CAMBRA Koldo* 1, ALONSO Eva 1, MEDINA Sylvia 2, LE TERTRE Alain 2, CASSADOU Sylvie 2, PASCAL Laurence 2, FRANK Florian 2, DIAZ DE QUIJANO Estela 3, VALERO Nuria 3, KNUDSEN Lisbeth 4, LOPEZ-CARRASCO Laura 5, SCHUMANN Michael 6, ATKINSON Richard 7, GARCIA Francisco 8, MOSHAMMER Hanns 9, TORO Silvia 10, FORSBERG Bertil 11, HURLEY Fintan 12, DE SAEGER Emile 13, KRZYZANOWSKY Michal 14 on behalf of the APHEIS and ENHIS networks Methods Exposure-Response Functions (RR) for HIA were selected according to the following criterion: 1) Summary estimates from meta-analysis or original studies involving large populations; and 2) Outcomes for which the overall evidence of a causal contribution of air pollution is high. The selected RR for 10 µg/m 3 increase of PM 10 were for total- and for respiratory postneonatal mortality (Lacasaña, 2005) and 1.12 for Postneonatal Sudden Infant Death Syndrome (PSIDS) (Woodruff, 1997). Three scenarios based on the annual mean of PM 10 were defined: a reduction of 5 µg/m 3 and the reduction to 40 and 20 µg/m 3, both limits of 1999/30/EC Directive. Each city used its own mortality rates. Attributable cases were estimated using the software created by the French Air Pollution and Health Surveillance Programme (PSAS-9) ( We used PM 10 data from 2001 or Introduction Health consequences of Air Pollution (AP) exposure are not equally spread among the population, and some groups, like children, may be at particular risk. Here we present the results of the Health Impact Assessment (HIA) of suspended particles of less than 10 µm (PM 10 ) on postneonatal mortality, carried out in 31 cities of the APHEIS network ( within the Environment and Health Information System (ENHIS) programme ( ). Acknowledgements ENHIS is supported by the European Commission DG SANCO (Grant: SPC ). APHEIS was supported by the European Commission DG SANCO (contracts: SI [99CVF2-604]; SI [2000CVG2-607]; SI [2001CVG2-602] and the participating local institutions. Results PM 10 annual mean was between 20 and 40 µg/m 3 in most of the participating cities (Fig 1). All other things being equal, in these cities (totalling almost 46 million inhabitants), a reduction of the annual mean value of PM 10 by 5 µg/m 3 would be associated with a decrease of 23 postneonatal deaths per year (4.7/ children), 5 from respiratory causes (1.4/ children) and 7 from PSIDS (1.8/ children). The accomplishment of the limit for 2010 of 1999/30/EC Directive (20 µg/m 3 ) would prevent 56 postneonatal deaths, 13 from respiratory causes and 9 from PSIDS (Table 1). 1 Department of Health, Basque Government, Spain. 2 InVS- Institute for Public Health Surveillance, France. 3 Public Health Agency of Barcelona, Spain. 4 University of Copenhagen, Denmark. 5 Regional Ministry of Health, Madrid, Spain. 6 Department of Health and Science, Hamburg, Germany. 7 St George’s Hospital Medical School, London, UK. 8 Valencian School of Public Health Studies, Valencia, Spain. 9 Institute of Environmental Health, University of Vienna, Austria. 10 Andalusian School of Public Health, Granada, Spain. 11 Department of Public Health and Clinical Medicine, Umeå University, Sweden. 12 Institute of Occupational Medicine, Edinburgh, UK. 13 Joint Research Centre, Institute for Environment and Sustainability, Italy. 14 WHO European Centre of Environment and Health, Bonn Office, Germany Health Impact Assessment of PM10 Air Pollution on Postneonatal Mortality in 31 European Cities These results add more evidence that AP continues to pose a significant threat to public health in urban areas in Europe, particularly for children. Nevertheless, postneonatal mortality does not seem to be a sensitive indicator to assess the impact of PM on children’s health in Western cities, where mortality rates are very low. The main obstacle to a more comprehensive HIA of outdoor AP on children is the lack of routine morbidity data. Table 1. Potential benefits of reducing PM 10 levels 1. Absolute numbers and death rates (per children). 1 PM 10 values from automatic netwoks were corrected to compensate the loss of volatiles. 2 Annual rates per have been calculated for the specific population of the cities in which each scenario is applicable. Fig 1. Annual mean, 5th and 95th percentiles of the distribution of PM 10 levels in the participating cities Discussion and Conclusions