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WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
HEALTH RISKS HEALTH RISKS OF PARTICULATEOF PARTICULATE MATTERMATTER
AIR POLLUTION AIR POLLUTION
An overview for the 41An overview for the 41stst Session of GRPE Session of GRPE
M. KrzyzanowskiM. KrzyzanowskiWHO ECEH Bilthoven DivisionWHO ECEH Bilthoven Division
Urban Particulate Matter – TEM image of a filterUrban Particulate Matter – TEM image of a filter
Source: BeruBe et al, in Particulate Matter, ed. Maynard & Howard, BIOS Sc Publ 1999
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
WHO Air Quality Guidelines, 2WHO Air Quality Guidelines, 2ndnd edition edition
Particulate matter (PM10 or PM2.5)Particulate matter (PM10 or PM2.5)
• “Available information does not allow a judgement to be made of concentrations below which no effects would be expected”
• “Use risk estimates for standard setting”
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Studies on health impacts of PMStudies on health impacts of PM
• Short term changes in pollution level (Time-series; panel)
• Efects of long-term exposure(cohort studies)
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Health effect estimates per 10Health effect estimates per 10g/m3 increase g/m3 increase in 24-h mean PM10 concentrationsin 24-h mean PM10 concentrations
Endpoint Relative risk (95% C.I.) Studies (a)
Bronchodilator use 1.031 (1.020-1.041) (b) 2 / 1
Cough 1.036 (1.020-1.052) 2 / 2
LRS 1.032 (1.019-1.046) 2 / 1
PEF change -.13% (-.17% - -.09%) 2 / 3
Hospitaladmissions
1.008 (1.005-1.011) (b) 1 / 4
Mortality 1.007 (1.006-1.009) (b) 3 / 14
(a) Europe / Americas (b) p<0.05 for test of heterogeneity
Source: WHO AQG 2nd ed.
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Questions in interpretation of studies Questions in interpretation of studies on short-term impacts of PMon short-term impacts of PM
• Physiopathological mechanism of effects?
• Extent of displacement of time of health effect?
• Harvesting?
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Recent studies on effects of PM Recent studies on effects of PM on cardiovascular systemon cardiovascular system
• Increase in blood viscosity in days with high PM (Peters et al, 1997; no effect in Seaton et al 1999)
• Increased heart rate associated with increased PM level (Stone & Godleski 1999, Peters et al, 1999, Pope et al. 1999)
• Incidence in cardiac arrhythmia and PM level (Peters et al, 2000)
Estimated effect of a 10 Estimated effect of a 10 µµg/m3 increase in PM2.5g/m3 increase in PM2.5
Source: Schwartz, Am J Epi 2000
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Summary of effect estimates of long-term exposure to PM on morbidity and mortality, associated with a 10 µg/m3 increase in the annual mean concentration of PM2.5 or PM10
Endpoint PM2.5 PM10
Relative risk (95% C.I.)
Mortality (Dockery et al. 1993) 1.14 (1.04, 1.24) 1.10 (1.03, 1.18)
Mortality (Pope et al. 1995) 1.07 (1.04, 1.11) n.a.
Bronchitis (Dockery et al. 1996) 1.34 (0.94, 1.99) 1.29 (0.96, 1.83)
% change in FEV1 (95% C.I.)
Lung function in children (Raizenne et al. 1996)
-1.9% (-3.1%, -0.6%) -1.2% (-2.7%, -0,1%)
Lung function in adults (Ackermann-Liebrich et al. 1997)
n.a. -1.0% (n.a.)
Source: WHO AQG 2nd ed.
WHO -AQG
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Relative risk of mortality by cause of deathRelative risk of mortality by cause of death Re-analysis of US cohort studiesRe-analysis of US cohort studies
0
0.5
1
1.5
2
2.5
RR 6-cities Study* ACS Study**
* Per 18.6 µg/m3 PM2.5 ** Per 24.5 µg/m3 PM2.5
Source: HEI 2000
RR for all cause mortality in ACS StudyRR for all cause mortality in ACS StudyRe-analysis of US cohort studiesRe-analysis of US cohort studies
Source: HEI 2000
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
% increase in mortality per 10 % increase in mortality per 10 µg/m3 PM10µg/m3 PM10by PM2.5 /by PM2.5 / PM10 ratioPM10 ratio
Meta-analysis of 19 US time-series studiesMeta-analysis of 19 US time-series studies
Source: Levy et al, 2000
-0.5
0
0.5
1
1.5
< 0.57 0.57 - 0.64 > 0.64
%
PM2.5/PM10
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Inflammogenic properties Inflammogenic properties of carbon black particles by particle sizeof carbon black particles by particle size
Source: Donaldson et al., 1999
0
10
20
30
40
50% neutrophils in BAL
14 nm
50 nm
260 nm
Effects of different size of ultrafine and fine PM Effects of different size of ultrafine and fine PM on daily mortality, Erfurt, 1995-8on daily mortality, Erfurt, 1995-8
Source: Spix et al, 2000
Best 1 day lag / distributed lag model
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Estimated contribution of the main sourcesEstimated contribution of the main sourcesto PM emissions in Europe*) in 1993to PM emissions in Europe*) in 1993
Source: Holman et al, 1999
0%
20%
40%
60%
80%
100%
PM10 PM2.5 PM0.1
Other
Productionprocesses
Power gener.
Road transport
*) excluding former Soviet Union
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Ambient concentrations Ambient concentrations of ultrafine (UP) and fine (FP) particlesof ultrafine (UP) and fine (FP) particles
Source: Wichmann & Peters 2000
UP = NC 0.01 – 0.1; FP = MC 0.01 – 2.5 PM2.5
0
20
40
60
80
100
UP (1000/cm3)
FP (ug/m3)
Erfurt Sachsen-Anhalt
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Overview of estimated health impacts of ambientair pollution in Europe in mid-1990s (1)
Exposureindicator
Health indicator, populationat risk
Attributableproportion
Estimatednumber of casesper year (x1000)
Long term exposureSPM (PM10) Mortality1), urban, age >35 4% - 13% 102 - 368
Short term variability of exposureSPM (PM10), dailylevels
Daily number of deaths1), urban 1.4% - 3.2% 41 - 89
SO2, daily levels Daily number of deaths1), urban 0.4% - 0.7% 12 - 20
Ozone, 8-h meanexceeds 110 µg/m3
Daily number of deaths1), allpop. in 15 EU countries
0.1% - 0.2% 2 - 4
1) All deaths except accidents
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Overview of estimated health impacts of ambient air pollution inEurope in mid-1990s (2)
Exposureindicator
Health indicator, populationat risk
Attributableproportion
Estimatednumber of casesper year (x1000)
Short term variability of exposure
SPM (PM10), dailylevels
Hospital admissions, forrespiratory disease, urban
1.5% – 3.4% 7 - 16
SO2, daily levels Hospital admissions for asthma,urban, age < 15 years
0.7% – 3.4% 0.2 – 1.0
Ozone, 8-h meanexceeds 110 µg/m3
Hosp. admissions for respiratorydis,. all pop. age > 15 years in15 EU countries
0.1% - 0.3% 0.3 – 1.0
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Number of cases attributable to air pollution in France Number of cases attributable to air pollution in France per year per year ((Künzli et al., Lancet 2000; 356:795-801)Künzli et al., Lancet 2000; 356:795-801)
Health outcome Cases 95% CI
Mortality (long term st.), adults>30y 31700 19200 - 44400
Respiratory hospital admissions 13800 1400 – 26300
Cardiovascular hospital admissions 19800 10400 – 29400
Chronic bronchitis incidence (>25y) 36700 3300 – 73100
Bronchitis (<15 y) 450000 198500 – 813600
Restricted activity days (>20y) (million) 26.4 20.7 – 28.5
Asthma attacks (<15 y) (person-days) 243000 149000 - 337000
Asthma attacks (>15 y) (person-days) 577000 281000-879000
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
CONCLUSIONSCONCLUSIONS
• PM is associated with a wide range of health effects, with significant public health consequences
• Significant role of fine PM
• Role of ultrafine particles – to be studied
WHO European Centre for Environment and HealthWHO European Centre for Environment and Health
Understanding the Health Effects of Particulate Air Understanding the Health Effects of Particulate Air Pollution: Pollution:
Recent Advances and Outstanding QuestionsRecent Advances and Outstanding Questions
A Meeting for Members of Government, Industry and the General Public
Organized by WHO and HEI in cooperation with EC DG Environment
Brussels , 6-7 March 2001
Information: mkr@who.nl or rokeefe@healtheffects.org
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