Transcript HEALTH RISKS OF PARTICULATE MATTER AIR POLLUTION An overview for the 41st Session of GRPE M.

HEALTH RISKS
OF PARTICULATE MATTER
AIR POLLUTION
An overview for the 41st Session of GRPE
M. Krzyzanowski
WHO ECEH Bilthoven Division
WHO European Centre for Environment and Health
Urban Particulate Matter – TEM image of a filter
Source: BeruBe et al, in Particulate Matter, ed. Maynard & Howard, BIOS Sc Publ 1999
WHO Air Quality Guidelines, 2nd edition
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 Health
Studies 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 Health
Health effect estimates per 10 mg/m3 increase
in 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
Hospital
admissions
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 Health
Questions in interpretation of studies
on short-term impacts of PM
• Physiopathological mechanism of effects?
• Extent of displacement of time of health effect?
• Harvesting?
WHO European Centre for Environment and Health
Recent studies on effects of PM
on 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)
WHO European Centre for Environment and Health
Estimated effect of a 10 µg/m3 increase in PM2.5
Source: Schwartz, Am J Epi 2000
WHO -AQG
Summary of effect estimates of long-term exposure to PM on
3
morbidity and mortality, associated with a 10 µg/m 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)
Lung function in adults
(Ackermann-Liebrich et al.
1997)
-1.9% (-3.1%, -0.6%)
-1.2% (-2.7%, -0,1%)
n.a.
-1.0% (n.a.)
nd
Source: WHO AQG 2 ed.
WHO European Centre for Environment and Health
Relative risk of mortality by cause of death
Re-analysis of US cohort studies
2.5
RR
6-cities Study*
2
ACS Study**
1.5
1
0.5
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* Per 18.6 µg/m3 PM2.5
** Per 24.5 µg/m3 PM2.5
Source: HEI 2000
WHO European Centre for Environment and Health
RR for all cause mortality in ACS Study
Re-analysis of US cohort studies
Source: HEI 2000
% increase in mortality per 10 µg/m3 PM10
by PM2.5 / PM10 ratio
Meta-analysis of 19 US time-series studies
1.5
1
%
0.5
0
-0.5
< 0.57
0.57 - 0.64
> 0.64
PM2.5/PM10
Source: Levy et al, 2000
WHO European Centre for Environment and Health
Inflammogenic properties
of carbon black particles by particle size
% neutrophils in BAL
50
40
14 nm
30
20
50 nm
10
260 nm
0
Source: Donaldson et al., 1999
WHO European Centre for Environment and Health
Effects of different size of ultrafine and fine PM
on daily mortality, Erfurt, 1995-8
Best 1 day lag / distributed lag model
Source: Spix et al, 2000
Estimated contribution of the main sources
to PM emissions in Europe*) in 1993
100%
Other
80%
60%
Production
processes
40%
Power gener.
20%
Road transport
0%
PM10
PM2.5
PM0.1
*) excluding former Soviet Union
Source: Holman et al, 1999
WHO European Centre for Environment and Health
Ambient concentrations
of ultrafine (UP) and fine (FP) particles
100
Erfurt
Sachsen-Anhalt
80
60
UP (1000/cm3)
40
FP (ug/m3)
20
99
19
93
19
/9
8
97
19
19
91
/9
2
0
UP = NC 0.01 – 0.1;
FP = MC 0.01 – 2.5  PM2.5
Source: Wichmann & Peters 2000
WHO European Centre for Environment and Health
Overview of estimated health impacts of ambient
air pollution in Europe in mid-1990s (1)
Exposure
indicator
SPM (PM10)
SPM (PM10), daily
levels
SO2, daily levels
Health indicator, population
at risk
Long term exposure
Mortality , urban, age >35
1)
Attributable
proportion
Estimated
number of cases
per year (x1000)
4% - 13%
102 - 368
Short term variability of exposure
Daily number of deaths1), urban
1.4% - 3.2%
41 - 89
Daily number of deaths1), urban
0.4% - 0.7%
12 - 20
0.1% - 0.2%
2-4
Ozone, 8-h mean
Daily number of deaths1), all
exceeds 110 µg/m3 pop. in 15 EU countries
1) All deaths except accidents
WHO European Centre for Environment and Health
Overview of estimated health impacts of ambient air pollution in
Europe in mid-1990s (2)
Exposure
indicator
Health indicator, population
at risk
Attributable
proportion
Estimated
number of cases
per year (x1000)
Short term variability of exposure
SPM (PM10), daily
levels
Hospital admissions, for
respiratory 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 mean
Hosp. admissions for respiratory
exceeds 110 µg/m3 dis,. all pop. age > 15 years in
15 EU countries
0.1% - 0.3%
0.3 – 1.0
WHO European Centre for Environment and Health
Number of cases attributable to air pollution in France
per year (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 Health
CONCLUSIONS
• 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 Health
Understanding the Health Effects of Particulate Air
Pollution:
Recent 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: [email protected] or [email protected]
WHO European Centre for Environment and Health