Professional Documents
Culture Documents
Institute for the Study of Natural Resources and Environmental Management, Mae Fah Luang University, Chiang Rai, Thailand
Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of NC, Chapel Hill, USA
a r t i c l e
i n f o
Article history:
Received 2 December 2013
Received in revised form 30 October 2014
Accepted 5 November 2014
Available online 26 November 2014
Editor: Lidia Morawska
Keywords:
PM2.5
Trafc
Health impact assessment
Variability
Uncertainty
a b s t r a c t
This paper develops and then demonstrates a new approach for quantifying health impacts of trafc-related particulate matter air pollution at the urban project scale that includes variability and uncertainty in the analysis. We
focus on primary particulate matter having a diameter less than 2.5 m (PM2.5). The new approach accounts for
variability in vehicle emissions due to temperature, road grade, and trafc behavior variability; seasonal variability in concentrationresponse coefcients; demographic variability at a ne spatial scale; uncertainty in air quality model accuracy; and uncertainty in concentrationresponse coefcients. We demonstrate the approach for a
case study roadway corridor with a population of 16,000, where a new extension of the University of North
Carolina (UNC) at Chapel Hill campus is slated for construction. The results indicate that at this case study site,
health impact estimates increased by factors of 49, depending on the health impact considered, compared to
using a conventional health impact assessment approach that overlooks these variability and uncertainty
sources. In addition, we demonstrate how the method can be used to assess health disparities. For example, in
the case study corridor, our method demonstrates the existence of statistically signicant racial disparities in exposure to trafc-related PM2.5 under present-day trafc conditions: the correlation between percent black and annual attributable deaths in each census block is 0.37 (t(114) = 4.2, p b 0.0001). Overall, our results show that the
proposed new campus will cause only a small incremental increase in health risks (annual risk 6 1010; lifetime
risk 4 108), compared to if the campus is not built. Nonetheless, the approach we illustrate could be useful for
improving the quality of information to support decision-making for other urban development projects.
2014 Elsevier B.V. All rights reserved.
1. Introduction
In the United States, nonprot organizations and public health practitioners increasingly advocate for formal health impact assessments
(HIAs) to inform regional and local land-use and transportation planning decisions (Wernham, 2011; Bhatia and Corburn, 2011). Signaling
the heightened interest in HIAs, the U.S. National Academy of Sciences
in 2011 published a report, Improving Health in the United States: The
Role of Health Impact Assessment, concluding that HIA is a particularly
promising approach for integrating health implications into decisionmaking (National Research Council, 2011). The report offered the following formal denition of HIA:
HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine
http://dx.doi.org/10.1016/j.scitotenv.2014.11.020
0048-9697/ 2014 Elsevier B.V. All rights reserved.
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While the above-mentioned ve previous quantitative HIAs estimate the magnitude of air quality and related health impacts, none considers the potential variability and uncertainty of the estimates. Rather,
these HIAs each provide a single, deterministic prediction of health impacts for each decision option (see Table 1). In so doing, these HIAs not
only convey a potentially misleading degree of certainty but also neglect to provide decision-makers with information about the plausible
range of impacts. U.S. Environmental Protection Agency guidance
documents indicate that health risk assessments of national and state
policies should include sensitivity and uncertainty analyses (U.S.
Environmental Protection Agency, 2001). Indeed, sensitivity and uncertainty analyses are cornerstones of health impact estimates the agency
prepares to inform national policy decisions, such as changes to air pollution standards (US Environmental Protection Agency, 2010). Nonetheless, current U.S. local-level HIAs do not report variability and
uncertainty in their health impact estimates.
The reliance of local HIA practitioners on deterministic estimates is a
major limitation for several reasons. First, it fails to consider the full
range of potential risksthat is, the potential for risks at the tails of
the risk distribution. For example, vulnerable populations are often at
the upper tails, not the centers, of the exposure and effect distributions
(Fann et al., 2011). Second, risk estimates relying only on central tendencies of each input variable may differ from those considering the
full distributions of each input variable. Except in special cases, the expected value of a function of random variables is not the same as the
function applied to the expected values of each variable. Third, deterministic approaches ignore the potential dependencies among model
input variables (for example, dependencies in meteorological characteristics used to estimate pollutant dispersion). Fourth, deterministic
Table 1
Previous quantitative transportation-related HIAs in the United States.
Study area
population
Title
Project scenario
analyzed
Trafc-related
air pollutants
considered
PM2.5
PM2.5
1,000,000
PM10
10,000
PM2.5
100,000
PM2.5
22,000
4770
= concentrationresponse coefcient used to estimate health impacts; RR = relative risk used to estimate health impacts.
C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
estimates fail to provide information to decision-makers about the degree of certainty in the estimated risks. For example, decision-makers
may be more concerned about a risk factor with a relatively low central
risk estimate (for example, 1 in 10,000) if there is a good chance that the
risk could be much higher than the central estimate (for example, a 10%
chance of the risk exceeding 1 in 100) than they would be if presented
only with the central estimate of risk.
Variability and uncertainty in estimated risks of trafc-related air
pollution can arise from multiple sources. Variability arises naturally
due to differences in members of a population, weather patterns, trafc,
geographic features, and so on; it is a property of nature, usually not reducible through further measurement or study (Frey and Burmaster,
1999). On the other hand, uncertainty arises due to the lack of information or knowledge, including limited data on a population, partial ignorance of phenomena inuencing a particular risk, and disagreements
between models and the reality they are intended to represent (Frey
and Burmaster, 1999). Example sources of uncertainty include the
mathematical form used to predict the effects of changes in pollution
exposure on public health, the parameters in such mathematical equations, and the accuracy of models predicting air pollution levels under
different trafc scenarios. Theoretically, uncertainty can be decreased
through further studies.
This paper aims to strengthen the knowledge base and tool set available to HIA practitioners wishing to incorporate variability and uncertainty in quantitative, transportation-related HIAs. Like the HIAs listed
in Table 1, this analysis focuses on a potential new land development
expected to increase future trafc on a major municipal road corridor
(see the Case study site section). The potential for increased trafc
has raised concerns about increases in air pollution and its associated
adverse health effects, including increased risks of cardiovascular and
respiratory diseases. Like four of the ve HIAs in Table 1, the analysis focuses on airborne particulate matter having a diameter less than 2.5 m
(denoted as PM2.5) as an indicator of trafc-related air pollution. Like
the other HIAs, this analysis is restricted to primary PM2.5 (that is,
PM2.5 emitted directly by vehicle operations rather than that formed
by chemical reactions in the atmosphere). This study considers the effects of short-term exposure to trafc-related PM2.5 on cardiovascular
and respiratory mortality (all ages) and unscheduled hospital admissions (age 65 and over). These health outcomes were previously selected for the core analysis in the U.S. Environmental Protection Agency's
(EPA's) quantitative health risk assessment for supporting the review
of the U.S. National Ambient Air Quality Standards for PM (U.S.
Environmental Protection Agency, 2010).
We use the case study road corridor to explore the effects on health
impact estimates of PM2.5 from roadway trafc when including or excluding various sources of variability and uncertainty. We rst use a
portion of the road corridor to explore the question, Which variability
and uncertainty sources have the greatest effects on the mean values
and upper condence limits of estimated health risks? Then, we demonstrate a method for incorporating the key variability and uncertainty
sources in a comprehensive assessment of potential air pollutionrelated health risks for the entire case study roadway corridor under
current conditions and future conditions with and without the proposed new development.
2. Case study site
We demonstrate the suggested new assessment process to explore
some of the potential health impacts arising from a planned new campus extension for the University of North Carolina (UNC) at Chapel
Hill. The new campus, called Carolina North, is intended to increase
the university's capability to translate research into applications. It will
be located about 3 km (2 miles) north of the existing campus (Fig. 1).
If constructed, it is expected to increase the number of trips to the
area by 10,000 per day by 2015, with most of the increases expected
to occur along Martin Luther King, Jr., Blvd., the main link to the existing
411
campus and the major northsouth road corridor in Chapel Hill (Vanasse
Hangen Brustlin Inc., 2009). By 2025, the number of additional daily trips
to the campus is expected to increase by as many as 40,000. We consider
the potential impacts of the expected additional trafc-related air pollution among residents living in census blocks within 500 m of Martin Luther King, Jr., Blvd. In all, this area encompasses 160 U.S. census blocks
(see Fig. 1) and has a total population of about 16,000more than onequarter of Chapel Hill's total population of 57,000.
We analyze the effects of primary emissions from trafc along Martin Luther King, Jr., Blvd. on ambient PM2.5 concentrations and population health under three different scenarios: (1) the year 2009,
(2) 2025, assuming the new campus is not built, and (3) 2025, with
the new campus. The baseline comparison year is 2009, because the
most comprehensive transportation analysis of the study corridor was
conducted using 2009 data (Vanasse Hangen Brustlin Inc., 2009).
Table 2 provides summary information about the population size and
trafc volumes under these three scenarios.
3. Methods and data sources
This analysis has two main parts:
1) Analyze the effects of including variability and uncertainty in the HIA:
First, we investigate in the effects on health impact estimates of including several different uncertainty and variability sources, as compared to results obtained using the conventional deterministic
approach. For computational efciency, we focus on the 12 census
blocks highlighted in Fig. 1B, which our prior air quality modeling indicated are more vulnerable to trafc-related PM2.5 than most other
census blocks in the corridor (Chart-asa et al., 2013). The total population in the 12 blocks is 1117 (about 7% of the total population in
the study corridor).
2) Quantify the health impacts of trafc from the proposed new campus in
the study corridor: Second, we quantify trafc-related air quality and
health outcomes along the entire study corridor for the three development scenarios in Table 2. This analysis includes the variability
and uncertainty sources identied in part 1 as having an inuence
on the central estimates or upper condence estimates of the
modeled risks.
Both analyses use the same modeling framework, described in detail
in the following sections. However, the rst analysis introduces variability and uncertainty sources one at a time, in order to explore their potential inuence on the computed health risks, while the second
analysis includes all key variability and uncertainty sources.
3.1. Modeling framework overview
Quantifying the health impacts of trafc-related air pollution requires three categories of information: (1) estimates of the excess
PM2.5 concentrations to which the population is exposed as a result of
primary emissions from trafc, (2) concentrationresponse functions
relating exposure concentrations to probabilities of adverse health outcomes, and (3) incidence rates of the health outcomes of concern (from
all causes) in the exposed population (Ostro, 2004; Ostro and Chestnut,
1998; Cohen et al., 2005; Li et al., 2010). Fig. 2 summarizes how this
analysis combines these three information categories (shows as shaded
boxes) to estimate health impacts. The unshaded boxes show variability
and uncertainty sources considered in this study. The subscript notation
indicates that the analysis is conducted at the census block scale, where i
represents an individual block. That is, health risks are characterized
separately for each census block, considering variability in trafcrelated PM2.5 exposure concentrations and population demographic
characteristics within each block. The subscripts j, k, and l indicate differences in baseline health status by age (j), gender (k), and race (l).
In addition, this analysis considers seasonal (subscript m) variability,
because epidemiologic evidence suggests seasonal differences in
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Fig. 1. (A) The study corridor between the intersection of Martin Luther King, Jr., Blvd. and Whiteld Rd. and the intersection of South Columbia St. and Mt. Carmel Church Rd., Chapel Hill,
NC, and the census blocks located within 500 m from the study corridor. (B) The road segment and census blocks for simulations to demonstrate differences in health burden estimates
when including variability and the uncertainty in the modeling approach. Dots represent census block centroids.
using an integrated air quality modeling approach described in Chartasa et al. (2013). In brief, the approach employs standard trafc emissions and air quality dispersion modeling tools, but it adds a novel approach for modeling variability in vehicle emissions due to variability
in hourly temperature, road grade, and trafc behavior (including cruising speed and percent time spent idling, decelerating, and accelerating).
The exposure modeling approach links a novel application of MOVES
2010b, commonly used in the United States to estimate vehicle emissions factors (g/vehicle-mile), and CAL3QHCR, which characterizes
PM2.5 dispersion away from roadways. By linking these models and
employing a new approach for characterizing variability in emission factors, we simulated probability distributions of the average 24-hour
Table 2
Population size and trafc volumes under three scenarios considered.
Scenario
Trafc volumes of road segments on study corridor (veh/h)a Total population of 160 census blocks located within 500 m from study corridor
2009
41758
2025 without the new campus 52443
2025 with the new campus
52832
a
b
16,042
19,140b
19,140b
Ranges indicate variability in trafc ow by road segment, day of week, and time of day.
Computed from growth rates forecasted by the North Carolina Capital Area Metropolitan Planning Organization (2005).
C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
413
Fig. 2. Overview of framework for incorporating variability and uncertainty into assessment of the health impacts of trafc-related PM2.5. The rectangles show sources of variability and
uncertainty. The shaded diamonds show the three major information categories needed for quantitative health impact assessment.
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C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
model are not precisely known but in which values toward the middle
of the range of possible values are considered more likely to occur than
values near either extreme. Based on previous evaluations of the performance of near-roadway air pollutant dispersion models, the exact
form of the distribution representing model uncertainty is not known,
making the triangular distribution an appropriate choice for characterizing model uncertainty. Correspondingly, in each census block, the excess PM2.5 24-hour average exposure concentration attributable to
primary emissions from trafc on the case study roadway was estimated for each season as
PM exposurei;m U F PM modeli;m
RRi;m;n e
i;m
0
yi; j;k;l;m;n
0
yi; j;k;l;m;n
3a
RRi;m;n 1
3b
RRi;m;n
e m;n
PMexposure
i;m
m;n PMexposure
0
yi; j;k;l;m;n 1e m;n
3c
i;m
PMexposure
i;m
3d
where AFi,j,k,l,m,n and yi,j,k,l,m,n are the fraction and number of cases
of adverse health event n attributable to trafc-related PM2.5 in season m in census block i for age group j, gender k, and race l and
0
where yi,j,k,l,m,n
is the observed total number of cases in the same location and among the same population group. Eqs. (2), (3a), (3b),
(3c) and (3d) are the standard equations used in analyses by the
WHO and other organizations to attribute observed cases of adverse health events to specic risk factors (Ostro and Chestnut,
1998; Murray et al., 2003; Mathers et al., 2001; Prss-stn et al.,
2003).
The values in Eqs. (2), (3c) and (3d) (known as doseresponse coefcients) were drawn from the U.S. Environmental Protection Agency
guidance document, Quantitative Health Risk Assessment for Particulate
Matter (U.S. Environmental Protection Agency, 2010; Zanobetti and
Schwartz, 2009; Bell et al., 2008). Table 3 shows the coefcient values
used in this analysis. EPA retrieved these coefcients from peerreviewed epidemiologic studies that met certain quality-assurance
criteria, including, for example, the estimation of exposure from measured rather than modeled PM2.5 data. For mortality effects, the coefcients are specic to 15 U.S. metropolitan areas. For morbidity effects,
coefcients are specic to region (Northeast, Southeast, Northwest,
and Southwest). This study employed mortality coefcients developed
from studies in Atlanta, since Atlanta is climatologically the most similar
to Chapel Hill among the 15 cities studied. We used morbidity
coefcients for the Southeast region, in which Chapel Hill is located.
All concentrationresponse coefcients were represented as normal
distributions, with all negative values truncated at zero (to avoid associating PM exposure with positive health effects). Standard deviations for
each season and health outcome were estimated from the condence
intervals in Table 3.
3.3. Baseline incidence rates of adverse health outcomes
Data on baseline incidence rates of health outcomes were obtained
from North Carolina public health databases. Annual mortality rates
for each age group (Table 4) were calculated by dividing the total number of deaths in Orange County (where Chapel Hill is located) in 2010
(North Carolina State Center for Health Statistics, 2012) by the 2010 Orange County census population (Minnesota Population Center, 2011).
Annual unscheduled hospital admission rates (Table 5) were obtained
from 2009 emergency department visit data reported by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) (University of North Carolina at Chapel Hill, 2011). We were
unable to obtain data on incidence rates by gender and race, so we assume that incidence rates are the same for both genders and all races
(which is a limitation of this analysis). It should be noted as well that
the ICD codes specic to the concentrationresponse coefcients
might not be entirely matched to the ICD codes specic to the incidence
rates used in this study, depending on reported data. Moreover, emergency department visits may not result in hospital admissions, and
some hospital admissions may occur without rst visiting the emergency department.
To reect seasonal variation, we adjusted the incidence rates for cardiovascular and respiratory mortality and unscheduled hospital admissions using data on temporal variability in cardiovascular and
respiratory deaths in Orange County during 19992010 from the CDC
WONDER database (Centers for Disease Control and Prevention,
2013). The fractions for cardiovascular events are 0.25, 0.31, 0.20, and
0.24 for winter, spring, summer, and fall respectively, while the fractions for respiratory events are 0.30, 0.26, 0.21, and 0.23 for winter,
spring, summer, and fall respectively.
To determine the total number of cases in any given season (i.e.,
0
yi,j,k,l,m,n
in Eqs. (3a), (3b), (3c) and (3d)), we multiplied the given incidence rate by the corresponding size of each demographic group in each
census block.
3.4. Testing the effects of variability and uncertainty on health impact
estimates
Five simulations of 2000 iterations each were run using Analytica
version 4.5 (Lumina Decision Systems, Los Gatos, California) to demonstrate differences in health burden estimates when including variability
and uncertainty. Table 6 lists the ve simulations and the variability and
uncertainty considered in each. The rst simulation (1a) follows the deterministic approach of previous HIAs, using average trafc volumes and
a constant trafc emission factor corresponding to trafc cruising at
35 mph on a at roadway under a constant ambient temperature of
70 F. Like previous HIAs, simulation 1a accounts for neither uncertainty
in the concentrationresponse coefcient (using the mean value as a deterministic estimate) nor seasonal variability. Simulation 1b is identical
to simulation 1a, except that it uses seasonal concentrationresponse
C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
415
Table 3
Concentrationresponse coefcients used in this study.
Health outcome
Disease category
Age group
Season
Mean concentration-response
coefcient (95% CI), % per 10 g/m3b
Mortality
Cardiovascular
I01I59
All ages
Respiratory
J00J99
All ages
Cardiovascular
65 and over
Respiratory
65 and over
All-yearc
Winter
Spring
Summer
Fall
All-yearc
Winter
Spring
Summer
Fall
All-yearc
Winter
Spring
Summer
Fall
All-yearc
Winter
Spring
Summer
Fall
a
b
c
Table 4
Annual mortality rates by race, gender, and age group for Orange County (per 1000 people).
Cause of death
ICD-10 code
Cardiovascular disease
Respiratory disease
J00J99
Age group
0 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85+
0 to 54
55 to 64
65 to 74
75 to 84
85+
Black male
Other male
White female
Black female
Other female
0.00
0.17
0.29
1.79
3.43
16.47
52.51
0.00
0.49
2.06
5.24
35.80
0.00
0.00
2.72
2.35
7.25
17.24
26.32
0.00
0.00
4.83
5.75
13.16
0.00
0.00
0.00
2.57
0.00
0.00
125.00
0.00
0.00
0.00
1.16
0.00
0.00
0.00
0.13
0.91
2.44
7.70
30.34
0.00
0.45
1.83
4.95
7.87
0.00
0.95
1.53
1.05
0.00
20.65
22.99
0.00
1.05
3.45
5.90
11.49
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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Table 5
Annual emergency department visits rates for North Carolina.
Cause of Visit
ICD 9 code
Age group
Annual rate
Cardiovascular disease
Respiratory disease
427.5, 428 and 518.4 (excluding failure due to fumes and vapors), 430435, and 437.0437.1
466 and 480486
65 and over
65 and over
0.0856
0.0355
Simulation
number
1a 1b 2 3 4
Sources of uncertainty
PM2.5 exposure concentration
Air quality model prediction accuracy
Doseresponse function
Doseresponse coefcient
Sources of variability
PM2.5 exposure concentration
Vehicle emissions variability on each roadway link arising
from the following sources: temperature; road grade;
cruising speed; and percent time spent decelerating, idling,
accelerating, and cruising
Doseresponse function
Seasonal variability
Demographic characteristics of exposed population
Age, race, and gender (by census block)
x
x x
x x x
x x x
x x x
C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
417
Fig. 3. Effect on health impact estimates of including the variability and uncertainty sources shown in Table 6. Error bars represent 95% condence intervals.
Table 7
Comparison of HIA results by development scenario.
Scenario
2009
2025 without Carolina North
2025 with Carolina North
a
b
Number of census
blocks affecteda
CVD hospital
admissions
Respiratory
mortality
Respiratory hospital
admissions
118148
75122
84137
0.00020.16
0.00020.10
0.00020.13
48 (15100)
19 (5.642)
28 (7.961)
140 (47280)
61 (19120)
87 (27170)
15 (530)
5.5 (1.712)
7.9 (2.417)
73 (21160)
30 (866)
42 (1293)
Number of census blocks with exposure concentrations greater than zero (varies by season).
Lowest and highest mean seasonal exposure concentration in affected census blocks (also varies by season).
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C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
Fig. 4. Spatial distribution of cardiovascular deaths (106) attributable to PM2.5 before and after Carolina North development.
toward comparably high values. For this analysis, the rank-order correlations differ by census block, season, and health outcome. Fig. 7 shows
CDFs of the rank-order correlations between each random input variable and CVD mortality risks among the census blocks by season. In winter, the season in which PM2.5 exposure concentrations are highest,
uncertainty in the doseresponse coefcient drives uncertainty in the
risk estimates in all census blocks. In spring and summer, the air quality
model uncertainty factor drives the uncertainty in the risk estimates. In
fall, the model uncertainty factor drives uncertainty except for in about
20% of census blocks, where the doseresponse coefcient contributes
the most uncertainty. Hence, overall, to decrease uncertainty in the
risk predictions, both the strength of the epidemiologic evidence and
the performance of near-roadway air pollutant dispersion models
must be improved.
In summary, Figs. 57 illustrate the importance for future
transportation-related HIAs of decreasing uncertainty in epidemiologic
estimates of the concentrationresponse coefcient and improving the
ability to model near-roadway concentrations of PM2.5 from trafc
5. Limitations
Key limitations in this analysis arise from deciencies in the available epidemiologic evidence, the capabilities of the air quality model,
and future population data. In addition, the attributable fraction approach considers effects of PM2.5 exposure on the incidence of
C. Chart-asa, J.M. Gibson / Science of the Total Environment 506507 (2015) 409421
419
Fig. 5. Effects of changing risk model input variables to their upper and lower 95% condence interval values. The cumulative distribution functions illustrate the variability in these effects
by census block in the case study roadway corridor.
Fig. 6. Overall effect (across all census blocks) of changing random variables in the risk
model to the upper and lower ends of their 95% condence intervals. The chart is centered
on the mean value of the risk estimate, 48 106. The ends of each bar correspond to the
new risk estimate if the variable is changed to its low (left side) or high (right side) 95%
condence interval value.
concentrations and conducting further epidemiologic studies examining the effects of vehicle emissions on health are important areas of research. Nonetheless, for the case study site, the estimated risks would be
very low even assuming the risks are under-estimated by a factor of 9
(the upper bound of Janssen et al.'s predicted under-estimation when
using PM2.5 rather than black carbon particles as an air pollution indicator). In the baseline scenario (year 2009), the annual average CVD or respiratory mortality risk to an individual from trafc-related air pollution
predicted by our model is 3.6 10 9 (= 45 10 6 CVD deaths plus
13 10 6 respiratory deaths divided by a population of 16,000). Assuming a 70-year lifetime exposure period, the resulting lifetime risk
is 2.5 10 7. Increasing these risks by a factor of 9 results in an annual
risk of 3.3 108 and a lifetime risks of 2.3 106risks that are considered very low according to U.S. EPA guidelines, which in general have
long designated as acceptable risks of less than 10 4 to 106 (EPA,
1989).
A second limitation is that the concentrationresponse coefcients
assume that the exposure histories of current and future residents of
the case study area will be similar to those in the areas from which
the epidemiologic studies were drawn (Atlanta and the southeastern
United States). Once again, this limitation is inherent in current air quality risk assessments, due to the costs of conducting epidemiologic studies and the resulting lack of studies for each U.S. metropolitan area. This
limitation may bias the absolute results of the risk estimates, but it does
not affect the estimates of risks of one scenario relative to another.
Hence, the conclusion that the development of the Carolina North campus is unlikely to lead to substantial trafc-related air quality health impacts is valid even if exposure histories of the Chapel Hill population
differ from those of the populations from which relative risk estimates
were derived.
A third limitation is that Eqs. (3a), (3b), (3c) and (3d), which have
been used as the basis for assessing health impacts of air pollution
exposure by nearly all researchers to date, may neglect the effects of
air pollution exposure on the disease progression leading up to hospitalizations for respiratory illnesses and CVD (Perez et al., 2013). Perez et al.
recently found that including such effects in analyzing health impacts of
trafc-related road pollution increased estimated health impacts on average by a factor of about 10 in a study of 10 major European cities
(Perez et al., 2013). However, implementing the approach of Perez
et al. is not possible when attempting to predict changes in health effect
estimates in the distant future, because Perez's calculation relies on
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Fig. 7. Cumulative distribution functions of rank-order correlations between model input variables and the predicted risk of CVD mortality by season for the census blocks in the case study
roadway corridor. A high rank-order correlation indicates that the variable has a strong inuence on the uncertainty in the estimated risk, so reducing uncertainty in the variable will substantially reduce uncertainty in the estimated risk. The cumulative distribution functions show the variability in these effects by spatial location (i.e., by census block) and season.
epidemiologic studies that use proximity to a busy roadway as the exposure metric. For estimating the effect of roadway emissions on coronary
heart disease (CHD) prevalence, for example, Perez relies on an epidemiologic study in Germany showing that living within 150 m of a
busy roadway (dened as an autobahn or federal highway) increased
the relative risk of CHD by 85%, compared to not living near such a roadway. Because per-vehicle emissions are expected to decrease substantially in the future, such studies cannot be used as the basis for
predicting the effects of road trafc pollution on populations in the distant future. We expect that future health impacts of living near busy
roads will decrease as vehicle emissions controls improve, so including
the effects on disease prevalence also would not change the conclusion
that the future risks will be less than today's risks, even if the new campus is built.
6. Conclusions
This study developed an improved modeling approach for estimating the health impacts of trafc-related PM2.5 air pollution under alternative future urban development scenarios. We then demonstrated the
approach by quantifying health impacts in a case study roadway corridor that could be affected by a new UNC campus extension in Chapel
Hill. The new approach accounts for the effects of variability in trafc
emissions factors and for seasonal variability in concentrationresponse
coefcients. It also accounts for uncertainty in concentrationresponse
coefcients and air quality model prediction error. The approach could
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