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Effects and Impact Effects: The health consequences of PM Impact The sum of all effects in the population, given the current pollution levels Cambridge1.ppt.

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Presentation on theme: "Effects and Impact Effects: The health consequences of PM Impact The sum of all effects in the population, given the current pollution levels Cambridge1.ppt."— Presentation transcript:

1 Effects and Impact Effects: The health consequences of PM Impact The sum of all effects in the population, given the current pollution levels Cambridge1.ppt

2 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

3 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

4 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

5 Typical Long-term effects of urban air pollution –Lower pulmonary function –Chronic respiratory symptoms increased –Lung cancer –Life expectancy decreased Cambridge1.ppt

6 Lung Cancer and Traffic related Air Pollution in Stockholm Nyberg et al. (Epidemiology 2000; 11:487-957) –All > 1000 lung cancer cases, 1985-1990 –Residential exposure modeling for past 30 years –NO 2 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

7 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 Relative Risk mean PM2.5 Cambridge1.ppt

8 Total Mortality: Smokers, Ex- smokers, and Air Pollution (Harvard Six City Cohort Study, Dockery et al, New Engl J Med 1993)

9 Short-term effects of Air Pollution Cambridge1.ppt Period of exposure Time Time to event Period of events Hospital admission Emergency visits Death counts, Pollution SHORT PERIODS Days or weeks

10 Typical short-term effects Reduced lung function, Disturbance Symptoms Medication Restricted activity Visit to the doctor Emergency room Hospital Death Number of susceptible people Cambridge1.ppt

11 Annual mean PM10 and expiratory capacity (FVC) in the 8 SAPALDIA areas Ackermann-Liebrich et al, AJRCCM 1997; 155 (1):122-129 PM10 annual mean ( g / m 3 ) FVC % deviation from predicted Cambridge1.ppt

12 The APHEA 2 Study in Europe Acute 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/m 3 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

13 The MISA Study – an italian example for short- term effects of air pollution Torino, Milano, Verona, Ravenna, Bologna, Firenze, Roma, Palermo Biggeri et al; Epidemiologia & Prevenzione 2001; 25(2) % change (and 95 th CI) per 10 g/m 3 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

14 Annual Cases (and %) attributed to Air Pollution Austria, France, and Switzerland (>50% are traffic related) Outcome CasesAttribut. % Death (adults 30 yrs.) 40600 (24600-56'900) ~ 6 % Hospital Admissions (cardio-respiratory causes) 48000 (17300–79100) ~ 2 % Chronic Bronchitis (incidence in adults) 47'100 (4300-93'500) ~ 12 % Bronchitis Episodes (children) 543'000 (239500-981'600) ~ 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

15 Impatto del PM10 in tre studi: 3 nazioni, Tirolo, 8 città italiane ambridge1.ppt Concentrazione media Mortalità Ammissioni osp. (cardio- resp) Bronchite chronica Bronchite (bambini) Giorni con attività ridotta Attachi dasma A/F/CH 24 g/m 3 6 % 2% 12% 30% 12% 6% Südtirol 15-20 g/m 3 3-5 % 1-2 % 7-11 % 17-28 % 6-11 % 3-5 % 8 Città ~50 g/m 3 2-8 % 2-4 % 2-22 % 18-33 % 13-16 % 8-9 % Conc. di riferimento 7.5 g/m 3 30 g/m 3

16 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

17 Aumento percentuale della mortalità giornaliera (e limiti di confidenza al 95%) associato ad un aumento di 10μg/m 3 nel livello di PM 10 Dati dello studio Europeo APHEA Katsouyanni et al, Epidemiology 2001; 12 (5): 521- 31 Cambridge1.ppt -1% 0% 1% 2%

18 Cambridge1.ppt Pneumonia Total cells (rat) Neutrophils in BAL Proteins in BAL IL-8 in BAL 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: 90 Toxicology: Dye et al, Env Health Perspect, 2001; 109 (suppl 3):395 Human Experiment: Ghio & Devlin, Am J Respir Crit Care Med, 2001; 164:704

19 Do these small effects matter ? Che cosa è limpatto di questi effetti piccoli? % increase (and 95% CI) per 10 g/m 3 change in PM10 Mortality4.3 % (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

20 % increase (and 95% CI) per 10 g/m 3 change in PM10 Mortality4.3 % (2.6-6.1) Mortality4.3 % (2.6-6.1) Hospital admissions (cardio-resp.) 1.3 %(0.1-2.5) Hospital admissions (cardio-resp.) 1.3 %(0.1-2.5) Chronic bronchitis (adults) 9.8 % (0.9-19.0) Chronic bronchitis (adults) 9.8 % (0.9-19.0) Bronchitis episodes (children) 30.6 % (13.5-50.2) Bronchitis episodes (children) 30.6 % (13.5-50.2) Restricted activity days 9.4 % (7.9-10.9) Restricted activity days 9.4 % (7.9-10.9) Asthma attacks (children & adults) 4.0 % (1.9-6.2) Asthma attacks (children & adults) 4.0 % (1.9-6.2) Cambridge1.ppt Inquinamento atmosferico Effetti a breve termine sulla salute delluomo

21 Fonte: ARPA

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24 Air pollution related health costs (EUROs) per capita ~600 EUR per persona, allanno Sommer et al, OECD Report, 2000 Cambridge1.ppt

25 ~600 Euro per persona allanno (Sommer et al, OECD Report, 2000) Cambridge1.ppt Inquinamento atmosferico Costi correlati agli effetti sulla salute delluomo

26 Conclusion Air pollution has adverse effects on health Evidence is strongest for short-term effects; long-term effects should be better investigated, in Europe PMs 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


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