Updating the science on health assessment Michal Krzyzanowski WHO European Centre for Environment and Health Bonn Office

WHO AQG: Global update 2005: Summary of updated AQG values Pollutant Averaging time AQG value Particulate matter PM2.5 PM10 1 year 24 hour (99th percentile) 10 µg/m3 25 µg/m3 20 µg/m3 50 µg/m3 Ozone, O3 8 hour, daily maximum 100 µg/m3 Nitrogen dioxide, NO2 1 hour 40 µg/m3 200 µg/m3 Sulfur dioxide, SO2 24 hour 10 minute 500 µg/m3 AQG levels recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution

Percent increase in the daily number of deaths per 10 µg/m3 of PM10 (lag 1): APHENA study Samoli et al, EHP 2008

RR for deaths for all causes per 10 µg/m3 annual mean PM2.5

Health impacts of fine PM – update analysis of ACS cohort Hazard rates for PM2.5 by cause-of-death (with adjustment for ecologic covariates). 18 years follow up of 360,000 participants of ACS cohort Krewski et al, HEI 140, May 2009

Risks for coronary artery calcification Risks for coronary artery calcification*) and exposure to traffic-related air pollution 4,494 participants (age 45-74 years) of the German Heinz Nixdorf Recall Study Hoffmann B et al, Circulation 2007 *) CAC assessed by non-contrast enhanced electron-beam computed tomography

Ischemic and thrombotic effects of dilute diesel exhaust inhalation in men with coronary heart disease Myocardial inchemia 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

Respiratory effects of exposure to diesel traffic: randomized study of 60 adults with asthma in London Mean % changes during and after 2 h walk on Oxford street and Hyde Park McCreanor et al, NEJM 2007

Reduction of PM exposure and increase of life expectancy in the US Reduction in PM accounts for 15% of overall increase in life expectancy Pope AC et al, NEJM 2009 A decrease of 10 µg/m3 of PM2.5 associated with increase of life expectancy by 7.3 months between 1980 and 2000

Potential reduction in YLL for two scenarios for PM2 Potential reduction in YLL for two scenarios for PM2.5 reduction: LV compliance and AEI-reduction target Source: F. De Leeuw, J. Horalek, ETC/ACC, 2009

Effects of long term O3 exposure Risk of death due to respiratory causes. Results of analysis of ACS cohort of 448,000 adults followed for up to 18 years RR per 10 ppb = 1.040 (95% CI 1.010 - 1.067) (2-pollutant model with O3 and PM2.5) Jerrett et al, NEJM 2009

Effects of long term O3 exposure Risk of asthma hospital admissions in children and mean O3 in 1995-1999 Lin et al, EHP 2008

Associations between air pollution and the incidence of asthma and wheeze – meta-analysis of cohort studies Per 10 µg/m3 NO2 Per 10 µg/m3 PM2.5 Anderson et al, Air Qual Atmos Health 2011

TFH review of health effects of BC – preliminary conclusions Sufficient evidence on association of short-term (daily) variations in BC concentrations with short term changes in health and on associations of all cause and cardiopulmonary mortality with long-term average BC exposure. Suggestive evidence for BC being a better indicator of harmful particulate substances from combustion sources - especially traffic - than undifferentiated PM mass Insufficient evidence to allow of an evaluation of the qualitative differences between health effects of exposure to BC or to PM mass

TFH review of health effects of BC – preliminary conclusions TFH agreed that the reduction of exposure to PM2.5 containing BC, and other combustion related PM material, for which BC is an indirect indicator, should lead to reduction of the health effects associated with PM. TFH recommended continuing the use of PM2.5 as the primary approach in quantifying the human exposure to PM and its health effects, and for predicting the benefits of exposure reduction measures. In evaluation of local actions aimed at reduction of population exposure to combustion particles (e.g. from motorized traffic) the use of BC as an additional indicator may be useful

European Study of Cohorts for Air Pollution Effects – ESCAPE http://www.escapeproject.eu/ EU FP7 project, 25 patners, coordinated by Univ Utrecht 30 cohorts, total 645,800 subjects followed over several years, ca. 37,000 deaths ESCAPE monitors PM2.5, PM10, NO2, NOx, BC, elemental composition of PM (TRANSPHORM) Exposure assessment based on land use regression models First results expected mid-2012

Conclusions Scientific evidence on health effects of air pollution increases confirming conclusions of WHO AQG Global Update 2006 Cardiovascular disease affected by PM exposure Uncertain long term effects of O3 exposure New studies (incl. ESCAPE) expected to respond to (some of the) outstanding questions