LEARNING AND TALKING ABOUT RISKS - ehbasel13.org · health aspects of air pollution ... Daniel Krewski, Canada Wolfgang G. Kreyling, Germany Nino Künzli, Switzerland Xavier Querol,

LEARNING –

AND TALKING –

ABOUT RISKS:

AIR QUALITY AND HEALTH

MICHAL KRZYZANOWSKI, Sc.D.

EH Basel, 19-23 August 2013 1

John Goldsmith Lecture

Retired Head, WHO European Centre for Environment and Health, Bonn

Visiting Professor, Environmental Research Group, King´s College London


We, the environmental epidemiologists of the

world, are the canaries, capable of giving warning

of impending environmental disaster in time for

remedial steps to be taken.

John Goldsmith

Arch Env Health 1988

Fortunately, our fate is not to have to die as the

unfortunate canaries of the coal mines did, but to

sing, to call out in clear tones the nature and type

of impending health danger that threatens. …

Global Burden of Disease 2010


Lim et al 2012

Knowledge on AQ and health –

1980-2013


Time

Knowledge

(arbitrary

scale)

AQG 1987 AQG 2005 AQG 2000

GBD 2010

1980 2013

State of the art, 1979


WHO Air quality guidelines for

Europe, 1987 (µg/m3)

Averaging

time

SO2 Black

smoke

TSP PM10

24 hours 125 125 120 70

1 year 50 50 - -


An arbitrary safety factor of 2 used for mortality and morbidity,

factor 1.5 for the decrement in lung function

Epi studies on short-term effects

of PM, 1990-1994


EHP 1995 Draft presented at 5th ISEE Conference,

Stockholm, 1993

Estimated health impacts of

suspended particulate matter in

Europe

Health effect Number of cases /year

Premature deaths (short term PM)* 27000-48000

>5% decrement of pulmonary function 4.5 million

New cases of obstructive airways disease 183000

New cases of asthma 176000

Episodes of respiratory illness, children* 22-31 million


“Concern for Europe´s Tomorrow”, WHO 1995

*24-h SPM>120 µg/m3

Survival and PM:

Harvard Six-cities study


Dockery et al, NEJM 1993

Confirmed in American Cancer Society cohort (Pope et al, AJRCCM 1995)

Selected activities of

research groups, 1990s

COST 613/2 Concerted Action on Air Pollution

Epidemiology (1990-94)

Committee on Research Priorities for Airborne

Particulate Matter, National Research Council,

1998

Health Effects Institute - projects and reports

ISEE Conferences

International collaborative research projects

(APHEA, CESAR, PEACE, …)


WHO Air Quality Guidelines for

Europe, 2nd

edition (2000)


Reduction of the number of survivors exposed to pollution increased by 10 µg/m3

(PM10) in a birth cohort of 100,000 people with mortality structure of Dutch men:

By age of 50: 383

By age of 60: 1250

By age of 70: 3148

Risk increase for all-cause mortality

per 10 µg/m3 daily PM10 in Europe


WHO 2004

(%)

Short term exposures to PM10

and mortality – global overview

EH Basel, 19-23 August 2013 13 Curtesy: A.Cohen, HEI 2004

Long term exposure to PM and risk of

mortality in ACS cohort (ca. 0.5

million people followed for 16 years)


Pope et al, JAMA 2002

Comparative Quantification

of Health Risks, 2004


Globally (in urban population):

0.8 million premature deaths / year

6.4 million YLL / year

WHO 2004

Loss of life expectancy due to PM2.5

from anthropogenic sources in Europe

(in months)


Source: IIASA 2004

WHO Air Qualty Guidelines,

Global update 2005


WHO 2006

Ischemic and thrombotic effects of

dilute diesel exhaust inhalation in

men with coronary heart disease


Myocardial ischemia 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

Carotid artery wall thickness (=risk of

atherosclerosis) and long-term PM2.5

exposure

AQG EU LV

Bauer et al, JACC 2010

% c

hange

in a

rtery

wall

thic

kness

Home outdoor PM2.5 (µg/m3)

19

Heinz Nixdorf RECALL study, Ruhr region, Germany

LAQN Seminar, London, 21 June 2013

Biological pathways linking PM

exposure with CVD


Brook et al, Circulation 2010

Mortality and long-term PM2.5 exposure

Results of a Canadian cohort study (2.1 million adults, 1991-2001)

LAQN Seminar, London, 21 June 2013 21

Crouse et al, EHP 2012

All non-accidental Cardiovascular

Ischemic heart

disease Cerebrovascular

PM2.5 estimated from satellite observations + monitoring

Mortality and long-term exposure to PM2.5

Ce

sa

ron

i e

t a

l. E

HP

20

13

c= % increase in risk per 10 µg/m3

c=10% c=6% c=4%

AQG EU LV

22

Results of a cohort study in Rome

(1.3 million adults followed from

2001 to 2010)

PM2.5: 3-dimensional Eulerian model (1x1 km)

LAQN Seminar, London, 21 June 2013

Reduction in PM and in mortality risk

– extended Harvard Six Cities study


WHO evaluation of recent evidence

to support EU air quality policies

(2011-2013)

• WHO – EC project “Review of evidence on

health aspects of air pollution - REVIHAAP”

http://www.euro.who.int/__data/assets/pdf_file/0

020/182432/e96762-final.pdf

• WHO – EC project ““Health risks of air

pollution in Europe – HRAPIE”


http://www.euro.who.int/__data/assets/pdf_file/0020/182432/e96762-final.pdf




Expected decrease of health impacts of PM

due to European policies on emission

reduction


Amann et al (eds). TSAP Report 10. IIASA 2013

Life expectancy lost due to anthropogenic PM2.5

8.5 months

5.3 months

3.6 months

2005 estimate

2030 under “Maximum

Technically Feasible

Reductions scenario”

2025 under “Current

Legislation” scenario

REVIHAAP contributors:

Scientific Advisory Committee

H. Ross Anderson, United Kingdom

Bert Brunekreef, The Netherlands

Aaron Cohen, United States

Klea Katsouyanni, Greece

Daniel Krewski, Canada

Wolfgang G. Kreyling, Germany

Nino Künzli, Switzerland

Xavier Querol, Spain

Authors of background text

Richard Atkinson, United Kingdom

Lars Barregård, Sweden

Tom Bellander, Sweden

Rick Burnett, Canada

Flemming Cassee, The Netherlands

E. de Oliveira Fernandes, Portugal

Francesco Forastiere, Italy

Bertil Forsberg, Sweden

Susann Henschel, Ireland

Gerard Hoek, The Netherlands

Stephen T Holgate, United Kingdom

Nicole Janssen, The Netherlands

Matti Jantunen, Finland

Frank Kelly, United Kingdom

Timo Lanki, Finland

Inga Mills, United Kingdom

Ian Mudway, United Kingdom

Mark Nieuwenhuijsen, Spain

Bart Ostro, United States

Annette Peters, Germany

David Phillips, United Kingdom

C. Arden Pope III, United States

Regula Rapp, Switzerland

Gerd Sällsten, Sweden

Evi Samoli, Greece

Peter Straehl, Switzerland

Annemoon van Erp, United States

Heather Walton, United Kingdom

Martin Williams, United Kingdom

External revievers

Joseph Antó, Spain

Alena Bartonova, Norway

Vanessa Beaulac, Canada

Michael Brauer, Canada

Hyunok Choi, United States

Bruce Fowler, United States

Sandro Fuzzi, Italy

Krystal Godri, Canada

Patrick Goodman, Ireland

Dan Greenbaum, United States

Jonathan Grigg, United Kingdom

Otto Hänninen, Finland

Roy Harrison, United Kingdom

Peter Hoet, Belgium

Barbara Hoffmann, Germany

Phil Hopke, United States

Fintan Hurley, United Kingdom

Barry Jessiman, Canada

Haidong Kan, China

Thomas Kuhlbusch, Germany

Morton Lippmann, United States

Robert Maynard, United Kingdom

Sylvia Medina, France

Lidia Morawska, Australia

Antonio Mutti, Italy

Tim Nawrot, Belgium

Juha Pekkanen, Finland

Mary Ross, United States

Jürgen Schneider, Austria

Joel Schwartz, United States

Frances Silverman, Canada

Jordi Sunyer, Spain

Observers

Markus Amann, IIASA

Arlean Rhode, CONCAWE

Wolfgang Schoepp, IIASA

André Zuber, European Commission

WHO Secretariat (ECEH Bonn)

Marie-Eve Héroux

Michal Krzyzanowski (up to 08.2012)

Svetlana Cincurak

Kelvin Fong

Elizabet Paunovic

Helena Shkarubo






2005 population-weighted regional estimated average PM2.5 (µg/m

3)


Brauer et al, Env Sc Tech 2011

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LEARNING AND TALKING ABOUT RISKS - ehbasel13.org · health aspects of air pollution ... Daniel Krewski, Canada Wolfgang G. Kreyling, Germany Nino Künzli, Switzerland Xavier Querol,