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PURE-AIR: A Global Assessment of Air Pollution and Cardiopulmonary Disease
PURE-AIR is a recently funded NIH study that is examining the associations between household and outdoor air pollution and cardiovascular and respiratory disease within the Prospective Urban and Rural Epidemiological (PURE) study.
The Global Burden of Disease (GBD) 2010 project estimated that 3.2 million deaths and 3.1% of disability-adjusted life-years (DALYs) are attributable to outdoor air pollution and 3.5 million deaths and 4.5% of DALYS to household air pollution annually. This places exposure to air pollution as the leading environmental risk factor and among the most important modifiable risk factors for global disease burden.
There is substantial uncertainty in our understanding of how air pollution impacts cardiovascular and respiratory disease and there remains a critical need to characterize the impacts of air pollution on cardiopulmonary health in populations that reside in both developed and developing countries. This uncertainty stems in part from the limited direct epidemiological evidence of the cardiopulmonary effects of the upper portion of the exposure-response relationship; a lack of research examining household air pollution and cardiovascular disease, and inadequate characterization of vulnerable populations. Almost all epidemiological studies of cardiopulmonary health effects associated with PM2.5 have been conducted in developed countries, where PM2.5 concentrations are relatively low compared to developing countries.
The objective of this research is to address these significant uncertainties by conducting the first global epidemiological study of PM2.5 air pollution and cardiopulmonary disease by leveraging the Prospective Urban and Rural Epidemiological Study (PURE). This cohort (Phase I) recruited 155,000 individuals residing in 628 communities in 17 countries and 5 continents, with current follow-up completed for four years and continuing for another six years. This research proposal will add an air pollution component (PURE-AIR) that will use novel satellite-based air pollution estimates, geographic information science (GIS) and new air pollution monitoring to characterize ambient and household PM2.5 exposure for PURE participants. Epidemiological analyses (both cross-sectional and longitudinal) will examine important cardiopulmonary outcomes as well as lung function change while controlling for important confounding factors.