PURE-AIR is a NIH funded study (DP5OD019850) 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 PM_2.5 have been conducted in developed countries, where PM_2.5 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 PM_2.5 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 median current follow-up of 9.1 years.

This research proposal adds an air pollution component (PURE-AIR) to the ongoing PURE cohort study. First, we will use novel satellite-based air pollution estimates, geographic information science (GIS) and new air pollution monitoring to characterize ambient PM_2.5 exposure for PURE communities. Second, we will collect new household air pollution measures for 4,500 households and 1,200 individuals in countries where solid fuel use for heating in common. Epidemiological analyses (both cross-sectional and longitudinal) will then examine associations between air pollution exposures and mortality, cardiopulmonary outcomes, and lung function while controlling for important confounding factors.

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