WHO European Centre for Environment and Health HEALTH RISKS OF PARTICULATE MATTER AIR POLLUTION An overview for the 41 st Session of GRPE M. Krzyzanowski

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 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”


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)


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.


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?


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


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


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


% 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


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


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


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


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


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


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


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


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: [email protected] or [email protected]

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Documents

WHO European Centre for Environment and Health HEALTH RISKS OF PARTICULATE MATTER AIR POLLUTION An overview for the 41 st Session of GRPE M. Krzyzanowski