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Statement Of Douglas Hornick
Environmental Protection Agency
Aging Initiative Public Listening Session
Iowa City, Iowa
April 15, 2003
Douglas Hornick
Iowa Thorasic Society and the American Thorasic Society
Iowa Thorasic Society and the American Thorasic Society
My name is Douglas Hornick and I am testifying on behalf of the Iowa Thoracic Society and the American Thoracic Society.
The American Thoracic Society, founded in 1905, is an independently incorporated, international professional and scientific society which focuses on respiratory and critical care medicine. Today, the Society has approximately 13,000 members who help prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy. Our journal, the American Journal of Respiratory and Critical Care Medicine is one of the leading scientific publications that documents the health effects of exposure to air pollution.
My mission today is threefold, to congratulate, to cajole and to express concern.
I first want to congratulate the EPA for focus attention on the interaction between aging, the environment and public health. Overwhelming research results show us that age - both in the early years and the later years of life - play an important role in susceptibility to environmental factors. The young and the old are the most susceptible to negative health effects of air pollution.
It has long been appreciated that exposure to air pollution exacerbates symptoms of respiratory disease, but recent work suggests that exposure to air pollution may be associated with the development of asthma. Investigators in Southern California confirmed a greater than 3 fold higher risk of developing asthma in children playing three or more team sports in high ozone areas. In fact, the authors conclude that, "...the incidence of new asthma diagnoses is associated with heavy exercise in communities with high levels of ambient ozone, and that in these conditions, air pollution and outdoor exercise might contribute to development of asthma in children."1
Additional studies from Southern California confirm that exposure to particulate pollution retards lung function growth in children. Investigators confirmed an approximate 10% reduction in pulmonary function with exposure to acid vapor, NO2 and particulate pollution. The authors noted that, "...ambient air pollution exposure has a similar magnitude of effect on lung function development to that previously observed for children who are active smokers."2
Exposure to air pollution has been associated with respiratory symptoms in children. An examination of 850 asthmatic children living in eight urban areas of the United States confirmed a strong relationship between exposure to NO2, SO2 and particulate on morning asthma symptoms.3
Similar results are available in adults with underlying asthma. For example, exposure to particulate pollution and ozone has been associated with an increase in severe asthma attacks4. Exposure to NO2 has been associated with an increased risk of mortality from severe asthma5. Furthermore, an analysis of emergency department visits for asthma among Ohio Medicaid recipients ages 5-34 years has confirmed a 12% increased likelihood for asthma with particulate exposure and 35% increase for SO2 exposure6. As a result, a recent Abt Associates study suggested that high smog levels in the eastern US is associated with 159,000 trips to the emergency room, 53,000 hospital admissions, and 6 million asthma attacks each summer.7
Pope et al confirmed that fine particulate and SO2 related pollution were associated with all-cause, lung cancer, and cardiopulmonary mortality. The authors concluded that, "...the associations between fine particle air pollution and lung cancer mortality as well as cardiopulmonary mortality are observed even after controlling for cigarette smoking, body mass, diet, occupational exposure, numerous other individual risk factors, and after using recent advances in statistical modeling to control for regional and other spatial differences."8
A study published just last week in the American Journal of Respiratory and Critical Care Medicine shows that older Americans with coexisting respiratory conditions are particularly susceptible to air pollution. The lead author, Samantha F. De Leon, M.S., and associates, analyzed deaths for New York City residents, including those from the Bronx, Kings, New York, Queens, and Richmond counties for the years 1985 to 19949. During that period, the population base was approximately 7.3 million people.
The study results show earlier studies may have underestimated the role of respiratory disease on pollution-related mortality and that respiratory disease can have an important contributing role in explaining observed association between air pollution and non-respiratory causes of deaths, such as cardiac deaths.
I could site more studies, but the take home message is clear, air pollution is causing death and disease in our children and our seniors. Additional studies are needed to develop better animal aging models to help elucidate the interaction between aging and the environment in humans. More effort is also needed to include susceptible populations - the young and the old - in air pollution epidemiology research.
Now for the cajoling part, I find it ironic that while EPA is paying increase attention to the health of effects of air pollution and other environmental factors on the senior population - the Administration is proposing significant role backs to the Clean Air Act that increase pollution. It is clear from the studies that I have cited, the increase pollution will lead to increase death and disease.
The current Clean Air Act law requires the EPA and states to reach emission targets for NOx, SOx and mercury. Under current law, SOx emissions would be reduced from the current level 11 million tons to 2 million ton by 2012. NOx emission would be cut from 5 million tons to 1.25 million tons in 2010. Current law would reduce mercury emission from current level of 48 million tons to 5 million tons in 2008.
The Administration would rollback and delays the emissions targets established under current law. Under the Bush plan, SOx emissions would be capped at 4.5 million tons in 2010 and reduced to 3 million tons in 2018. The NOx emissions cap would be set a 2.1 million tons in 2008 and cap at 1.7 million tons in 2018. Mercury emissions would be capped at 26 million tons in 2010 and reduced to 15 million tons in 2018.
The bottom line is the Clean Skies proposal increases pollution levels and delays enforcement targets.
And now for the note of concern, I have read various press reports that the Office of Management and Budget is using cost analysis figures to justify the increased air pollution under the Clear Skies proposal. Underlying the cost analysis is the assumption that death of a senior citizen from air pollution is on 63% as "costly" as the death of an employed adult. Senior discounts might be a good idea when it to prescription drugs, but a senior discount in estimating the effects of air pollution is bad policy. The American Thoracic Society is extremely concerned that OMB is using a senior discount to estimate the effects of air pollution. We strongly urge the OMB and the EPA to stop using this deceptive estimating ploy.
On behalf of the American thoracic Society I would like to thank the EPA for the opportunity to share our comments.
1 McConnell, R., Berhane, K., Gilliland, F., Johnson, S.L., Islam, T., Gauderman, J.W., Avol, E., Margolis H.G., Peters, J.M. Asthma in Exercising Children Exposed to Ozone: A Cohort Study. Lancet Vol. 359, pp. 386-390, February 2, 2002.
2 Gauderman, W.J., Gilliland, G.F., Vora, H., Avol, E., Stram, D., McConnell, R., Thomas, D., Lurman, F., Margolis, H.G., Rappaport, E.B., Berhane, K., and Peters, J.M. Association Between Air Pollution and Lung Function Growth in Southern California Children: Results from a Second Cohort Study. Am. J. Respir. Crit. Care Med. Vol. 166, pp. 76-84, 2002.
3 Mortimer KM, Neas LM, Dockery DW, Readline S, Tager IB. The effect of air pollution on inner-city children with asthma. Eur Respir J 2002; 19: 699-705.
4 Desqueroux H, Puet J-C, Prosper M, Squinazi F, and Momas I. Short-term effects of low-level air pollution on respiratory health of adults suffering from moderate to severe asthma. Environ Res Section A. 2002; 89: 29-37.
5 Sunyer J, Basagna X, Belmonte J, Anto JM. Effects of nitrogen dioxide and ozone on the risk of dying in patients with severe asthma. Thorax. 2002; 57: 687-93.
6 Jaffe DH, Singer ME, Rim AA. Air pollution and emergency department visits for asthma among Ohio Medicaid recipients, 1991-1996. Environ Res 2003; 91: 21-8.
7 www.savethecleanairact.org/factsheet.html
8 Pope, C.A., Burnett, R.T., Thun, M.J., Calle, E.E., Krewski, D., Ito, K., and Thurston, G.D. Lung Cancer, Cardiopulmonary Mortality, and Long-term exposure to Fine Particulate Air Pollution, Journal of the American Medical Association, Vol. 287, No. 9, March 6, 2002.
9 De Leon SF, Thurston GD, Ito K, Contribution of Respiratory Disease to Nonrespiratory Mortality Associations with Air Pollution Am. J. Respir. Crit. Care Med. 2003; 167: 1117-1123.