 Apr;47(2):121–126. doi: 10.1136/jech.47.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. McFadden E. R., Jr, Kiser R., DeGroot W. J. Acute bronchial asthma. Relations between clinical and physiologic manifestations. N Engl J Med. 1973 Feb 1;288(5):221–225. doi: 10.1056/NEJM197302012880501. [DOI] [PubMed] [Google Scholar]
  33. Menon P., Rando R. J., Stankus R. P., Salvaggio J. E., Lehrer S. B. Passive cigarette smoke-challenge studies: increase in bronchial hyperreactivity. J Allergy Clin Immunol. 1992 Feb;89(2):560–566. doi: 10.1016/0091-6749(92)90323-t. [DOI] [PubMed] [Google Scholar]
  34. Moolgavkar S. H., Luebeck E. G., Hall T. A., Anderson E. L. Air pollution and daily mortality in Philadelphia. Epidemiology. 1995 Sep;6(5):476–484. doi: 10.1097/00001648-199509000-00003. [DOI] [PubMed] [Google Scholar]
  35. Oberdorster G., Gelein R. M., Ferin J., Weiss B. Association of particulate air pollution and acute mortality: involvement of ultrafine particles? Inhal Toxicol. 1995 Jan-Feb;7(1):111–124. doi: 10.3109/08958379509014275. [DOI] [PubMed] [Google Scholar]
  36. Oberdörster G. Airborne pollutants and acute health effects. Lancet. 1995 Mar 25;345(8952):799–800. [PubMed] [Google Scholar]
  37. Ostro B. D., Lipsett M. J., Mann J. K., Krupnick A., Harrington W. Air pollution and respiratory morbidity among adults in southern California. Am J Epidemiol. 1993 Apr 1;137(7):691–700. doi: 10.1093/oxfordjournals.aje.a116729. [DOI] [PubMed] [Google Scholar]
  38. Ostro B. The association of air pollution and mortality: examining the case for inference. Arch Environ Health. 1993 Sep-Oct;48(5):336–342. doi: 10.1080/00039896.1993.9936722. [DOI] [PubMed] [Google Scholar]
  39. Pan W. H., Li L. A., Tsai M. J. Temperature extremes and mortality from coronary heart disease and cerebral infarction in elderly Chinese. Lancet. 1995 Feb 11;345(8946):353–355. doi: 10.1016/s0140-6736(95)90341-0. [DOI] [PubMed] [Google Scholar]
  40. Piantadosi S., Byar D. P., Green S. B. The ecological fallacy. Am J Epidemiol. 1988 May;127(5):893–904. doi: 10.1093/oxfordjournals.aje.a114892. [DOI] [PubMed] [Google Scholar]
  41. 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]
  42. 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]
  43. Pope C. A., 3rd, Dockery D. W., Spengler J. D., Raizenne M. E. Respiratory health and PM10 pollution. A daily time series analysis. Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):668–674. doi: 10.1164/ajrccm/144.3_Pt_1.668. [DOI] [PubMed] [Google Scholar]
  44. 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]
  45. Richardson S., Stücker I., Hémon D. Comparison of relative risks obtained in ecological and individual studies: some methodological considerations. Int J Epidemiol. 1987 Mar;16(1):111–120. doi: 10.1093/ije/16.1.111. [DOI] [PubMed] [Google Scholar]
  46. Rogot E., Padgett S. J. Associations of coronary and stroke mortality with temperature and snowfall in selected areas of the United States, 1962-1966. Am J Epidemiol. 1976 Jun;103(6):565–575. doi: 10.1093/oxfordjournals.aje.a112261. [DOI] [PubMed] [Google Scholar]
  47. Rothman K. J., Poole C. A strengthening programme for weak associations. Int J Epidemiol. 1988 Dec;17(4):955–959. doi: 10.1093/ije/17.4.955. [DOI] [PubMed] [Google Scholar]
  48. Sackett D. L. Bias in analytic research. J Chronic Dis. 1979;32(1-2):51–63. doi: 10.1016/0021-9681(79)90012-2. [DOI] [PubMed] [Google Scholar]
  49. Saldiva P. H., Lichtenfels A. J., Paiva P. S., Barone I. A., Martins M. A., Massad E., Pereira J. C., Xavier V. P., Singer J. M., Böhm G. M. Association between air pollution and mortality due to respiratory diseases in children in São Paulo, Brazil: a preliminary report. Environ Res. 1994 May;65(2):218–225. doi: 10.1006/enrs.1994.1033. [DOI] [PubMed] [Google Scholar]
  50. Saldiva P. H., Pope C. A., 3rd, Schwartz J., Dockery D. W., Lichtenfels A. J., Salge J. M., Barone I., Bohm G. M. Air pollution and mortality in elderly people: a time-series study in Sao Paulo, Brazil. Arch Environ Health. 1995 Mar-Apr;50(2):159–163. doi: 10.1080/00039896.1995.9940893. [DOI] [PubMed] [Google Scholar]
  51. Samet J. M., Bishop Y., Speizer F. E., Spengler J. D., Ferris B. G., Jr The relationship between air pollution and emergency room visits in an industrial community. J Air Pollut Control Assoc. 1981 Mar;31(3):236–240. doi: 10.1080/00022470.1981.10465214. [DOI] [PubMed] [Google Scholar]
  52. Samet J. M. Particulate air pollution and mortality: the Philadelphia story. Epidemiology. 1995 Sep;6(5):471–473. doi: 10.1097/00001648-199509000-00001. [DOI] [PubMed] [Google Scholar]
  53. Schwartz J. Air pollution and daily mortality in Birmingham, Alabama. Am J Epidemiol. 1993 May 15;137(10):1136–1147. doi: 10.1093/oxfordjournals.aje.a116617. [DOI] [PubMed] [Google Scholar]
  54. Schwartz J. Air pollution and daily mortality: a review and meta analysis. Environ Res. 1994 Jan;64(1):36–52. doi: 10.1006/enrs.1994.1005. [DOI] [PubMed] [Google Scholar]
  55. Schwartz J. Air pollution and hospital admissions for the elderly in Birmingham, Alabama. Am J Epidemiol. 1994 Mar 15;139(6):589–598. doi: 10.1093/oxfordjournals.aje.a117048. [DOI] [PubMed] [Google Scholar]
  56. Schwartz J. Air pollution and hospital admissions for the elderly in Detroit, Michigan. Am J Respir Crit Care Med. 1994 Sep;150(3):648–655. doi: 10.1164/ajrccm.150.3.8087333. [DOI] [PubMed] [Google Scholar]
  57. 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]
  58. 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]
  59. Schwartz J. Particulate air pollution and daily mortality in Detroit. Environ Res. 1991 Dec;56(2):204–213. doi: 10.1016/s0013-9351(05)80009-x. [DOI] [PubMed] [Google Scholar]
  60. Schwartz J. Short term fluctuations in air pollution and hospital admissions of the elderly for respiratory disease. Thorax. 1995 May;50(5):531–538. doi: 10.1136/thx.50.5.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Schwartz J., Slater D., Larson T. V., Pierson W. E., Koenig J. Q. Particulate air pollution and hospital emergency room visits for asthma in Seattle. Am Rev Respir Dis. 1993 Apr;147(4):826–831. doi: 10.1164/ajrccm/147.4.826. [DOI] [PubMed] [Google Scholar]
  62. Schwartz J., Spix C., Wichmann H. E., Malin E. Air pollution and acute respiratory illness in five German communities. Environ Res. 1991 Oct;56(1):1–14. doi: 10.1016/s0013-9351(05)80104-5. [DOI] [PubMed] [Google Scholar]
  63. Schwartz J. Total suspended particulate matter and daily mortality in Cincinnati, Ohio. Environ Health Perspect. 1994 Feb;102(2):186–189. doi: 10.1289/ehp.94102186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Schwartz J. What are people dying of on high air pollution days? Environ Res. 1994 Jan;64(1):26–35. doi: 10.1006/enrs.1994.1004. [DOI] [PubMed] [Google Scholar]
  65. Schwartz S. The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences. Am J Public Health. 1994 May;84(5):819–824. doi: 10.2105/ajph.84.5.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Seaton A., MacNee W., Donaldson K., Godden D. Particulate air pollution and acute health effects. Lancet. 1995 Jan 21;345(8943):176–178. doi: 10.1016/s0140-6736(95)90173-6. [DOI] [PubMed] [Google Scholar]
  67. Silverman F., Hosein H. R., Corey P., Holton S., Tarlo S. M. Effects of particulate matter exposure and medication use on asthmatics. Arch Environ Health. 1992 Jan-Feb;47(1):51–56. doi: 10.1080/00039896.1992.9935944. [DOI] [PubMed] [Google Scholar]
  68. Stankus R. P., Menon P. K., Rando R. J., Glindmeyer H., Salvaggio J. E., Lehrer S. B. Cigarette smoke-sensitive asthma: challenge studies. J Allergy Clin Immunol. 1988 Sep;82(3 Pt 1):331–338. doi: 10.1016/0091-6749(88)90003-6. [DOI] [PubMed] [Google Scholar]
  69. Stidley C. A., Samet J. M. A review of ecologic studies of lung cancer and indoor radon. Health Phys. 1993 Sep;65(3):234–251. doi: 10.1097/00004032-199309000-00001. [DOI] [PubMed] [Google Scholar]
  70. Styer P., McMillan N., Gao F., Davis J., Sacks J. Effect of outdoor airborne particulate matter on daily death counts. Environ Health Perspect. 1995 May;103(5):490–497. doi: 10.1289/ehp.95103490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Sunyer J., Sáez M., Murillo C., Castellsague J., Martínez F., Antó J. M. Air pollution and emergency room admissions for chronic obstructive pulmonary disease: a 5-year study. Am J Epidemiol. 1993 Apr 1;137(7):701–705. doi: 10.1093/oxfordjournals.aje.a116730. [DOI] [PubMed] [Google Scholar]
  72. Wilmshurst P. Temperature and cardiovascular mortality. BMJ. 1994 Oct 22;309(6961):1029–1030. doi: 10.1136/bmj.309.6961.1029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Woolcock A. J., Read J. Improvement in bronchial asthma not reflected in forced expiratory volume. Lancet. 1965 Dec 25;2(7426):1323–1325. doi: 10.1016/s0140-6736(65)92343-3. [DOI] [PubMed] [Google Scholar]
  74. Xu X., Gao J., Dockery D. W., Chen Y. Air pollution and daily mortality in residential areas of Beijing, China. Arch Environ Health. 1994 Jul-Aug;49(4):216–222. doi: 10.1080/00039896.1994.9937470. [DOI] [PubMed] [Google Scholar]
  75. Yang S. C., Yang S. P. Respiratory function changes from inhalation of polluted air. Arch Environ Health. 1994 May-Jun;49(3):182–187. doi: 10.1080/00039896.1994.9940380. [DOI] [PubMed] [Google Scholar]

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

RESOURCES