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Health impact of air pollution in Mexico

A review of selected investigations

Mauricio Pardón Ojeda (1) Ana Patricia Martínez (2)

(1) Environmental Health Advisor - Pan American Health Organization PAHO/WHO-México.Tel (525)2028200; Fax (525)5228868; Email [email protected]

(2) External consultant, Pan American Health Organization PAHO/WHO. Tel & Fax (525)3080674;Email [email protected]

Key Words: air pollution, health, research.



Health impact of air pollution in Mexico

A review of selected investigations

Mauricio Pardón Ojeda (1) Ana Patricia Martínez (2)

Key words: air pollution, health, research.

SUMMARY

This paper presents a critical review of investigations on health effects of air pollution in Mexicocovering a 31 year period (1966-97). The selected papers include research at different levels: urbanand rural, general public and occupational, and indoor and outdoor environments. The discussionconsiders major contaminants, e.g. lead exposures in the air and in ceramic glazes, suspendedparticulate matter, sulphur and nitrogen oxides, carbon monoxide, and ozone and their demonstratedhealth impact. The major conclusions include: a) a change in focus from rural areas, leaded pottery,craftsmen and miners of the 60’s through the 80’s, to a focus on urban areas, impact on general and

specific public, ozone and concern about exacerbating and attenuating factors; b) the support of policydecisions and air quality management strategies by the demonstration of health impact associated withvarious air pollutants; and c) exacerbating factors on health (e.g. pregnancy, infancy and groups withhigh exposure), as well as attenuating factors (e.g. diet).

INTRODUCTION

This paper is based on articles selected by four institutions working in Mexico the National Instituteof Public Health, the Institute of Environmental and Occupational Health of the University of California,and the Pan American Centre of Human Ecology and Health PAHO

47. The articles cover the period

1966-97 and were used for an international expert meeting on air pollution risk management for theCity of Mexico. Additional recent publications are included by the authors for this review.

This review includes clinical, environmental and epidemiological studies. The analysis aims to showhealth impact of air pollutants under defined circumstances. Also there is a description of the impact of such investigations on public awareness, which has led to mitigation of exposures and improvementsof health through air quality management in Mexico.Research on health impact of lead (Pb) ingestion derived from the use of Pb glazed ceramics, cannedfoodstuff and working environment were the basis of subsequent research on Pb air pollution. Articleson this subject are consequently included. Chronologically, health impact related to glazed ceramicswas followed by concern and research on Pb in air. At the same time sulphur and particulate matter,and subsequently carbon and nitrogen oxides, ozone and photochemical oxidants in the environmentbecame important factors in air pollution. This paper presents tables of the information reviewed anda critical discussion of the main findings and evolution of health and air pollution research in Mexico.

ANALYSIS OF INFORMATION

In the tables, studies are grouped by contaminant and presented chronologically. Table 1 includesmajor studies on health effects related to Pb pollution in both rural and urban environments. Table 2is related to ozone. Table 3 groups the effects of diverse pollutants. All studies presented in Tables 2and 3 were conducted in urban environments.

Table 1 shows how studies in the 60s and 70s focused on clinical cases of acute intoxication andsaturnism. Glazed ceramics used for cooking and food storage, and ingestion were identified ascauses

1-7,9. Studies in the 80s begun to focus on inhaled Pb associated with vehicular fuel

combustion11,12,18

. An association was found between Pb blood and urinary concentrations and air contamination.

This association has been reported among people living in high traffic areas and commuters13,16-20

.Blood Pb concentrations have been related to long term exposure

19. The Pb concentration (in blood,

urine or bone) is exacerbated by



Use of Pb glazed ceramics1-7, 9,12, 13,18-22

Industrial or heavy traffic residence area8

Canned food or beverage consumption14

Living more than 20 years in a high Pb concentration environment21

Low calcium (Ca) diet21-22

Smoking21

Pregnancy 15 Extended breast feeding

14

Age less than 1 year 17

Cardiovascular diseases46

The main findings reported associated with blood Pb concentration are diminished weight and height atbirth

23, diminished cranial circumference

15, and diminished IQ

10, 13. A reduction of 0.25 points in IQ

per 3.9 g/dl Pb in blood per change of 1g/m3

in air was reported46

. Changes in arterialhypertension, premature deaths for cardiovascular diseases and non mortal strokes were reported inassociation with high concentrations of Pb in air

46. It was demonstrated that a Ca rich diet and the

intake of Ca supplements reduce Pb absorption22

. Finally, studies have demonstrated that theintroduction of unleaded gasoline has resulted in a reduction of blood Pb concentration among childrenin Mexico City

24.

Table 2 presents health effects related to ozone in air 25, 27, 28

. The impact of ozone is related torespiratory effects, e.g. acute respiratory infections, cough, phlegm, wheezing, nasal mucous atrophy,decrements in Peak Expiratory Flow rate, emergency visits for asthma. Observed effects include anincrease in the amount of people with respiratory problems one day after the ozone concentration

exceed 110 ppb26,29

. Exacerbating factors associated with health effects are

Low temperature26,30

Presence of SO2 25,29

Presence of TSP, PM10 or PM2.5 28,30

Age less than 5 years29

Asthma or respiratory diseases29,30

It has been observed that vitamin supplements reduce the health effects of ozone pollution

27.

Table 3 presents the effects of other pollutants on health. Two studies of carbon monoxide35,36

andseveral studies of general pollutants that focus on PM10 and PM2.5

39-41show associations of pollutants

with infant mortality, respiratory effects32,34,37,38

, and daily mortality42

. Difference in carbon monoxideemissions have been reported for different vehicles

36. Another article compares curbside pollution

levels with official air quality monitoring data. The curbside measurements indicate that pedestriansand street vendors can be exposed to levels of pollutants up to five times greater than those stated inMexican Standards and WHO Guidelines

35,36.

Identified high risk population includes: children less than 5 years, elderly grater than 65 years, andpeople with respiratory diseases (e.g. asthmatics).

Sulphur dioxide emissions markedly increased between 1972 and 1976. Specific research evaluated

diseases among children, chronically ill and the elderly

43

. Environmental and epidemiological studieswere associated with suspended particular matter SPM because it has been suggested that SO2 andSPM are usually associated in the environment

44,45.



TABLE 1. STUDIES OF HEALTH EFFECTS RELATED TO LEAD

REF. YEAR ENVIRONMENT Lead (Pb) MAIN FINDINGSUrban Rural Occup. Ingested Inhaled

1 1966 X X The risk of saturnism is associated with Pb glazed ceramics. Crafts in the State of Guanajuato showehighest Pb concentrations at 1264 ppm.

2 1972 X X Orange juice stored in Pb glazed vessels. Highest conc. of Pb in the boy: 81g/dl blood & 3000g/dl Increased neurological symptoms in the daughter and the father.

3 1978 X Saturnism associated with Pb glazed ceramics; Pb levels ranges 59-102 g/dl blood and 180-570 g/dl uri

4 1979 X X X Saturnism ranked third occupational health disease by the Mexican Institute of Occupational Health IMSS.

5 1981 X X Use of Pb glazed ceramics with conc. of Pb 7 g/ml, associated with levels of Pb of 30.5 - 52.5 g/dl

and 250 - 270 g/dl urine.

6 1982 X X X X Mean blood conc. of Pb in potters (children) 39.5 g/dl. Non potters children control families: 24.8 g/dl.7 1983 X X X X Higher conc. of Pb in blood in children of potter families; negative correlation between Pb in blood and IQ.

8 1989 X X Zone differences of Pb conc. in blood in the city of Mexico. Higher in men; higher in women living i

eastern area and lower in the north; overall mean 19.5 g/ dl.

9 1991 X X High conc. of Pb in blood correlate with the use of l-glazed ceramics. Mean 10.6 g/dl; range 1-52 g/dl.

10 1992 X X Decrease in children’s IQ associated with increase in Pb conc. in blood.

11 1992 X X Demonstration of vehicular traffic impact on Pb conc. in children’s blood. Ranges of 0.17-1.21 mol/l;

exceeded 0.73 mol/l.

12 1993 indoor /outdoor

X X Determinants of Pb conc. in blood: exposure to vehicular traffic (more than 30 min); followed by ope

sports, and use of glazed ceramics. Concentrations 10 g/dl in 76% of cases.

13 1993 X X X Greater conc. of Pb in children living in high traffic areas and using Pb glazed ceramics. Inverse corre

between Pb in blood and IQ. Mean 17.8 g/dl.

14 1993 X X High levels of Pb associated with caned milk, soft drinks, and extended breast feeding. Conc. of Pb in

10 g/dl at 24 months in 70% cases; 15 g/dl at 21 m for 38% cases; and 25 g/dl at 18 m for 8% of ca

15 1993 X Inverse correlation between Pb conc. in mother blood and umbilical cord at 36 months pregnancy, anblood conc. in children at 6, 18 & 36 months. Also inverse correlation with cranial circumference at 36 mo

16 1992 ??? X X Correlation of Pb conc. in blood of children aged 1 to 10 years and vehicular traffic in home residence

Mean 10 g/dl (range 6-14) in residential areas; 14 g/dl (11-17) moderate traffic; 15.5 g/dl (11.5-19) traffic.

17 1994 X X Greater conc. of Pb in blood in mothers and children living in high Pb air conc. (study conducted in two are

Mexico City: Xalostoc and Tlalpan). Marked difference in children under 1 year: mean 4.3g/dl in Tlalpa8.5g/dl in Xalostoc. Correlation between mother and child: 0.58 (p=0.0001). Blood Pb conc. in mpredictor of Blood Pb conc. in her children.

18 1994 X X X Mayor sources of Pb: fuel combustion emissions, Pb glazed ceramics, leaded paints, and canned food

Mean conc. of Pb in blood of children living in secondary streets 10.3 g/dl vs. 15.5g/dl in main ave

overall mean 12.7g/dl; and 80% greater than 10g/dl.

19 1995 X X X Relation between blood Pb conc. and levels of Pb in air 3 months prior to blood sampling. Mean 9.9

range 1-30g/dl. Higher levels in Xalostoc 10.5g/dl vs. Tlalpan 9.4g/dl correlating with higher air pollut

Xalostoc. 44% of children aged over 18 months showed Pb levels 10g/dl. Also association with Pb-gceramics, vehicle emissions and dust in children’s hands.



TABLE 1. STUDIES OF HEALTH EFFECTS RELATED TO LEAD (continued)

REF. YEAR ENVIRONMENT Lead (Pb) MAIN FINDINGSUrban Rural Occup. Ingested Inhaled

20 1996 X X X Pb blood conc. in umbilical cord increase with mother use of Pb glazed ceramics and residence area in M

City. Maximum mean in Southeast 8g/dl (range 2.3-20.4). Use of Pb-glazed ceramics: mean 7.6g/d

20.4); non users mean 6.3g/dl (2.0-17.7).

21 1996 X X X Positive comparison between bone Pb conc. and more than 20 yrs. Living in Mexico City, low consumptiCa rich food, no Ca supplements, use of Pb glazed ceramics and smoking. Pb in patella contr

significantly to Pb blood conc. during pregnancy and breast feeding. Mean Pb conc. in blood 9.6g/dl; in

12.5g/g and in patella 16.7g/g of mineral bone. An estimated mean difference of 20g Pb/g in pabetween women living less than 5 and more than 20 years in Mexico City.

22 1996 X X X Greater conc. of Pb associated with use of Pb glazed ceramics, living in busy traffic areas, and in the indu

area of Xalostoc. Inverse correlation with Ca rich foods consumption. Mean Pb conc. in blood 9.7g/dl.

23 1997 X Decrease of 73g at birth correlated with each 10 g Pb/g mineral bone in tibia increment. Mean Pb in moblood of 8.9g/dl, in umbilical cord 7.1g/dl, in mother’s tibia 9.8g/g and in patella 14.2g/g of mineral bon

24 1997 X X Decrease of Pb conc. in women’s blood from 10.5 to 7.47g/dl in the period 1992 - 95. Mean values of 8.7

in blood (range 0.5-66.2) and 7.9g/dl (range 0.4-50.6) in umbilical cord.



TABLE 2. STUDIES OF HEALTH EFFECTS RELATED TO OZONE

REF. YEAR O3 association withother pollutants

MAIN FINDINGS

PM2.5 SO2

25 1990 X Relation between acute respiratory diseases and levels of ozone and sulphur dioxide. Effects at lung level.

26 1992 Positive relation between ozone level and school absenteeism. Increase in absenteeism with increase in ozone levels: 49% for medium oexposures (13-22 ppb) and 92% for days with high levels (23-34 ppb), using a 1-day lag time and comparing with days with low ozone le50% of the children had at least one respiratory-related absenteeism period, and 11.75 had two or more. Children exposed for two consec

days to high ozone levels (13 ppb) had a 20% increase in risk of respiratory illness. The risk reached 40% when children were exposed fo

consecutive days to high ozone levels, and the previous day to low temperature (5°C).

27 1993 X Increment of neutrophils (PMN) with ozone levels 0.11 ppm. Increment in squamous metaplasia, nasal mucous atrophy and hyperaemia, group without vitamin supplement.

28 1995 X Report of 33% of the children had chronic cough or phlegm, and 30% had wheezing history associated with high ozone pollution episodes

29 1995 X The levels of ozone and sulphur dioxide exposure were significantly associated with the number of emergency visits for asthma. An increa50 ppb in the 1-hour maximum ozone level is related to a 43% increase in the number of emergency visits for asthma on the following day. effects were observed 1 day after exposure. Exposure to high ozone levels (>110 ppb) for 2 consecutive days increased the number of asrelated emergency visits by 68%. Interaction between ozone levels and age suggesting that young children (<5 years) may be more susceto ozone exposure. Levels of SO2 (daily 1-h max) were related to the total number of emergency visits for respiratory diseases on the same

30 1997 TSP andPM10

NOx Children with mild asthma who resided in the south of Mexico City were affected adversely by the high ozone ambient levels observed iarea. Decrements in peak expiratory flow rate were associated with ozone, and respiratory symptoms were associated with both ozone

ambient particulate matter(<10 m) levels. An increase of 50 ppb in a daily ozone 1- h maximum was related to an 8% increase in cough, aincrease in phlegm and an 11% increase in low respiratory symptoms index. Increase in the adverse effects of O3 when low temperaturePM10 are simultaneously present.



TABLE 3. STUDIES OF HEALTH EFFECTS RELATED TO GENERAL POLLUTANTS

REF. YEAR POLLUTANT MAIN FINDINGS

31 1978 Sodium hypochloritespill

Intoxication symptoms of 52% because of chlorine exposure. Mucous irritation,cough, and lost of conscience. 10% present shock. Detected chlorine air conc.

3ppm.32 1982 TSP y SO2 Increase in infant mortality and mortality by respiratory disease in Atzcapotzalcoas compared to Tlalpan (north and south of Mexico City respectively).

33 1990 O3, CO, SO2, NOx, PM10 y Pb.

Environmental monitoring information, pollutants levels in the ZMCM. Studies in

children 5 years, asthmatics and elderly were recommended.

34 1990 O3, NO2, PM10 y Pb. Greater frequency of respiratory disease effects in days with higher air pollutionlevels.

35 1993 CO Curbside CO conc. of 26ppm reported (range 2-70). Average curside/backgroundrate of 2.2. The study reports 1000 street vendors exposed over periods of 10 hrsper day and 6 days a week.

36 1995 CO Reports rates of pollution of different types of public transport againstbackground: cars 5.2, minivans 5.2, minibus 4.3, lorries 3.1, trolleys 3, andunderground 2.2.

37 1995 O3, CO, SO2, NOx, PM10 y Pb.

Observations of 26% children with FVC90% and 52% with FEF90% werereported in five Mexico City monitoring zones. Alterations in the children mucous

membrane and FVC90% were observed mainly in the SE followed in severity by

the NE. SW children present normal FVC, but show the highest proportion of FEF90%.

38 1996 O3, CO, SO2, NOx, PM10 y Pb.

A high risk of respiratory diseases was associated with an increase in number of hours that pollutants exceed standards. The following symptoms were observed:headache, eye and throat irritation and otitis.

39 1996 O3, CO, SO2, NOx, PM10 y Pb.

Report of mean values of 1,81ml FEV and 2.11ml FVC. These values werehigher in men and in night school attendants. The centre zone of Mexico Cityshow the lower values, together with NO2 maximum levels. Inverse relationbetween FVC, and SO2 conc. in air 15 days prior to tests, and with SPM 2 daysprior to the PFM tests.

40 1996 O3, NO2, PM10 y Pb. Description of epidemiological methods for the development of a cohort of asthmatic children and air pollution exposure.

41 1996 PM2.5 , PM10, NO2,SO2, O3

Increase in PM10 related to increase in adverse respiratory symptoms: 10%

cough and 62% breathing difficulties. An increase in 10g/m3

of PM2.5 associated with an increase of 19% cough and 16% phlegm.

42 1997 TSP, SO2, O3 An increase of 6% in daily mortality associated with an increase of 100 g/m3

of

TSP was observed in a model adjusted for temperature and long time trend, O 3 and SO2. Total mortality, cardiovascular mortality, and mortality for those over 65years were associated with ozone concentration after adjusting for minimumtemperature (2.4%, 2.3% and 3.9% increase for each 100 ppb change in dailymaximum ozone level, respectively), but dropped when adjusted for TSP.

FVC: Forced Vital Capacity.FEF: Forced Expiratory Fraction.FEV: Forced Expiratory Volume.PFM: Peak Flow Meter.ZMCM: Mexico City Metropolitan Zone.



CONCLUSIONS

The major conclusions on the Mexican research reviewed are:

1. The early focus on rural areas, leaded pottery, craftsmen and miners of the 60’s through the 80’s, hasevolved to a focus on urban areas, the general and specific public, ozone, and concern for exacerbating & attenuating factors.

2. The following represent the main findings and elements of health impact associated with air pollution in

Mexico Lead

a) Extended Pb exposure first related to glazed ceramics (foodstuff consumption, workplace,households), and from vehicular fuel combustion increased contributions.

b) The presence of Pb in blood and urine, and accumulation in bone tissue.

c) Demonstrated impact on weight at birth, IQ reduction, and neurological and metabolic disordersrelated to lead.

d) Reduction of blood Pb associated with reduction of airborne Pb from change to unleaded gasoline.

Ozone and general pollutantse) Increasing quantities of photochemical oxidants in the air of Mexico City.

f) Demonstrated exacerbation of respiratory effects due to the synergism between pollutants,specially ozone and SPM.

g) Increased school absences, reduction of Forced Vital Capacity (FVC) and Forced ExpiratoryVolume (FEV), and increased number of visits to emergency wards for respiratory problems

3. Recent research has demonstrated that the health impact of air pollution is exacerbated in pregnancy,infancy, and among groups with high exposure (e.g. street vendors), as well as attenuated by factors suchas diet.

4. Scientific research has unequivocally demonstrated the health impact associated with various air pollutants, and has supported policy decisions and air quality management strategies. Mexico hasseen improvements associated with the control of particles, SO2 and Pb, and now concentrates itsefforts on photochemical oxidants in the air.

5. For Mexico, demonstration of health effects to justify interventions is not the only option. A wealth of information regarding health effects of air pollution already exists. Therefore monitoring systemsshould be perfected, and corrective actions taken upon evidence of exposure. A substantial part of theresearch effort should be directed toward interventions and participatory strategies. The authors areconfident that this strategy will prove cost effective over time.



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