E R Carla van Wiechen, Danny Houthuijs, Siem Heisterkamp, Erik Lebret

Monitoring environmental health around Schiphol airport

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GB B NL D F EUROHEIS 30-31 March 2003 | Carla van Wiechen 2

Health Impact Assessment Schiphol (HIAS)

Monitoring programme 2002 - 2006 Aims • to keep the “finger on the pulse” • to assess changes in environmental quality and environmentally related health effects • to support the decision making process on the development of air traffic EUROHEIS 30-31 March 2003 | Carla van Wiechen 3

HIAS - Monitoring

Combination of various study designs • cross-sectional questionnaire survey (2002) – reference data • panel study (2002 - 2005) – in areas with expected changes in aircraft noise • small area level analyses with routine data – follow-up spatial pattern of disease EUROHEIS 30-31 March 2003 | Carla van Wiechen 4

HIAS - small area health statistics

Health data • hospital admissions – cardiovascular diseases – respiratory diseases • medication use – cardiovascular – respiratory – sleeping pills / sedatives • Environment Advisory Committee Schiphol – number of complainants about aircraft noise EUROHEIS 30-31 March 2003 | Carla van Wiechen 5

HIAS - small area health statistics

Population data • per postcode area, by 5-year age and sex – yearly updated (national statistical office) Health determinants at postcode level • socio-economic indicators – % high and low income – average value of housing stock • % non-Western immigrants • smoking – estimation of % smokers EUROHEIS 30-31 March 2003 | Carla van Wiechen 6

HIAS - small area health statistics

Geographical data • spatial link via postcode • area 55 km 2 • 490 postcodes • total population: 2,890,000 • postcode average: 5,900 inhabitants [10 - 21,000] EUROHEIS 30-31 March 2003 | Carla van Wiechen 7

HIAS - small area health statistics

Environmental exposure data air traffic noise L den (day, evening, night) 58 dB(A) 50 dB(A) EUROHEIS 30-31 March 2003 | Carla van Wiechen 8

HIAS - small area health statistics

Environmental exposure data L night (23:00-7:00) 49 dB(A) EUROHEIS 30-31 March 2003 | Carla van Wiechen 9

EUROHEIS 30-31 March 2003 | Carla van Wiechen 10

Average L den per postcode with min. and max. values (2000)

dB(A) 80 75 70 65 60 55 50 45 40 35 30 25 EUROHEIS 30-31 March 2003 | Carla van Wiechen 11

Average values of L den per postcode variance: • between postcodes high (30) • within postcodes low (1) • between years lowest (0.5) EUROHEIS 30-31 March 2003 | Carla van Wiechen 0 km 10 12

HIAS - small area health statistics

Statistical method – Bayesian disease mapping – spatiotemporal modelling – Markov chain Monte Carlo simulation methods (MCMC) – compare competing models: exchangeable conditional autoregressive (CAR) – use of Expected Predicted Deviance (EPD) EUROHEIS 30-31 March 2003 | Carla van Wiechen 13

Complainants aircraft noise – Standard Ratio – year 2000 – model: exchangeable – interaction of time and site not significant EUROHEIS 30-31 March 2003 | Carla van Wiechen 0 km 10 14

x-axis: average Lden per postcode (logarithmic) y-axis: Mean SMR (complainants), Exchangeable-model + interaction, year 2000 where postcode areas have >= 100 inhabitants 1,000 800 600 400 200 100  0 25 30 35 40 45 50 55 60 65 70 EUROHEIS 30-31 March 2003 | Carla van Wiechen 15

HIAS - small area health statistics

Resuming • ingredients to get started • further development of aggregated health determinants • search for solutions to constraints • further exploration of exposure co-variables Thank you for your attention!

EUROHEIS 30-31 March 2003 | Carla van Wiechen 16

HIAS - Monitoring

Environmental exposure data noise increase Expected changes between years 2000 and 2005 (L den ) noise decrease EUROHEIS 30-31 March 2003 | Carla van Wiechen 17

HIAS - Monitoring

Environmental exposure data Road traffic L day (7:00-23:00)  49 dB(A) EUROHEIS 30-31 March 2003 | Carla van Wiechen 18

Health Impact Assessment Schiphol (HIAS)

Phase I 1991-1993 Health studies in relation to environmental pollution, as part of Environmental Impact Assessment Phase II 1995-2002 Fill up gaps in knowledge • Ecological studies: health registries • Epidemiological field studies on e.g.: - annoyance, self-reported health, perceived risks - sleep disturbance - respiratory complaints in children - performance of children (RANCH) EUROHEIS 30-31 March 2003 | Carla van Wiechen 19