Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Environ Int. 2019 May;126:627-634. doi: 10.1016/j.envint.2019.01.052. Epub 2019 Mar 8.
Air pollution control policies resulting from the 1990 Clean Air Act Amendments were aimed at reducing pollutant emissions, ambient concentrations, and ultimately adverse health outcomes.
As part of a comprehensive air pollution accountability study, we used a counterfactual study design to estimate the impact of mobile source and electricity generation control policies on health outcomes in the Atlanta, GA, metropolitan area from 1999 to 2013.
We identified nine sets of pollution control policies, estimated changes in emissions in the absence of these policies, and employed those changes to estimate counterfactual daily ambient pollutant concentrations at a central monitoring location. Using a multipollutant Poisson time-series model, we estimated associations between observed pollutant levels and daily counts of cardiorespiratory emergency department (ED) visits at Atlanta hospitals. These associations were then used to estimate the number of ED visits prevented due to control policies, comparing observed to counterfactual daily concentrations.
Pollution control policies were estimated to substantially reduce ambient concentrations of the nine pollutants examined for the period 1999-2013. We estimated that pollutant concentration reductions resulting from the control policies led to the avoidance of over 55,000 cardiorespiratory disease ED visits in the five-county metropolitan Atlanta area, with greater proportions of visits prevented in later years as effects of policies became more fully realized. During the final two years of the study period, 2012-2013, the policies were estimated to prevent 16.5% of ED visits due to asthma (95% interval estimate: 7.5%, 25.1%), 5.9% (95% interval estimate: -0.4%, 12.3%) of respiratory ED visits, and 2.3% (95% interval estimate: -1.8%, 6.2%) of cardiovascular disease ED visits.
Pollution control policies resulting from the 1990 Clean Air Act Amendments led to substantial estimated reductions in ambient pollutant concentrations and cardiorespiratory ED visits in the Atlanta area.
1990 年《清洁空气法案修正案》所带来的空气污染控制政策旨在减少污染物排放、环境浓度，并最终减少对健康的不良影响。
作为一项全面的空气污染责任研究的一部分，我们采用反事实研究设计来估计 1999 年至 2013 年期间亚特兰大都会区的移动源和发电控制政策对健康结果的影响。
我们确定了九套污染控制政策，估计了在没有这些政策的情况下的排放量变化，并利用这些变化来估计中心监测点的反事实日常环境污染物浓度。使用多污染物泊松时间序列模型，我们估计了观察到的污染物水平与亚特兰大医院每日心肺急救部门 (ED)就诊次数之间的关联。然后，我们使用这些关联来估计由于控制政策而避免的 ED 就诊次数，将观察到的每日浓度与反事实浓度进行比较。
控制政策的实施预计会大大降低 1999 年至 2013 年期间研究的九种污染物的环境浓度。我们估计，控制政策导致的污染物浓度降低避免了亚特兰大都会区五县地区超过 55000 次心肺疾病 ED 就诊，随着政策效果的全面实现，后期年份的就诊次数减少比例更大。在研究期间的最后两年，即 2012 年至 2013 年，政策预计将预防 16.5%的哮喘 ED 就诊（95%置信区间估计值：7.5%，25.1%）、5.9%的呼吸道 ED 就诊（95%置信区间估计值：-0.4%，12.3%）和 2.3%的心血管疾病 ED 就诊（95%置信区间估计值：-1.8%，6.2%）。
1990 年《清洁空气法案修正案》带来的污染控制政策导致亚特兰大地区的环境污染物浓度和心肺急救部门就诊量大幅下降。
