Long-term ambient concentrations of total suspended particulates, ozone, and sulfur dioxide and respiratory symptoms in a nonsmoking population

TY - JOUR

T1 - Long-term ambient concentrations of total suspended particulates, ozone, and sulfur dioxide and respiratory symptoms in a nonsmoking population

AU - Abbey, David E.

AU - Petersen, Floyd

AU - Mills, Paul K.

AU - Lawrence Beeson, W.

N1 - Funding Information: grant numbers A833-057 and A933-160 and by University of California grant number 21T 0093. Funding Information: ********** This research was supported by the California Air Resources Board Funding Information: in the current study had completed a detailed lifestyle questionnaire in 1976 as part of the Adventist Health Study (AHS), a study of lifestyle and cancer in SDAs funded by the National Institutes of Health (NIH)." This questionnaire ascertained demographic and dietary information and lifestyle factors thought to be related to cancer and heart disease incidence. In April 1977, a subset (n - 7 445) of the subjects who had completed the AHS questionnaire completed the standardized respiratory symptoms questionnaire developed originally by the BMRC and modified in 1971 for use in the United States by the National Heart and Lung Institute (NHLI, now known as NHLBI). The questionnaire was used to determine self-reported symptoms of chronic respiratory disease. In addition, detailed personal smoking histories were obtained as were histories of ever having lived or worked with a smoker and the duration of those exposures. Residence and work location histories were ascertained by month and zip code since 1966. The questionnaire contained queries about lifestyle factors pertinent to relative air pollution exposure, such as occupational exposures, hours spent driving on crowded freeways, percentage of time spent indoors and outdoors, etc. The response fraction to the 1977 questionnaire was 87%. Of the 7 445 individuals who completed the April 1977 questionnaire, 6 340 were followed prospectively for chronic disease incidence and mortality. Individuals included in the prospective cohort met the following criteria: 25 y or older at time time of completing the Adventist Health Ques-tionaire in 1974; baptized member of the Seventh-day Adventist church at the time of enrollment in the AHS; non-Hispanic, white (although individuals of all races completed questionnaires, only non-Hispanic whites were following in the cancer and heart disease surveillance project); living 10 y or longer within 8 km (5 miles) of the current residence; and residing in one of three metropolitan areas-San Francisco, the South Coast Air Basin (i.e., Los Angeles and eastward), or San Diego, or being included in a random sample of 862 individuals residing in the rest of California. Of the 5 261 individuals who were not deceased by April 1987, 87% returned follow-up questionnaires that contained the Same standardized respiratory symptoms questions of the 1977 questionnaire, plus additional questions from the newly developed ATS questionnaire. The ATS questionnaire also ascertained residence and work location histories since 1977 and household and lifestyle characteristics relevant to relative air pollution exposure. Definition of health outcomes. Computer algorithms developed by Hodgkin' were used to classify individuals as having chronic bronchitis, asthma, or emphysema. The computer algorithms were designed to require clinical significance of symptoms in terms of persistence and severity. These computer algorithms were based on 21 respiratory symptoms questions from the standard NHLI questionnaire. Hodgkin' lists the respiratory symptoms questions that were used and provides the percentage of individuals having each symptom. The computer algorithms classified individuals as having definite symptoms of chronic bronchitis, emphysema, or asthma. Individuals who met the criteria for one of these three diagnoses were classified as having definite AOD symptoms. An individual was classified as having definite chronic bronchitis symptoms if he or she had symptoms of cough and/or sputum production on most days, for at least 3 mo/y, for 2 y or more. A diagnosis of definite asthma was accepted if individuals had been told by their physician that they had asthma, and if they had a history of wheezing. Emphysema was accepted as a diagnosis if the subjects had been told by their physician that they had emphysema and if they experienced shortness of breath when walking or exercising. Individuals who did not meet the criteria for definite symptoms for a respiratory symptoms complex, but who had some respiratory symptoms as- sociated with that complex, were classified as possible. In addition to a classification of none, possible, or definite for each respiratory symptoms complex, a severity score was developed for each complex as well as for overall AOD. The definitions and frequency distributions of these scores are given by Abbey.'* The computer algorithms were used to classify and score the individual's respiratory symptoms complexes, as ascertained by questionnaire in 1977 and again in 1987. The insufficient number of cases of emphysema to warrant disease-specific analyses for this outcome necessitated the restriction of the analyses to three diseases-AOD, chronic bronchitis, and asthma. Three outcomes were defined for each disease: (1) new cases-having definite symptoms in 1987 but not in 1977; (2) persistent prevalences-having definite symptoms in 1977 and 1987; and (3) change in severity score-1987 value minus 1977 value. Methods for estimating cumulative ambient concentration of air pollutants. The methods for estimating cumulative ambient concentrations of air pollutants involved interpolating monthly statistics for each pollutant from fixed-site monitoring stations to zip code centroids and cumulating over the zip code, by month resi- dence and work location history, for each study participant. The relative precision of interpolation was assessed, using fixed-site monitoring stations in turn as receptor sites and interpolating from other stations; we then compared the actual with interpolated values over a 2-y period (1985 and 1986). Interpolated values did not differ significantly from actual values and had high correlations with actual values. The Pearson correlation coefficients between interpolated mean concentrations and actual mean concentrations were 0.83 for TSP, 0.87 for ozone, and 0.64 for SO,; the mean values did not differ significantly. Abbey13 describes the interpolation methods and relative precision assessments in greater detail.

PY - 1993

Y1 - 1993

UR - http://www.scopus.com/inward/record.url?scp=0027481486&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027481486&partnerID=8YFLogxK

U2 - 10.1080/00039896.1993.9938391

DO - 10.1080/00039896.1993.9938391

M3 - Article

C2 - 8452397

SN - 0003-9896

VL - 48

SP - 33

EP - 46

JO - Archives of Environmental Health

JF - Archives of Environmental Health

IS - 1

ER -