Transcript Older Americans 2004

Effects of Air Pollution on the
Health of Older Adults
Mickey Leland National Urban Air
Toxics Research Center and the EPA
June 15, 2005
Changes in Physiology: Nathan
Shock,1960
Courtesy of Dr. Ed Masaro
Air Quality and Human Health
• As people age, their bodies are less able
to compensate for the effects of
environmental hazards.
• An important indicator for environmental
health is the percentage of older adults
living in areas that have measured air
pollutant concentrations above the EPA
established standards.
Indicator 27--Air Quality
• Air pollution can aggravate heart & lung disease,
leading to increased medication use, more visits
to health care providers, admissions to
emergency rooms and hospitals, and even
death.
• Ozone, even at low levels, can exacerbate
respiratory diseases such as chronic obstructive
pulmonary disease (COPD) or asthma.
Ozone and Particulate Matter
• Ozone and particulate matter (PM)
(especially smaller, fine particle pollution
called PM 2.5) have the greatest potential
to affect the health of older adults.
• PM has been linked to premature death,
cardiac arrhythmias and heart attacks,
asthma attacks, and the development of
chronic bronchitis.
Ozone in 2000 and 2002
• In 2002, 46 % of people age 65+ lived in
counties with poor air quality for ozone
compared with 26% in 2000.
• The hot, dry 2002 summer climate was
particularly conducive to the formation of
ground-level ozone, and this, in turn, may
have contributed to the higher ozone
measurements in 2002.
Population 65 Living in Areas with
Poor Air Quality
• The percentage of people 65+ living in counties
that experienced poor air quality for any air
pollutant increased from 41% in 2000 to 49% in
2002.
• This increase was largely due to the increased
number of areas that experienced poor air
quality for ozone in 2001 and 2002.
• Air quality varies across the US, thus, where
people live can affect their health risk.
Older Adults and PM
• A comparison of 2000 and 2002 shows a
reduction in PM 2.5.
• In 2000, 27 percent of people age 65 and
over lived in a county where PM 2.5
concentrations were at times above the
EPA standards compared with 19 percent
of people age 65 and over in 2002.
Older Americans 2004: Key
Indicators of Well-Being
Economic Burden of Chronic
Diseases
• Heart disease, stroke & chronic lung diseases
are exacerbated by air pollution.
• In 2002, we spent $250 billion on these
conditions on direct medical costs. $9 billion in
lost productivity.
•
Source: Morbidity & Mortality: 2002 Chart book on Cardiovascular Lung and Blood Diseases,
National Institutes of Health, NHLBI, May 2002
Air Pollution Can Exacerbate the
Health of Older Adults
• Particle pollution has been linked to asthma attacks, chronic
bronchitis, changes in heart rate, arrhythmias and heart attacks,
among other health problems.
• Ozone presents an increased risk to older adults because it can
aggravate pre-existing respiratory diseases. Older adults
experience reduced sensitivity to symptoms of ozone; therefore,
early warning signs of the harmful effects of ozone may be ignored.
•
Older adults most at risk have underlying cardiovascular and
respiratory diseases.
• Each year, tens of thousands of older adults die prematurely due to
air pollution in the US.
NAS Workshop, December 2002
Cardiovascular Effects of Particulate Matter
• Particulate matter can cause inflammation in the lungs.
• Combustion particles penetrate into the blood and reach the
heart and liver. Particles can lower heart rate variability
which is a risk factor for arrhythmia.
• Hundreds of studies have demonstrated that day-to-day
changes in particles are associated with day-to-day changes
in mortality.
• Most of those excess deaths are cardiovascular deaths, not
respiratory deaths.
Asthma deaths by age, 1999-2000
Deaths per 1,000,000 population
1999
2000
2010 Target
70
60
50
40
30
20
10
0
Under 5
5-14
15-34
35-64
65 and over
Years of age
Source: National Vital Statistics System, CDC, NCHS.
Obj. 24-1 a-e
CA: Older Adults: Highest rate of
daily or weekly symptoms
COPD
• COPD is the 4th leading cause of death in
the US, claiming 119,000 lives each year
• In 2000, COPD was responsible for
726,000 hospitalizations, 1.5 million
hospital emergency room visits and 8
million doctor visits.
Environmental Triggers:
What You Can Do
• Avoid tobacco smoke and Smoke from
wood-burning stoves
• Reduce mold, dust mites & cockroaches in
your home
• Keep pets out of sleeping areas
• Check furnaces and heating units annually
• Fix water leaks promptly
• Check the air quality index
http://www.epa.gov/airnow
Older Adults and COPD
• According to the National Health Interview
Survey in 1999, about 3.1 million persons
over 65 years of age reported having
COPD.
• The COPD mortality rate per 100,000 was
1.8 for persons between the age of 50-54
and 7.6 for persons 75-85 years of age.
Chicago Heat Wave
July 14-July 20, 1995
• 1,000 excess hospital admissions due to
heat stroke, dehydration, heat exhaustion,
renal failure and electrolytic imbalances
• 739 Chicago residents died
Unequaled mortality
• Chicago has no equal in the record of US heat
disasters
• 739 more people died than during a typical week
in July. The proportional death toll from a heat
wave was unprecedented
• The victims were primarily older adults (73%
were over 65 years of age).
Mortality by Sex
• 55% men
• 45% woman
• Age-adjusted death rate men were more than
twice as likely as woman to die
• These figures confused many gerontologists
because they knew that women are more likely
to live alone
Mortality by Race
• Blacks had highest proportional death rate of
any ethnic group
• 1.5:1 in the total age-adjusted population
• Deaths were concentrated in low income,
elderly, black and violent regions of the city
Aging and Dying Alone Not Just in
Chicago
• The number of persons living alone is increasing
everywhere in the world making it one of the
major demographic trends
• Between 1930 and 1995, households with one
person increased from 7% to 25% and the
percentage of people living alone rose from 2% to
10% during this same period. (Census)
North Lawndale
“Dangerous ecology of abandoned
buildings, open spaces, commercial
depletion, violent crime, degraded
infrastructure, low population density, and
family dispersion undermines the viability of
public life and strength of local support
systems.”
Little Village
• “Busy streets, heavy commercial activity,
residential concentration, and relatively low
crime promote social contact collective life,
and public engagement …provide
particular benefits for the elderly who are
more likely to leave home when they are
drawn out by nearby amenities.”
Matching pairs
• North Lawndale: 19 deaths, rate of
40/100,000
• Little Village: 3 deaths, rate of 4/100,000
• Same characteristics
Resources
• You are invited to visit the EPA Aging Initiative
Website www.epa.gov/aging
• Please join our Aging list serve that can be found
on the homepage of the website.
A fact sheet on environmental triggers can be
found in English, Spanish, Chinese, and
Vietnamese at
http://www.epa.gov/aging/resources/epareports.
htm#facts
Resources
• Federal Interagency Forum on Aging- Related
Statistics. Older Americans 2004: Key Indicators
of Well-Being. Washington, D.C. US
Government Printing Office. November 2004
• Heat Wave, A Social Autopsy of Disaster in
Chicago, University of Chicago Press, 2002
Other Resources
• COPD Coalition website http://www.uscopd.com/
• CDC MMWR Article
Chronic Obstructive Pulmonary Disease
Surveillance --- United States, 1971--2000
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5106a1.ht
m#tab1
NHLBI Fact Sheet - What is COPD?
http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_W
hatIs.html