The first of these was a study of six relatively small towns, from 1974-1990, conducted by seven doctors and reported in the New England Journal of Medicine in 1993. This was the first study with control groups to 'null out' the effect of smoking. The results were striking; very fine particulate material (2.5 microns and below) were implicated at a 50% higher rate than any other contaminant -- in such towns as Portage, WI (population 10,000); Watertown, MA (32,000); Harriman, TN (pop. 6000); Topeka, KS (127,000); a portion of St. Louis (half? of 320,000), and Steubenville, OH (19,000). This study should have been widely acknowledged, and galvanizing.
[1] Douglas Dockery, C. Arden Pope III, Xiping Xu, John D. Spengler, James H. Ware, Martha E. Fay, Enjamin G. Ferris, Jr.; and Frank E. Speizer, “An Association between Air Pollution and Mortality in Six U.S. Cities,” New England Journal of Medicine (329: 24), December 9, 1993
The second of these was done by three CDC statisticians, reporting CDC COPD death-rates by HSA (Health-Service Area), which is 805 separate health areas for America (versus 50 states, and 3,000+ counties). Colorado, for example, is granular of ONE as a state; 64 as counties, and 16 HSA regions (four of which are shared across state boundaries). They studied five-year aggregated age-normalized COPD death-rates for three periods ('83-'87; '88-'92; and '93-'97), along with a map of 'hot spots' for change in ranking (Figure 5 counting from the last post). The Rockies and New England were stunningly high in COPD death-rates; the South with its high smoking prevalence was low. Again, so far as I know, this important 2001 paper received almost no acknowledgment.
[2] Jay H. Kim, Jimmie D. Givens, Jai W. Choi; “Geographic
Distribution and Changes in COPD Mortality: United States, 1983-1997, National
Center for Health Statistics, Hyattsville, MD, presented at American
Statistical Society, August, 2001.
The final paper that I will mention along these lines was commissioned by the Colorado COPD Institute, to study deeper why Colorado is consistently among the top COPD death-rate states, even though it is not a high-smoking state. While it found not 'smoking gun', it was suggestive, and it certainly comfirmed that urban areas were not high in incidence.
[3] Ryan McGhan and Greg Kinney, “2007 Colorado Chronic obstructive pulmonary disease (COPD) Surveillance Report”, Colorado COPD Institute, with the American Lung Association, Colorado branch
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