who european centre for environment and health overview of health impacts of particulate matter in...

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



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

http://www.euro.who.int/document/e79097.pdf




http://www.euro.who.int/document/E82790.pdf














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


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


Source: WHO 2004

Relative risk for all-cause mortality and a 10 µg/m3 increase in daily PM10 in Europe

0

10

20

30

40

50

60

70

-4.0

-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

mean PM10 RR

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RR

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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


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)


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



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


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)



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



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.



Loss of life expectancyDue to PM2.5 from anthropogenic sources

2000 2010Loss of Life expectancy in months

Source:EMEP & IIASA



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


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


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.



Thank youThank you

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