Air Quality, Barcelona 17Air Quality, Barcelona 17 --18 June 201018 June 2010

WHO assessments WHO assessments of health effects of health effects of air pollutionof air pollution

Michal Krzyzanowski, Sc.D .European Centre for Environment and Health, Bonn Office

World Health Organization, Regional Office for Europe

Air quality and health Air quality and health –– WHO assessmentWHO assessment

This presentation:

• WHO assessments of health effects of air pollution

• Air quality in Europe and related health effects

• Recent research results

WHO assessments of health risks WHO assessments of health risks of air pollution of air pollution

• Health effects of transport-related air pollution (WHO 2005)

• WHO Air quality guidelines – global update 2005 (WHO 2006)

• Health risk of particulate matter from LRTAP (WHO 2006)

• Health risk of ozone from LRTAP (WHO 2008)

• Annual reports on health effects of AP presented to CLRTAP (http://www.unece.org/env/lrtap/lrtap_h1.htm )

WHO AQG: Global update: WHO AQG: Global update: Summary of updated AQG valuesSummary of updated AQG values

20 µg/m3

500 µg/m324 hour10 minute

Sulfur dioxide, SO 2

40 µg/m3

200 µg/m31 year1 hour

Nitrogen dioxide, NO 2

100 µg/m38 hour, daily maximumOzone, O 3

10 µg/m3

25 µg/m3

20 µg/m3

50 µg/m3

1 year24 hour (99th percentile)

1 year24 hour (99th percentile)

Particulate matterPM2.5

PM10

AQG valueAveraging timePollutant

AQG levels recommended to be achieved everywhere in order to significantly reduce the adverse health effects of poll ution

WHO AQG: Global update: WHO AQG: Global update: Particulate matter Particulate matter -- annual meanannual mean

Lowest levels at which total, CP and LCA mortality have been shown to increase (Pope et al., 2002). The use of PM2.5guideline is preferred.

1020Air quality guideline (AQG)

Mortality risk reduced by approximately 6% compared to IT2 levels.

1530Interim target-3 (IT-3)

Risk of premature mortality decreased by approximately 6% compared to IT1

2550Interim target-2 (IT-2)

Levels associated with about 15% higher long-term mortality than at AQG

3570Interim target-1 (IT-1)

Basis for the selected levelPM2.5(µg/m 3)

PM10(µg/m 3)

Annual mean level

PassingPassing interim interim targetstargets on on thethe way way towardstowardsAQG AQG

Exposure

Effect

AQG IT-2 IT-1

Long term exposure to PM and risk of mortality in AC S cohort (ca. 0.5 million people followed for 16 years)

Source: Pope et al, JAMA 2002

Air quality and health Air quality and health –– WHO assessmentWHO assessment

This presentation:

• WHO assessments of health effects of air pollution

• Air quality in Europe and related health effects

• Recent research results

PM2.5 concentration map, annual average, 2005

Based on the combination of scaled rural and urban PM10 maps using region specific PM2.5/PM10 ratios;

Population weighted mean PM2.5:

EU27: 16.6 – 17.0 µg/m3Spain: 16.1 – 17.6 µg/m3

Source: F. De Leeuw, J. Horalek, ETC/ACC, 2009

PM10 annual mean 1999-2008

all stations<-6 %/yr

-6 - -3 %/yr

-3 - 0 %/yr

> 0 %/yr

source: ETC/ACC-AIRBASE February -2010

PM10trend(%/yr)1999-2008

PM10 annual mean

0

10

20

30

40

50

1998 2000 2002 2004 2006 2008

urban traffic rural

Source: F. de Leeuw, ETC ACC

PM10 – annual mean

PM10 concentration in Spanish cities (urban background)

0

10

20

30

40

50

60

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Madrid

Barcelona

Sevilla

Zaragoza

Málaga

Palma de Mallorca

Vitoria/Gasteiz

Oviedo

Pamplona/Iruña

Santander

Toledo

Badajoz

Bilbao

Córdoba

Granada

Móstoles

Jerez de la Frontera

San Sebastián/Donostia

Burgos

Salamanca

Albacete

Jaén

Marbella

Torrejón de Ardoz

Source: Airbase

Effect indicator:Premature mortality attributable to PM2.5 (2005)

Source: F. De Leeuw, J. Horalek, ETC/ACC, 2009

Total: 492,000 premature deaths per year; 4892,000 YLL

Spain:Spain:373,100 YLL373,100 YLL

HealthHealth --relevant indicator of ozone levels relevant indicator of ozone levels (SOMO35) in 2000 and expected in 2020(SOMO35) in 2000 and expected in 2020

2000

Source: CAFE 2004

2020

Number of deaths attributed to O3 exposure in Number of deaths attributed to O3 exposure in EU25EU25

0

1000

2000

3000

4000

5000

Aus

tria

Bel

gium

Den

mar

k

Fin

land

Fra

nce

Ger

man

y

Gre

ece

Irel

and

Italy

Luxe

mbo

urg

Net

herla

nds

Por

tuga

l

Spa

in

Sw

eden UK

Cze

ch R

ep.

Est

onia

Hun

gary

Latv

ia

Lith

uani

a

Pol

and

Slo

vaki

a

Slo

veni

a

2000 2010 2020

Source: CAFE 2004

Ozone Ozone levelslevels in urban in urban backgroundbackground locationslocations of of selectedselected countriescountries , 1997 , 1997 -- 20072007

Source: AirBase

Note: all countries average based on data from varying number ofcities & countries (223 cities in 27 countries in 2008)

0

2000

4000

6000

8000

10000

12000

14000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

SO

MO

35 u

g/m

3 *

day

sall countries

AT

BE

CH

CZ

DE

ES

NL

PL

SI

SK

GB

Air quality and health Air quality and health –– WHO assessmentWHO assessment

This presentation:

• WHO assessments of health effects of air pollution

• Air quality in Europe and related health effects

• Recent research results

RR for deaths for all causes RR for deaths for all causes per 10 per 10 µµg/m3 annual mean PM10g/m3 annual mean PM10

Health impacts of ozone –an update of evidence

Jerrett et al, NEJM 2009

Exposure-response curve for relation between long term O3 exposure and risk of death due to respiratory causes. Results of analysis of ACS cohort of 448,000 adults followed for up to 18 years

RR per 10 ppb = 1.040 (95% CI 1.010 - 1.067)(2-pollutant model with O3 and PM2.5)

Exposure to air pollution and infections, asthmatic and Exposure to air pollution and infections, asthmatic and allergic symptoms at 4 years old childrenallergic symptoms at 4 years old children

Birth cohort study of ca. 4,000 children in Netherlands. Exposure to traffic-related air pollution based on validated models.

Source: Brauer, Hoek et al, ERJ 2007

32*45*55*Allergen sensitivity (lab tests in sub-group)

1418*21*Doctor diag. flu / cold

17*15*13Ear / nose / throat infections

-10-10-22Doctor diag. bronchitis

111311Dry cough at night

121515Doctor diagnosed asthma

131823*Wheeze

NO2SootPM2.5

% change in risk (per inter-quartile range)

* p<0.05

Association between incident asthma with NO2*) as a n Association between incident asthma with NO2*) as a n indicator of trafficindicator of traffic --related air pollutionrelated air pollution

*) Effect estimates are over a 6.2-ppb (12.4 µg/m3) exposure contrast

10-18 years old children followed for 8 years in S. California.

Source: Jerrett EHP 2008

Respiratory effects of exposure to diesel traffic: Respiratory effects of exposure to diesel traffic: randomized study of 60 adults with asthma in Londonrandomized study of 60 adults with asthma in London

Mean % changes during and after 2 h walk on Oxford street and Hyde Park

McCreanor et al, NEJM 2007

Ischemic and thrombotic effects of dilute diesel Ischemic and thrombotic effects of dilute diesel exhaust inhalation in men with coronary heart disea seexhaust inhalation in men with coronary heart disea se

p<0.001

Myocardial inchemia during 15-minute intervals of exercise-induced stress and exposure to diesel exhaust or filtered air in the 20 subjects

Mills et al, NEJM 2007

Reduction of PM exposure and increase of life expectancy in the US

Fine particulate air pollution and life expectancy in the United States ( Pope AC et al, NEJM 2009): A decrease of 10 µg/m3 of PM2.5 associated with increase of life expectancy by 0.61 years between 1980 and 2000

Reduction in PM accounts for 15% of overall increas e in life expectancy

Potential reduction in YLL for two scenarios for PM2.5 reduction: LV compliance and AEI-reduction target

Source: F. De Leeuw, J. Horalek, ETC/ACC, 2009

ConclusionsConclusions

• Large and still growing body of evidence on adverse health effects of air pollution (PM2.5, PM10, ozone)

• Impacts of air pollution cause loss of life expectancy by ca. 8.8 months in Europe (half a year in Spain) and contribute to morbidity of adults and children

• Slight decrease in PM10 levels in urban areas in 2007-8 after several years of no decrease in most countries of Europe – no clear trends in Spanish cities

• Constant or growing (with exception of 2003 peak) O3 levels

• Population exposure reduction – recommended strategy for Europe