Monetizing the Burden of Childhood Asthma Due to Traffic Related Air Pollution in the Contiguous United States in 2010.

BACKGROUND: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. OBJECTIVE: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. METHODS: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. RESULTS: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95$101,019,728.20-$256,980,126.65). The state with the highest cost burden is California with$24,501,859.84 (95% CI: $10,020,182.62-$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95$33,491.06-$144,269.18). CONCLUSION: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP's impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population's exposure

Traffic-Related Air Pollution and Childhood Asthma: Recent Advances and Remaining Gaps in the Exposure Assessment Methods

Background: Current levels of traffic-related air pollution (TRAP) are associated with the development of childhood asthma, although some inconsistencies and heterogeneity remain. An important part of the uncertainty in studies of TRAP-associated asthma originates from uncertainties in the TRAP exposure assessment and assignment methods. In this work, we aim to systematically review the exposure assessment methods used in the epidemiology of TRAP and childhood asthma, highlight recent advances, remaining research gaps and make suggestions for further research. Methods: We systematically reviewed epidemiological studies published up until 8 September 2016 and available in Embase, Ovid MEDLINE (R), and “Transport database”. We included studies which examined the association between children’s exposure to TRAP metrics and their risk of “asthma” incidence or lifetime prevalence, from birth to the age of 18 years old. Results: We found 42 studies which examined the associations between TRAP and subsequent childhood asthma incidence or lifetime prevalence, published since 1999. Land-use regression modelling was the most commonly used method and nitrogen dioxide (NO2) was the most commonly used pollutant in the exposure assessments. Most studies estimated TRAP exposure at the residential address and only a few considered the participants’ mobility. TRAP exposure was mostly assessed at the birth year and only a few studies considered different and/or multiple exposure time windows. We recommend that further work is needed including e.g., the use of new exposure metrics such as the composition of particulate matter, oxidative potential and ultra-fine particles, improved modelling e.g., by combining different exposure assessment models, including mobility of the participants, and systematically investigating different exposure time windows. Conclusions: Although our previous meta-analysis found statistically significant associations for various TRAP exposures and subsequent childhood asthma, further refinement of the exposure assessment may improve the risk estimates, and shed light on critical exposure time windows, putative agents, underlying mechanisms and drivers of heterogeneity

Exposure to Traffic-related Air Pollution and the Onset of Childhood Asthma: A Review of the Literature and the Assement Methods Used

The overall objective of this study is to examine the literature investigating the associations between traffic-related air pollution (TRAP) and the incidence and prevalence of childhood asthma throughout a critical literature review The study examines and demonstrates the association between TRAP and childhood asthma, the literature associated with it, and the gaps in the current state of research. The exposure assessment methods currently in use in the literature are also overviewed and critically discussed for strengths and limitations

Early-Life Exposure to Traffic-Related Air Pollution and Risk of Development of Childhood Asthma: A Systematic Review and Meta-Analysis, a Novel Exposure Assessment Study and a Health Impact Assessment

Asthma is the most common chronic disease of childhood. In this thesis, I investigated whether there is an association between traffic-related air pollution (TRAP) and the development of childhood asthma, quantified the magnitude of this association and estimated its public health impact in Bradford, UK. For these purposes, I conducted a systematic review and a meta-analysis. I then developed a new vehicle emission model to estimate traffic NOx and compared it to the standard European model. Subsequently, I set up and validated two full-chain health impact assessment models; linking distinct traffic, emissions, atmospheric dispersion and health impact models. Each full-chain model was underlined by a different vehicle emission model, the new and the standard one, and as such I tested the sensitivity of final air quality and health impact estimates to the vehicle emission estimates. I estimated the childhood population exposure to NO2 and NOx at the smallest census tract level and quantified the annual number of asthma cases associated with these exposures, whilst disentangling the impacts of traffic-related NO2 and NOx, and also the impacts of traffic-related NO2 and NOx specifically from minor roads and cold starts. I compared the full-chain models’ estimates to estimates from commonly used land-use regression models which further provided exposure and health impact estimates for black carbon, PM2.5 and PM10. I quantified positive and statistically significant associations for black carbon, NO2, PM2.5, PM10 and risk of childhood asthma. The association with NOx was positive but not statistically significant. I showed that the new vehicle emission model, as compared to the standard model, resulted in different source apportionment and higher emissions at low average speeds. These differences, however, did not translate into meaningful differences in air quality or health impacts, partly due to limitations in the traffic data which underestimated congestion. The full-chain models estimated NO2 and NOx with satisfactory predictive power but resulted in lower exposures and health impacts as compared to land-use regression. I estimated that 15% to 38% of all asthma cases in Bradford may be attributable to air pollution. Up to 6% and 12% of all cases were specifically attributable to TRAP, with and without minor roads and cold starts, respectively, but this percentage was underestimated. Full-chain health impact modelling was demonstrated as a valuable but underutilized tool to estimate the burden of disease associated with TRAP and to test the impacts of specific policy scenarios with a temporal and/or spatial element. There is a further need to improve the feasibility, utility, resolution and validity of the supporting data and the full-chain modelling approach, especially by addressing its underestimation of TRAP, and consequently, the associated health impacts

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

Burden of disease from transportation noise and motor vehicle crashes: Analysis of data from Houston, Texas

Background: Transportation systems have an essential role in satisfying individuals' needs for mobility and accessibility. Yet, they have been linked to several adverse health impacts, with a large, but modifiable, burden of disease. Among the several transportation-related health risk factors, this study focused on transportation-related noise as an emerging exposure whose burden of disease remains partially recognized. We compared premature deaths potentially attributable to transportation-related noise with deaths from motor vehicle crashes, a well-researched and widely recognized transportation risk factor. Method: We employed a standard burden of disease assessment framework to quantify premature cardiovascular diseases mortality attributable to transportation-related (road and aviation) noise at the census tract level (n = 592) in Houston, Texas. The results were compared to motor vehicle crash fatalities, which are routinely observed and collected in the study area. We also investigated the distribution of premature deaths across the city and explored the relationship between household median income and premature deaths attributable to transportation-related noise. Results: We estimated 302 (95% CI: 185-427) premature deaths (adults 30-75 years old) attributable to transportation-related noise in Houston, compared to 330 fatalities from motor vehicle crashes (adults younger than 75 years old). Transportation-related noise and motor vehicle crashes were responsible for 1.7% and 1.9% of all-cause premature deaths in Houston, respectively. Households with lower median income had a higher risk of adverse exposure and premature deaths potentially attributable to transportation-related noise. A larger number of premature deaths was associated with living in the central business district and the vicinity of highways and airports. Conclusion: This study highlighted the significant contribution of transportation-related noise and motor vehicle crashes to premature deaths in the city of Houston. The analogy between the estimated premature deaths attributable to transportation-related noise and motor vehicle crashes showed that the health impacts of transportation-related noise were as significant as motor vehicle crashes. The estimated premature death rate attributable to transportation-related noise was also comparable to the death rate caused by suicide, influenza, or pneumonia in the US. There is an urgent need for imposing policies to reduce transportation noise emissions and human exposures and to equip health impact assessment tools with a noise burden of disease analysis function

Transport and health ; present and future

In this chapter, we provide a summary of the book for transport and its effects on health, recent and future developments, tools, designs and policies, and education and workforce development. Transport is an essential component of economic and social progress and is often envisioned as a driver for urban development and a key contributor to economic returns. Yet, transport has direct negative, and potentially positive, impacts on the health of a population. These impacts are modifiable. Transport is also important to raise economic standards and thereby health. This book summarizes an impressive evidence base and shows that transport still poses many negative environmental, climate, social, and health impacts that can and should be reduced. This is not easy and needs strategic and systemic approaches with long-term vision and commitment. New technologies such as electrification and the integration of autonomous vehicles into the market can address some of these concerns. However, many profound changes are needed to make a larger impact, including land use, life style, and behavioral and social changes, some of which have been discussed in this book. Throughout the book the consensus was that we need more multidisciplinary and systemic approaches that address not only one aspect or one exposure but also tackles issues more holistically and avoid (unintended) negative consequences