Expert Group on PM, 1st Meeting, 23-24 May 2005
Overview of health impacts
of particulate matter in Europe
Michal Krzyzanowski
WHO ECEH Bonn Office
Joint WHO / Convention Task Force on Health
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Assessment of health impacts of PM: References
Health aspects of air pollution with particulate matter, ozone and nitrogen
dioxide. Report on a WHO Working Group, Bonn, Germany 13-15 January 2003.
http://www.euro.who.int/document/e79097.pdf
Health aspects of air pollution – answers to follow up questions from CAFÉ.
Report on a WHO Working Group, Bonn, Germany 15-16 January 2004 WHO 2004
(E82790)
http://www.euro.who.int/document/E82790.pdf
Meta-analysis of time series studies and panel studies of particulate matter (PM)
and ozone (O3). WHO 2004 (E82792)
http://www.euro.who.int/document/e82792.pdf
Health aspects of air pollution: Results from the WHO project “Systematic
review of health aspects of air pollution in Europe”, WHO 2004 (E83080)
http://www.euro.who.int/document/E83080.pdf
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Assessment of health impacts of PM: References
Technical Reports from TFH Meetings:
6th TFH Meeting: Modelling and
assessment of health impact of particulate matter
and ozone. EB.AIR/WG.1/2004/11
7th TFH Meeting: Modelling and assessment of
health impact of particulate matter and ozone.
EB.AIR/WG.1/2004/11
United Nations Economic Commission for
Europe, Geneve.
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Relative risks (RR) for mortality related to 10 µg/m3 increase
in daily PM concentration – results of meta-analysis
RR
1.03
Ozone
PM2.5
1.025
all cause
cardiovascular
respiratory
all cause
cardiovascular
1
respiratory
1.005
all cause
1.01
all cause
1.015
cardiovascular
respiratory
1.02
cardiovascular
BS
respiratory
PM10
0.995
European studies
American studies
0.99
WHO European Centre for Environment and Health
Source: WHO 2004
Bir
min
gh
am
, W Stoc
est
k
Mid holm
lan
d
Pas
He ris
ls
Lo inki
nd
Ro on
ue
Ba n
se
Str Zuric l
asb h
Le ourg
Ha
Ge vre
ne
v
Am Mad a
ste rid
rda
m
Ne
the Koln
rla
nd
Lyos
n
A
Bu thens
da
p
Hu est
Flo elva
re
Bo nce
log
Te na
pli
Se ce
Pa ville
ler
Cz
m
ech Tel A o
Re viv
pu
b
Mil lic
an
Erf o
Cra urt
cow
Ba Rom
rce e
lo
To na
r
Pra ino
gu
e
mean PM10 level in µg/m3
70
mean PM10
RR
50
WHO European Centre for Environment and Health
3.0
40
2.0
1.0
30
0.0
20
-1.0
0
RR increase per 10 µg/m3
Expert Group on PM, 1st Meeting, 23-24 May 2005
Relative risk for all-cause mortality
and a 10 µg/m3 increase in daily PM10 in Europe
6.0
60
5.0
4.0
10
-2.0
-3.0
-4.0
Source: WHO 2004
Expert Group on PM, 1st Meeting, 23-24 May 2005
Excess relative risk from US cohort studies
Study
PM Metric
Excess RR*) (%)
95% CI
Six City
PM2.5
13
4 - 23
Six City new
PM2.5
14
5 - 23
ACS
PM2.5
6.6
3 - 10
ACS New
PM2.5
7
4 - 10
ACS New
PM15-2.5
0.4
-1.4 – 2.2
ACS New
PM10/15
4.1
0.9 - 7.4
ACS New
PM10/15 SSI
1.6
-0.8 – 4.1
ACS extended
PM2.5 1979-83
4.1
0.8 – 7.5
ACS extended
PM2.5 1999-2000
5.9
2.0 – 9.9
ACS extended
PM2.5 Avg.
6.2
1.6 - 11
AHSMOG
PM10/15
2.1
-4.5 – 9.2
AHSMOG
PM2.5
8.5
-2.3 – 21
VA
PM2.5
-10
-15 - -4.6
*) per 10 µg/m3 PM2.5 and 20 µg/m3 PM10/15
WHO European Centre for Environment and Health
Source: US EPA 2003
Expert Group on PM, 1st Meeting, 23-24 May 2005
Long term exposure to PM and risk of mortality
in ACS cohort
(ca. 0.5 million people followed for 16 years)
WHO European Centre for Environment and Health
Source: Pope et al, JAMA 2002
Expert Group on PM, 1st Meeting, 23-24 May 2005
The effects of air pollution on
children's health and development
Conclusions on causal associations:
 PM and respiratory deaths in post-neonatal period
 Ambient air poll & lung function development (pre & post natal)
 PM and O3 exposure and asthma aggravation
 Pb and neurobehavioural development
Several suggestions for causal associations
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Systematic Review
Q3)
Is there a threshold below which no effects on
health of PM are expected to occur in all people?
Answer:
Epidemiological studies on large populations have been unable to
identify a threshold concentration below which ambient PM has no
effect on health. It is likely that within any large human population,
there is such a wide range of susceptibility that some subjects are
at risk even at the lowest end of concentration range.
Comments:
• Thresholds differ depending on endpoint selected
• Increasingly sensitive epidemiological study designs have
identified adverse effects of air pollution at increasingly lower
levels
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Systematic Review
Q7: Which of the physical and chemical characteristics
of particulate air pollution are responsible for health
effects?
- Fine PM is more hazardous than larger particles
- Metal content
- Organic components such as PAH
- Endotoxins
- Extremely small particles (< 100 nm)
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Physical and chemical characteristics of PM in relation
to health effects
Comments:
-
Role of size vs. chemical composition – difficult to be
separated
-
Even not toxic particles may be carriers of toxic chemicals
or act as catalysers of reactions on the surface
-
Different PM components affect different systems
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Physical and chemical characteristics of PM in relation
to health effects
(7th TFH meeting, following 2nd Round of Systematic Review):
Conclusion para. 24:
• only the anthropogenic contribution to PM2.5 mass should be
assessed;
• for this anthropogenic contribution, no no-effect level was
assumed
• due to the absence of compelling toxicological data about different
PM components acting in the complex ambient PM mixture, it was not
possible to precisely quantify the relative importance of the main PM
components for effects on human health at this stage.
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Loss of life expectancy
Due to PM2.5 from anthropogenic sources
2000
Loss of Life expectancy in months
Source:EMEP & IIASA
WHO European Centre for Environment and Health
2010
Estimates of health impacts of anthropogenic PM in EU
Health end-point
Mortality – life expectancy
reduction
Mortality – long term
exposure
Mortality – long term
exposure
Infant mortality
Chronic bronchitis
Respiratory hospital
admissions
Cardiac hospital admissions
Restricted activity days
Respiratory medication use
(children)
Respiratory medication use
(adults)
Lower respir. symptoms
(children)
Lower respir. symptoms in
adults with chronic disease
Units (per year)
Months
EU25
Germany
8.6
10.2
3001
657
288
65
0.6
136
51
0.09
31
11
32
288292
3510
7
63832
781
Days x 1000
22990
5166
Days x 1000
160349
32291
Days x 1000
236498
52636
Life years lost x1,000
Number of premature
deaths x1,000
Cases x1,000
Cases x 1000
cases x 1000
Cases x 1000
Days x 1000
Days x 1000
Source: CAFE 2005
WHO European Centre for Environment and Health
Determinants of health damage by air pollution
Health effect =
unit risk
x baseline health
x PM concentration
x size of exposed population
PM level = C
Health
effects
EQUAL
Population = P
WHO European Centre for Environment and Health
PM level = ½ C
Population = 2 P
Expert Group on PM, 1st Meeting, 23-24 May 2005
Conclusions
 The body of evidence on health effects of PM has strenghtened
consideralbly in the past few years.
 Initial insight to the possible mechanisms from toxi studies.
 The evidence is sufficient to recommend further policy actions on
local, regional and international levels to reduce PM exposure.
 Further research needed to resolve several detailed questions and
increase European data base.
WHO European Centre for Environment and Health
Expert Group on PM, 1st Meeting, 23-24 May 2005
Thank you
http://www.euro.who.int/air
[email protected]
WHO European Centre for Environment and Health