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Air Pollution and Health: An introduction

Air Pollution and Health: An introduction. Ferran Ballester. Air pollution projects involved: APHEA APHEIS EMECAS. Unit of Epidemiology & Statistics Valencian School of Studies for Health-EVES. Literature. There are many articles and books on air pollution and health

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Air Pollution and Health: An introduction

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  1. Air Pollution and Health: An introduction Ferran Ballester

  2. Air pollution projects involved:APHEAAPHEISEMECAS Unit of Epidemiology & Statistics Valencian School of Studies for Health-EVES

  3. Literature There are many articles and books on air pollution and health There are also useful resources in Internet.

  4. OBJECTIVES: • Introduce the basic concepts on air pollution and health • Comment on the most used epidemiological designs • Present the results of some of the main studies carried out in recent years

  5. Air, Water and Places Hippocrates

  6. Air Pollution Major Episodes in the mid XXth century • Meuse Valley, Belgium (1930) • Donora, Pennsilvania, USA (1948) • London, UK (1952)

  7. The London Fog

  8. The London Fog 1000 5,000 900 4,500 800 4,000 700 3,500 600 3,000 Daily deaths, London 500 2,500 400 2,000 Black Smoke Central Hall mg/m3 300 1,500 200 1,000 100 0,500 0 0,000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 December 1952

  9. Anual average of black smoke (in g/m3) London 1958-1971.

  10. Petrol Major emission sources of air pollutants SO2 PM NOX VOCs Pb Domestic Dwellings Power Generation Industry Stationary Emission Sources CO NOX Pb VOCs PM Diesel Mobile Emission Sources (Road Traffic)

  11. Major Air Pollutants (1)

  12. Major Air Pollutants (2)

  13. Health Effects of Air Pollution • Mortality • Cardiopulmonary Hospitalizations • Emergency department or outpatient visits • Symptomatic exacerbations • Changes in lung function • Cardiopulmonary symptoms • Upper respiratory illnesses • Lower respiratory illnesses

  14. Other Effects of Air Pollution Immune System; Allergies Allergic Asthma, Allergic Rhinoconjunctivitis Extrinsic Allergic Alveolitis / Hypersensitivity Central Nervous System Toxic Damage of Nerve Cells Mental retardation Carcinogenic Effects Lung Cancer, Leukemia Reproductive effects Infant mortality, Low weight birth

  15. Deaths ADVERSE HEALTH EFFECTS Hospitalizations Emergencies Visits to doctors Restricted activity Medication Symptoms Annoyance, discomfort Number of persons concerned

  16. Health effect assessment • Toxicological studies • Epidemiological studies

  17. Basic study designs in air pollution epidemiology

  18. Exposure assesment approaches in epidemiology of air pollution • Categorical exposure (high vs low) • Measured (or modeled) outdoor concentrations • Measurement of indoor and outdoor concentrations • Estimation of individual exposure using indoor, outdoor along time-activity diaries • Direct measurement of personal exposures • Measurement of biomarkers of exposure COST VALIDITY

  19. Results from some epidemiological studies • Time series • Cohort studies • Intervention studies

  20. Relationship between the factors implied in the time series epidemiological studies of air pollution

  21. APHEA1 cities Population > 25,000,000

  22. APHEA1 FINDINGS 1. All pollutants studied have small acute effects on the daily total, cardiovascular and respiratory mortality. 2. Particulates and ozone levels were consistently associated with respiratory and COPD admissions. 3. NO2 levels were associated with asthma admissions. 4. The effects were observed in locations where, in the majority of days, air pollutant levels were well below the set (W.H.O., E.C., U.S.E.P.A.) standards at that time.

  23. APHEA2 • EC Funded • 30 cities • 43 million inhabitants • Period of study: 5 years (~ 1990-1996)

  24. The EMECAS Project

  25. 3,0 2,5 TOTAL CVS 2,0 RES 1,5 change 1,0 % 0,5 0,0 -0,5 TSP PM10 SO2_24h EMECAS: Combined estimates for mortality and air pollution (1)

  26. 6,0 5,0 TOTAL 4,0 CVS 3,0 RES 2,0 change 1,0 % 0,0 -1,0 -2,0 NO2_24h CO_24h EMECAS: Combined estimates for mortality and air pollution (2)

  27. Particles R BS PM10 TSP 1.03 F 1.02 R F F 1.01 F R F RR lag 01 F F F F 1.00 1.5 % Increase in cardiac admissions 0.99 0.98 CVS HD IHD CBS EMECAS: combined results for cardiovascular admissions

  28. Harvard Six-City Cohort StudyRelative risk of mortality and long-term exposure to PM2.5Dockery et al, 1993 RR Annual mean PM2.5 (g/m3)

  29. Cause of death RR (10µg/m3) Total mortality 1.06 (1.02-1.11) Cardiopulmonary 1.09 (1.03-1.16) Lung cancer 1.14 (1.04-1.23) Other causes 1.01 (0.95-1.06) Long-term exposure to fine particulates and mortality in the ACS cohort (n:500 000)Pope et al, 2002

  30. Long term effectsin mortality and indicators of traffic-related air pollution in the NetherlandsHoek et al, 2002

  31. Intervention studies • Close of a steel mill in the Utah Valley:  particle levels,  morbidity,  inflammatory process • Ban on marketing and sale of smoky coal in Dublin:black smoke levels,  mortality • Introduction of gas with low sulphur in Hong Kong: levels of SO2 and SO4,  mortality and respiratory symptoms in children

  32. Summary of estimates of particulate matter effects (1)

  33. Summary of estimates of particulate matter effects (2)

  34. Summary • Main acute effects: • Increase in the number of deaths • Increase in hospital admissions and emergency visits, especially for cardio-respiratory causes • Alterations in lung performance, cardiac problems and other symptoms and discomfort • Main chronic effects: • Increase in the risk of death • Increased cardio-respiratory morbidity and decline of pulmonary function

  35. References

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