apheis air pollution and health: a european information system
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Monitoring and assessment of health effects from air pollution Meeting 26 - 27.5.2005, JRC, EC, Ispra, Italy. APHEIS Air Pollution and Health: A European Information System Monitoring the impact of Air Pollution on Public Health in 26 European cities. - PowerPoint PPT PresentationTRANSCRIPT
Institut de Veille Sanitaire
APHEIS Air Pollution and Health: A European Information System
Monitoring the impact of Air Pollution on Public Health in 26 European cities
Monitoring and assessment of health effects from air pollutionMonitoring and assessment of health effects from air pollutionMeeting 26 - 27.5.2005, JRC, EC, Ispra, ItalyMeeting 26 - 27.5.2005, JRC, EC, Ispra, Italy
Sylvia Medina, National Institute of Public Health Surveillance, InVS, Saint Maurice, France
Hans-Guido Mücke, Federal Environmental Agency, Berlin, Germany
on behalf of the Apheis network
Institut de Veille Sanitaire
• European public health surveillance systemEuropean public health surveillance system to monitor the effects of air pollution (AP) on public health (PH)
• Objective: translates epidemiological findings into decision-decision-making toolsmaking tools and provide reliable, up-to-date and easy-to-use information on the effects of AP on PH
• Target audiences: policy-makers, environment and health policy-makers, environment and health professionalsprofessionals, NGOs, the general public
What is Apheis ?
Institut de Veille Sanitaire
• Create a Europe-wide surveillance network on the effects of AP on public health
• Perform health-impact assessments (HIAs) on short- and long-term effects of AP over time
• Deliver periodic reports on the impact of AP on PH at the city and European levels simultaneously
• Develop communications tools for its different target audiences
How Apheis meets the information needs of its key audiences (1)
Institut de Veille Sanitaire
The Apheis Network
Institut de Veille Sanitaire
The Apheis Network
APHEIS Coordination Centre
Paris
Advisory groupsExposure assessmentEpidemiologyStatisticsPublic health Health impact assessment
APHEIS Participating Centre
Technical committeeExposure assessmentEpidemiologyStatisticsPublic HealthHealth Impact Assessment
City committeeNEHAPsLocal/national authoritiesMedical/environmental sciencesCitizens
Local/regional coordinator
Institut de Veille Sanitaire
• Created five advisory groupsfive advisory groups: public health; health-impact assessment; epidemiology; exposure assessment; statistics
• Drafted guidelinesguidelines for designing and implementing the surveillance system, and for developing a standardised protocol for data collection and analysis for HIA
• Review of capacitiescapacities for HIA in institutions of participating cities
Actions, steps and resultsduring the first year
Institut de Veille Sanitaire
• ImplementImplement or adapt organisational modelsorganisational models designed during first year
• Collect and analyse dataCollect and analyse data for health-impact assessment
• Prepare different health-impact scenarioshealth-impact scenarios
• Prepare HIA reportHIA report in standardised format (HIA in 26 cities)
Actions, steps and resultsduring the second year
Institut de Veille Sanitaire
* Our first HIA provided a conservative and detailed picture of the impact of air pollution on health in 26 European cities, and showed that air pollution continues to threaten public health in Europe.
* Even very small and achievable reductions in air pollution levels have an impact on public health
- All other things being equal, reducing long-term exposure to PM10 by just 5 µg/m3 would have ‘prevented’ more than 5 000 premature deaths annually
Institut de Veille Sanitaire
Institut de Veille Sanitaire
• To keep our HIA as accurate and up-to-date as possible:
- Produce new exposure-response functionsnew exposure-response functions on short-term effects of AP
- Calculate years of life lostyears of life lost or reduction in life reduction in life expectancyexpectancy, in addition to the attributable number of deaths based on long-term effects of AP
Actions, steps and resultsduring the third year
Institut de Veille Sanitaire
• To fulfill our mission of making our learnings available to the broadest possible audiences, and to evaluate the usefulness of our work on HIA among those who need to know:
- Explore and understand in terms of content and form how best to meet the information needsinformation needs of policy makers concerned with the impact of air pollution on public health
- Develop tool templates/generic toolsDevelop tool templates/generic tools that centres can use
Actions, steps and resultsduring the third year
Saklad Consultants for Apheis 3
Institut de Veille Sanitaire
1. Specify exposure
2. Define the appropriate health outcomes
3. Specify the exposure-response functions
4. Derive population baseline frequency measures for health outcomes
5. Calculate number of attributable cases in target population
Five main steps in HIA
HIA modelKünzli, Kaiser, Medina et al, Lancet 2000; 356: 795 - 801
PM10
Incidence/prevalence
Attributable cases
Reference level PM10
Scenarios
E-R function
Observed level: annual mean
Institut de Veille Sanitaire
Short-term scenarios
Apheis 3
Health indicator ToolRR (95% IC)
For 10 µg/m3 increaseScenarios References
Attributable cases
ICD9 ICD10 Daily mean
Black smoke
All ages, all causes mortality (excluding external causes)All ages, cardiovascular mortalityAll ages, respiratory mortalityAll ages, cardiac hospital admissionsAll ages, respiratory hospital admissions
< 800390-459 460-519390-429460-519
A00-R99I00-I99J00-J99I00-I52J00-J99
PSAS-9Excel spreadsheet
1.006 (1.004 - 1.009)1.004 (1.002 - 1.007)1.006 (0.998 - 1.015)1.011 (1.004 - 1.019)
1.0030 (0.9985 -1.0075)
Reduction to 50 µg/m3
Reduction to 20 µg/m3
Reduction by 5 µg/m3
WHO, 2004WHO, 2004WHO, 2004
APHEIS 3, 2004APHEIS 3, 2004
PM10
very short-term
All ages, all causes mortality (excluding external causes)All ages, cardiovascular mortalityAll ages, respiratory mortalityAll ages, cardiac hospital admissionsAll ages, respiratory hospital admissions
< 800 390-459 460-519 390-429460-519
A00-R99I00-I99J00-J99I00-I52J00-J99
PSAS-9Excel spreadsheet
1.006 (1.004 - 1.008)1.009 (1.005 - 1.013)1.013 (1.005 - 1.021)1.006 (1.003 - 1.009)
1.0114 (1.0062 - 1.0167)
Reduction to 50 µg/m3
Reduction to 20 µg/m3
Reduction by 5 µg/m3
WHO, 2004WHO, 2004WHO, 2004
APHEIS 3, 2004APHEIS 3, 2004
PM10 cumulative
short-term (40 days)
All ages, all causes mortality (excluding external causes)All ages, cardiovascular mortalityAll ages, respiratory mortality
< 800 390-459 460-519
A00-R99I00-I99J00-J99
PSAS-9Excel spreadsheet
1.01227 (1.0081 - 1.0164)1.01969 (1.0139 - 1.0255)1.04206 (1.0109 - 1.0742)
Reduction to 50 µg/m3
Reduction to 20 µg/m3
Reduction by 5 µg/m3
A. Zanobetti et al, 2002A. Zanobetti et al, 2003A. Zanobetti et al, 2003
PM10 with
shrunken estimates All ages, all causes mortality (excluding external causes) < 800 A00-R99
PSAS-9Excel spreadsheet
RRs calculated from betas & se of Apheis shrunken estimates for each city
Reduction to 50 µg/m3
Reduction to 20 µg/m3
Reduction by 5 µg/m3 Apheis 3, 2004
ICD
ST HIA for all Apheis cities
Complementary ST HIA for some Apheis cities
Institut de Veille Sanitaire
Long-term scenarios
Apheis 3
Mortality indicator ICD 9 ICD10 ToolRR (95% IC)
For 10 µg/m3 increaseScenarios Cities
Attributable cases
Annual mean
PM10 All causes < 800 A00-Q99 InVS Excel Apheis 21,043 (1,026-1,061)
Reduction to 40 µg/m3Reduction to 20 µg/m3Reduction by 5 µg/m3
All cities with PM10
PM2,5
Total Cardiopulmonary LCA
0-999 401-440 and 460-519
162
A00-T98I10-I70 and J00-J99
C33-C34 InVS Excel
Average Pope, 20021.06 (1.02-1.11)1.09 (1.03-1.16)1.14 (1.04-1.23)
Reduction to 20 µg/m3Reduction to 15 µg/m3Reduction by 3,5 µg/m3
All cities with PM2,5 and converted from PM10
YoLL Annual mean
PM2,5
Total Cardiopulmonary LCA
0-999 401-440 and 460-519
162
A00-T98I10-I70 and J00-J99
C33-C34 AirQ
Average Pope, 20021.06 (1.02-1.11)1.09 (1.03-1.16)1.14 (1.04-1.23)
Reduction to 20 µg/m3Reduction to 15 µg/m3Reduction by 3,5 µg/m3
All cities with PM2,5 and converted from PM10
LT HIA for all-cities report
Summary LONG-TERM HIA
Institut de Veille Sanitaire
Apheis 3
Health Impact Assessment
Example of findings
Institut de Veille Sanitaire
0
20
40
60
80
100
120 PM10 (µg/m3)
2010
2005
Annual mean levels and 5th and 95th percentiles of the distribution of PM10
Institut de Veille Sanitaire
Reductions of PM2.5: 20 vs 15 µg/m3
Our HIA revealed that reducing PM2.5 levels to 15 µg/m3 produces
a benefit in terms of both total and cause-specific mortality that is over 30% greater than for a reduction to 20 µg/m3
However, because a significant health impact can be expected even below 15 µg/m3, we advise reducing air pollution to levels lower than 15 µg/m3:
All other things being equal, the HIA estimated that 6 355 premature deaths, including 4 199 cardiopulmonary deaths and 743 lung-cancer deaths, could be prevented annually if long-term exposure to PM2.5 levels were reduced by 3.5 µg/m3 in each city
Institut de Veille Sanitaire
Expected Gain in Life Expectancy at 30 years old if annual PM2.5 levels were reduced to 15 µg/m3
00.20.40.60.8
11.21.41.61.8
22.22.42.62.8
33.2
Gain in life expectancy ( years)
Institut de Veille Sanitaire
Expected life expectancy for current PM2.5 levels and
reduction to 15 µg/m3 in Seville
0
10
20
30
40
50
60
70
80
Life expectancy at age x
Lif
e e
xp
ec
tan
cy
(y
ea
rs)
Life expectancy if PM2.5 annualmean w ere reduced to 15 µg/m3
Life expectancy w ith currentPM2.5 annual mean
Institut de Veille Sanitaire
Expected gain in life expectancy if PM2.5 current annual
mean levels (35 µg/m3) did not exceed 15 µg/m3 in Seville
0.00
0.50
1.00
1.50
2.00
2.50
Life expectancy at age x
Expected gain in life expectancy (years)
Institut de Veille Sanitaire
• Exposure measurements– Measurements methods (TEOM/Gravimetric)
• Use of local/European correction factor
– Number of stations and site selection
– Quality assurance and control (QA/QC), and data quality (DQ)
=> Importance of the EURAQHEM project
Uncertainties in the HIA process
Institut de Veille Sanitaire
• Health Outcomes– Mortality data
• Quality/Control Programme
• Low percentage of missing data
• Comparable data
– Hospital admissions data
• Completeness of registries-Quality/Control programmes
• Problem of comparability of emergency vs total discharge diagnoses
– Other morbidity data
• Missing information
Uncertainties in the HIA process
Institut de Veille Sanitaire
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Infraclinical stage
Symptoms
Medication
Restricted activity
Medical visits
Emergencies
Hospital admissions
Mortality
Number of persons
Institut de Veille Sanitaire
• Transferability of Expo-Response Functions– Short-term HIA
• European studies
– Long-term HIA
• US ACS study (Pope 2002)
• Waiting for European cohort studies
Uncertainties in the HIA process
Institut de Veille Sanitaire
• The APHEIS findings add one more brick in the wall of evidence that air pollution continues to threaten public health in Europe
• Main source of air pollution in Apheis cities:Traffic
• A bottom-up network very successful to help simultaneously local and European decision-making
Learnings from Apheis
Institut de Veille Sanitaire
• The Apheis programme fosters ongoing cross-fertilization between multiple disciplines and regions to:
– create skilled, local teams
– enrich know-how and the quality of its findings
– and explore important HIA methodological issues
• Using this approach, Apheis has established a good basis for comparing methods and findings between cities
Learnings from Apheis
Institut de Veille Sanitaire
• Today Apheis is a highly active network of environmental and health professionals in Europe:
- Various local and national authorities have identified this network as able over time to provide sound scientific advice on health risks related to air pollution
- Cities not involved in the Apheis programme have expressed a desire to join the Apheis network
Learnings from Apheis
Institut de Veille Sanitaire
Co-funded by:
* Pollution-Related Diseases Programme of Health and Consumer Protection DG (DG SANCO) of the European Commission, contract Nos.:
• SI2.131174 [99CVF2-604]
• SI2.297300 [2000CVG2-607]
• SI2.326507 [2001CVG2-602]
* Participating institutions in 12 European countries
=> JRC in Ispra 26-27 May 2005
Who funds Apheis
Institut de Veille Sanitaire
Special thanks to all the APHEIS group !
Athens: Antonis Analitis, Giota Touloumi, Klea Katsouyanni, Department of Hygiene and Epidemiology, University of Athens, Athens, Greece Barcelona: Lucía Artazcoz, Antoni Plasència, Agencia Municipal de Salut Pública (Municipal Institute of Public Health), Barcelona, SpainBilbao: Koldo Cambra, Eva Alonso, Francisco Cirarda, Teresa Martínez, Departamento de Sanidad, Gobierno Vasco, Vitoria-Gasteiz, SpainBucharest: Emilia Maria Niciu, Institutul de Sanatate Publica (Institute of Public Health), Bucharest, Romania Budapest: Anna Paldy, Janos Bobvos and Eszter Erdei, “Fodor József” Országos Közegészségügyi Központ Országos Környezetegészségugyi Intézet (“Jozsef Fodor” National Center for Public Health, National Institute of Env Health), Budapest, HungaryCracow: Krystyna Szafraniec, Epidemiology and Preventive Medicine, Jagiellonian University, Cracow, Poland. Dublin: Pat Goodman and Luke Clancy, Saint James Hospital, Dublin, Ireland France, PSAS-9 project: Sylvie Cassadou (Toulouse), Pascal Fabre, Hélène Prouvost, Christophe Declerq (Lille), Daniel Eilstein (Strasbourg), Laurent Filleul (Bordeaux), Laurence Pascal (Marseille), Jean François Jusot (Lyon), Myriam D’Elf (Rouen, Le Havre), Agnès Lefranc, Benoit Chardon (Paris), and Alain Le Tertre, Institut de Veille Sanitaire, Saint-Maurice
Institut de Veille Sanitaire
Ljubljana/Celje: Tina Gale, Peter Otorepec, Mateij Gregoric, Inštitut za Varovanje Zdravja (Institute of Public Health), Ljubljana, Republic of SloveniaLondon: Richard Atkinson and Ross Anderson, Saint George’s Hospital Medical School, London, UKMadrid: Mercedes Martínez (Dirección General de Salud Pública), Belén Zorrilla, Laura Lopez, Ana Gandarillas, Elena Boldo (Instituto de Salud Pública) Consejería de Sanidad, Laura Crespo (Dirección General de Calidad y Evaluación Ambiental) Consejería de Medio Ambiente, Comunidad de Madrid, Spain. Rome: Ursula Kirchmayer and Paola Michelozzi, ASL RM/E Azienda Sanitaria Locale Roma E (Local Health Authority Roma E), Rome, ItalySeville: Inmaculada Aguilera, Antonio Daponte, Escuela Andaluza de Salud Pública (Andalusian School of Public Health), Granada, SpainStockholm/Gothenburg: Bertil Forsberg, Bo Segerstedt, Lars Modig, Umeå Universitet, Institutionen főr folkhalsa och klinisk medicin (Umeå University, Department of Public Health and Clinical Medicine), Umeå, Sweden Tel-Aviv: Ayana Goren, Sarah Hellmann, Department of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Aviv, IsraëlValencia: Ferrán Ballester, Carmen Iñíguez and José Luis Bosch (City Council), Escuela Valenciana de Estudios para la Salud (Valencian School of Studies for Health), Valencia, Spain
Special thanks to all the APHEIS group !
Institut de Veille Sanitaire
Brussels: Catherine Bouland, Brussels Institute for the Management of The Environment (BIME) and Pierre Biot FPS Health, Food Chain Safety and Environment CAE, Belgium. Copenhagen: Lisbeth Knudsen, Institute of Public Health University of Copenhagen and Lis KEIDING National Board of Health, Denmark.Hamburg: Michael Schûmann, Arbeitsgruppe Epidemiologie, Institut für medizinische Biometrie und Epidemiologie (IMBE) and Hermann NEUS, Department for Science and Health (BWG) Germany.Lisbonne: Cristina Fraga Amaral, Filomena Araujo, Teresa Correia, General Health Directorate, Environmental Health Department, PortugalPrague: Ruzena Kubinova, Vladimíra Puklová, Environmental Health, National Institute of Public Health , Czech Republic.Rotterdam: Ingrid Walda, Municipal Health Service, Reind Van Doorn and Harma Boerema, Health Protection Agency, The Netherlands.Vienna: Manfred Neuberger and Hanns Moshammer, Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Austria
Special thanks to all the APHEIS group !
Institut de Veille Sanitaire
Steering Committee
• Ross Anderson, Saint George’s Hospital Medical School, London, UK
• Emile De Saeger, Nikolaos Stilianakis, Joint Research Centre, Institute for Environment and Sustainability, Joint Research Centre Ispra, Italy
• Klea Katsouyanni, Department of Hygiene and Epidemiology, University of Athens, Athens, Greece
• Michal Krzyzanowski, WHO European Centre for Environment and Health, Bonn Office, Germany
• Hans-Guido Mücke, Umweltbundesamt - Federal Environmental Agency, WHO Collaborating Centre, Berlin, Germany
• Joel Schwartz, Harvard School of Public Health, Boston, USA
Special thanks to all the APHEIS group !
Institut de Veille Sanitaire
For further information please visit:
www.apheis.net
KNOWLEDGE KNOWLEDGE ACTIONACTION