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WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Overview of health impacts of particulate matter in Europe
Michal Krzyzanowski
WHO ECEH Bonn OfficeJoint WHO / Convention Task Force on Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Assessment of health impacts of PM: References
Health aspects of air pollution with particulate matter, ozone and nitrogen dioxide. Report on a WHO Working Group, Bonn, Germany 13-15 January 2003. http://www.euro.who.int/document/e79097.pdf Health aspects of air pollution – answers to follow up questions from CAFÉ. Report on a WHO Working Group, Bonn, Germany 15-16 January 2004 WHO 2004 (E82790)http://www.euro.who.int/document/E82790.pdf Meta-analysis of time series studies and panel studies of particulate matter (PM) and ozone (O3). WHO 2004 (E82792) http://www.euro.who.int/document/e82792.pdf
Health aspects of air pollution: Results from the WHO project “Systematic review of health aspects of air pollution in Europe”, WHO 2004 (E83080) http://www.euro.who.int/document/E83080.pdf
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Assessment of health impacts of PM: References
Technical Reports from TFH Meetings:
6th TFH Meeting: Modelling and assessment of health impact of particulate matter and ozone. EB.AIR/WG.1/2004/11
7th TFH Meeting: Modelling and assessment of health impact of particulate matter and ozone. EB.AIR/WG.1/2004/11
United Nations Economic Commission for Europe, Geneve.
WHO European Centre for Environment and Health
Source: WHO 2004
Expert Group on PM, 1st Meeting, 23-24 May 2005
Relative risks (RR) for mortality related to 10 µg/m3 increase in daily PM concentration – results of meta-analysis
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0.99
0.995
1
1.005
1.01
1.015
1.02
1.025
1.03PM10 BS Ozone PM2.5
European studies American studies
RR
WHO European Centre for Environment and Health
Source: WHO 2004
Relative risk for all-cause mortality and a 10 µg/m3 increase in daily PM10 in Europe
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-4.0
-3.0
-2.0
-1.0
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mean PM10 RR
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Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Excess relative risk from US cohort studies
Study PM Metric Excess RR*) (%)
95% CI
Six City PM2.5 13 4 - 23
Six City new PM2.5 14 5 - 23
ACS PM2.5 6.6 3 - 10
ACS New PM2.5 7 4 - 10
ACS New PM15-2.5 0.4 -1.4 – 2.2
ACS New PM10/15 4.1 0.9 - 7.4
ACS New PM10/15 SSI 1.6 -0.8 – 4.1
ACS extended PM2.5 1979-83 4.1 0.8 – 7.5
ACS extended PM2.5 1999-2000
5.9 2.0 – 9.9
ACS extended PM2.5 Avg. 6.2 1.6 - 11
AHSMOG PM10/15 2.1 -4.5 – 9.2
AHSMOG PM2.5 8.5 -2.3 – 21
VA PM2.5 -10 -15 - -4.6*) per 10 µg/m3 PM2.5 and 20 µg/m3 PM10/15 Source: US EPA 2003
WHO European Centre for Environment and Health
Source: Pope et al, JAMA 2002
Long term exposure to PM and risk of mortalityin ACS cohort
(ca. 0.5 million people followed for 16 years)
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
The effects of air pollution on The effects of air pollution on children's health and developmentchildren's health and development
Conclusions on causal associations:
PM and respiratory deaths in post-neonatal period Ambient air poll & lung function development (pre & post natal) PM and O3 exposure and asthma aggravation Pb and neurobehavioural development
Several suggestions for causal associations
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Q3) Is there a threshold below which no effects on health of PM are expected to occur in all people?
Answer:Epidemiological studies on large populations have been unable to identify a threshold concentration below which ambient PM has no effect on health. It is likely that within any large human population, there is such a wide range of susceptibility that some subjects are at risk even at the lowest end of concentration range.
Comments:• Thresholds differ depending on endpoint selected• Increasingly sensitive epidemiological study designs have
identified adverse effects of air pollution at increasingly lower levels
Systematic ReviewExpert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Systematic ReviewSystematic Review
Q7: Which of the physical and chemical characteristics of particulate air pollution are responsible for health effects?
- Fine PM is more hazardous than larger particles
- Metal content
- Organic components such as PAH
- Endotoxins
- Extremely small particles (< 100 nm)
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Physical and chemical characteristics of PM in relation to health effects
Comments:
- Role of size vs. chemical composition – difficult to be separated
- Even not toxic particles may be carriers of toxic chemicals or act as catalysers of reactions on the surface
- Different PM components affect different systems
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Physical and chemical characteristics of PM in relation to health effects
(7th TFH meeting, following 2nd Round of Systematic Review):Conclusion para. 24:
• only the anthropogenic contribution to PM2.5 mass should be assessed;
• for this anthropogenic contribution, no no-effect level was assumed
• due to the absence of compelling toxicological data about different PM components acting in the complex ambient PM mixture, it was not possible to precisely quantify the relative importance of the main PM components for effects on human health at this stage.
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Loss of life expectancyDue to PM2.5 from anthropogenic sources
2000 2010Loss of Life expectancy in months
Source:EMEP & IIASA
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Estimates of health impacts of anthropogenic PM in EUHealth end-point Units (per year) EU25 Germany
Mortality – life expectancy reduction
Months 8.6 10.2
Mortality – long term exposure
Life years lost x1,000 3001 657
Mortality – long term exposure
Number of premature deaths x1,000
288 65
Infant mortality Cases x1,000 0.6 0.09Chronic bronchitis Cases x 1000 136 31Respiratory hospital admissions
cases x 1000 51 11
Cardiac hospital admissions Cases x 1000 32 7Restricted activity days Days x 1000 288292 63832Respiratory medication use (children)
Days x 1000 3510 781
Respiratory medication use (adults)
Days x 1000 22990 5166
Lower respir. symptoms (children)
Days x 1000 160349 32291
Lower respir. symptoms in adults with chronic disease
Days x 1000 236498 52636
Source: CAFE 2005
WHO European Centre for Environment and Health
Determinants of health damage by air pollutionHealth effectHealth effect =
unit risk x baseline health
x PM concentrationx size of exposed population
PM level = CPM level = ½ C
Population = P Population = 2 P
Health Health effectseffectsEQUALEQUAL
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
ConclusionsConclusions
The body of evidence on health effects of PM has strenghtened consideralbly in the past few years.
Initial insight to the possible mechanisms from toxi studies.
The evidence is sufficient to recommend further policy actions on local, regional and international levels to reduce PM exposure.
Further research needed to resolve several detailed questions and increase European data base.
Expert Group on PM, 1st Meeting, 23-24 May 2005
WHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Thank youThank you
http://www.euro.who.int/airhttp://www.euro.who.int/air
Expert Group on PM, 1st Meeting, 23-24 May 2005