Air pollution and mortality: Timing is everything

Abstract

This paper considers timing issues in health-effect exposure and response studies. Short-term studies must consider delayed and cumulative responses; prior exposures, disease latency, and cumulative impacts are required for long-term studies. Lacking individual data, long-term air quality describes locations, as do greenspaces and traffic density, rather than exposures of residents. Indoor air pollution can bias long-term exposures and effect estimates but short-term effects also respond to infiltrated outdoor air. Daily air quality fluctuations may affect the frail elderly and are necessarily included in long-term averages; any true long-term effects must be given by differences between annual and daily effects. I found such differences to be negligible after adjusting for insufficient lag effects in time-series studies and neglect of prior exposures in long-term studies. Aging of subjects under study implies cumulative exposures, but based on age-specific mortality, I found relative risks decreasing with age, precluding cumulative effects. A new type of time-series study found daily mortality of previously frail subjects to be associated with various pollutants without exposure thresholds, but the role of air pollution in the onset of frailty remains an unexplored issue. The importance of short-term fluctuations has been underestimated and putative effects of long-term exposures have been overestimated.