Effects and Impact

• Effects:The health consequences of PM

• ImpactThe sum of all effects in the population, given

the current pollution levels

Cambridge1.ppt

Studying Air Pollution Health Effects is a Research Challenge

• Air pollution • a complex mixture, not ONE substance

• low concentrations

• everybody is exposed

Cambridge1.ppt

• Health outcomes• Unspecific, no ‘air pollution disease’

• multi-causal, multi-pathway

EPIDEMIOLOGY

Investigating Air Pollution

– With epidemiologic methods: difficult to assess effects of single pollutants!

– We use single pollutants as indicators of the mixture

– PM10 and finer particles: important health relevant indicator !

Cambridge1.ppt

Long-term effects of air pollution

– Exposure over years or life-time

– Effects occur late (after years)

– Effects may be chronic

Requires mostly studies in very large populations, observed over years and decades !

Cambridge1.ppt

Typical Long-term effects of urban air pollution

– Lower pulmonary function

– Chronic respiratory symptoms increased

– Lung cancer

– Life expectancy decreased

Cambridge1.ppt

Lung Cancer and Traffic related Air Pollution in Stockholm

Nyberg et al. (Epidemiology 2000; 11:487-957)

– All > 1’000 lung cancer cases, 1985-1990

– Residential exposure modeling for past 30 years

– NO2 as a surrogate for carcinogens from traffic

exhaust

Results:

–Those with lung cancer had higher 10-yrs-exposure to traffic related air pollution

–highest exposure group, 20-30 years ago: 40% higher risk for lung cancer (95%CI:0-100%)

UN

Mortality (adjusted Relative Risk) and long-term mean pollution (PM2.5)

Harvard Six-City Cohort Study, Dockery et al, NEJM 1993; 329 (24):1753-9

1.00

1.05

1.10

1.15

1.20

1.25

1.30

0 10 20 30 40

Rel

ativ

e R

isk

mean PM2.5Cambridge1.ppt

Total Mortality: Smokers, Ex-smokers, and Air Pollution

(Harvard Six City Cohort Study, Dockery et al, New Engl J Med 1993)

0

0.5

1

1.5

2

2.5

3

Smoking Ex-Smoking Air Pollution

Rel

ativ

e R

isk

Short-term effects of Air Pollution

Cambridge1.ppt

Period of exposure

Time

Time to event

Period of events

Hospital admission Emergency visitsDeath counts,

Pollution

SHORT PERIODSSHORT PERIODSSHORT PERIODSSHORT PERIODSSHORT PERIODS

Days or weeks

Typical short-term effects

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Reduced lung function, Disturbance

Symptoms

Medication

Restricted activity

Visit to the doctor

Emergency room

Hospital

Death

Number of susceptible people

Cambridge1.ppt

Annual mean PM10 and expiratory capacity (FVC) in the 8 SAPALDIA

areas Ackermann-Liebrich et al, AJRCCM 1997; 155 (1):122-129

-6

-4

-2

0

2

4

6

0 10 20 30 40

PM10 annual mean (g / m3)

FV

C

% d

evia

tio

n f

rom

pre

dic

ted

Cambridge1.ppt

The APHEA 2 Study in EuropeAcute effects of particulate pollution on respiratory

admissions(includes Milano and Roma)

Atkinson RW et al; Am J Respir Crit Care Med 2001; 164 (10): 1860-66)

% change per 10 g/m3 increase in PM10(fixed effects single pollutant model)

Asthma, age 0-14: +1.2% (0.2-2.3)

Asthma, age 15-64: +1.1% (0.3-1.8)

COPD + asthma, 65+ yr +1.0% (0.4-1.5)

All respiratory, 65+ +0.9% (0.6-1.3)

Cambridge1.ppt

The MISA Study – an italian example for short-term effects of air pollution

Torino, Milano, Verona, Ravenna, Bologna, Firenze, Roma, PalermoBiggeri et al; Epidemiologia & Prevenzione 2001; 25(2)

% change (and 95th CI) per 10 g/m3 increase in PM10

(random effects model)

Total daily mortality: +1.27% (0.62-1.92)

Hospital Admissions:

–Cardiac diseases +1.15% (0.62-1.68)

–Respiratory diseases +2.41% (1.72-3.11)Cambridge1.ppt

Annual Cases (and %) attributed to Air Pollution Austria, France, and Switzerland (>50% are traffic related)

Outcome Cases Attribut. %Death (adults 30 yrs.)

40‘600(24‘600-56'900)

~ 6 %

Hospital Admissions(cardio-respiratory causes)

48’000(17’300–79’100)

~ 2 %

Chronic Bronchitis (incidence in adults)

47'100(4’300-93'500)

~ 12 %

Bronchitis Episodes (children)

543'000(239’500-981'600)

~ 30 %

Restricted Activity Days (adults)

30.5 mill.(25.7-37.3 mill)

~ 12 %

Asthma attacks

Künzli et al, Lancet 2000; 356: 795-801

1.04 mill.(0.54–1.54 mill.) ~ 6 %

ambridge1.ppt

Impatto del PM10 in tre studi: 3 nazioni, Tirolo, 8 città italiane

ambridge1.ppt

Concentrazione media

MortalitàAmmissioni osp. (cardio-resp)

Bronchite chronica

Bronchite (bambini)

Giorni con attività ridotta

Attachi d‘asma

A/F/CH

24 g/m3

6 %

2%

12%

30%

12%

6%

Südtirol

15-20 g/m3

3-5 %

1-2 %

7-11 %

17-28 %

6-11 %

3-5 %

8 Città

~50 g/m3

2-8 %

2-4 %

2-22 %

18-33 %

13-16 %

8-9 %

Conc. di riferimento 7.5 g/m3 30 g/m3

Effects of PM10 on daily respiratory admissions (age 65+) are stronger on days with high ozone

Atkinson et al, APHEA 2 (Am J Respir Crit Care Med 2001; 164 (10): 1860-66)

Cambridge1.ppt

Aumento percentuale della mortalità giornaliera (e limiti di confidenza al 95%) associato ad un aumento di 10μg/m3 nel

livello di PM10

Dati dello studio Europeo APHEA

Katsouyanni et al, Epidemiology 2001; 12 (5): 521-

31

Cambridge1.ppt

0 1 2-1

Pe rc e nt inc re a se in m o rta lity

-1% 0% 1% 2%

Cambridge1.ppt

Pn

eum

on

iaT

ota

l ce

lls

(rat

)

Neu

tro

ph

ils in

BA

LP

rote

ins

in B

AL

IL-8

in B

AL

0

20

40

60

80

100

120

Steal mill ON (1986) Steal mill OFF (1987) Steal mill ON (1988)

% of 1986

Epidemiologic (hospital admiss. in children, pneumonia), toxicological and human broncho-alveolar effects of PM10 in

the Utah Valley, with Steal mill on/off/on

PM10

Epidemiology: Pope et al, Arch Env Health, 1991;46: 90Toxicology: Dye et al, Env Health Perspect, 2001; 109 (suppl

3):395Human Experiment: Ghio & Devlin, Am J Respir Crit Care Med, 2001; 164:704

Do these small effects matter ? Che cosa è l‘impatto di questi effetti piccoli?

% increase (and 95% CI) per 10 g/m3 change in PM10

Mortality 4.3

% (2.6-6.1)

Hospital admissions (cardio-resp.) 1.3 % (0.1-

2.5)

Chronic bronchitis (adults) 9.8 %

(0.9-19.0)

Bronchitis episodes (children) 30.6 %

(13.5-50.2)

Restricted activity days 9.4

% (7.9-10.9)

Asthma attacks (children & adults) 4.0 % (1.9-

6.2)

Cambridge1.ppt

% increase (and 95% CI) per 10 % increase (and 95% CI) per 10 g/mg/m33 change in PM10change in PM10

MortalityMortality

4.3 % 4.3 % (2.6-6.1)(2.6-6.1)

Hospital admissions (cardio-resp.) Hospital admissions (cardio-resp.) 1.3 % 1.3 %

(0.1-2.5)(0.1-2.5)

Chronic bronchitisChronic bronchitis (adults) (adults)

9.8 % (0.9-19.0)9.8 % (0.9-19.0)

Bronchitis episodes (children)Bronchitis episodes (children)

30.6 %30.6 % (13.5-50.2) (13.5-50.2)

Restricted activity days Restricted activity days

9.4 % 9.4 % (7.9-10.9) (7.9-10.9)

Asthma attacksAsthma attacks (children & adults) (children & adults) 4.0 % 4.0 %

(1.9-6.2) (1.9-6.2)

Cambridge1.ppt

Inquinamento atmosfericoInquinamento atmosfericoEffetti a breve termine sulla salute Effetti a breve termine sulla salute

dell’uomodell’uomo

Inquinamento atmosfericoInquinamento atmosfericoEffetti a breve termine sulla salute Effetti a breve termine sulla salute

dell’uomodell’uomo

Fonte: ARPA

Fonte: ARPA

Fonte: ARPA

Air pollution related health costs (EUROs)

per capita

~600 EUR per persona, all‘anno

Sommer et al, OECD Report, 2000

Cambridge1.ppt

~600 Euro per persona all‘anno~600 Euro per persona all‘anno(Sommer et al, OECD Report, 2000)(Sommer et al, OECD Report, 2000)

Cambridge1.ppt

Inquinamento atmosfericoInquinamento atmosfericoCosti correlati agli effetti sulla salute Costi correlati agli effetti sulla salute

dell’uomodell’uomo

Inquinamento atmosfericoInquinamento atmosfericoCosti correlati agli effetti sulla salute Costi correlati agli effetti sulla salute

dell’uomodell’uomo

Conclusion • Air pollution has adverse effects on

health

• Evidence is strongest for short-term effects; long-term effects should be better investigated, in Europe

• PM’s are an important aspect of air pollution, but other pollutants and the mixture may be relevant, too

• The impact on public health is substantial, in Italy and Europe

• Some ‘experimental evidence’ that improvements in air quality lead to health benefits very fastly (short-term effects)

Cambridge1.ppt