1. Bert Brunekreef, PhD Professor of Environmental Epidemiology
Cardiopulmonary Burden of Air Pollution in Turkey…. and elsewhere in Europe
Bert Brunekreef, PhD
Professor of Environmental Epidemiology

6. Air Quality Standards for annual PM2.5 concentration
WHO
AQG
US EPA Standard EU
Limit
Value
The major American study is the so called American Cancer Society Study, and this graph shows the relationship between PM2.5 and mortality as it was observed in that study. What is clear from the graph is that the European Limit Value for PM2.5 of 25 microgram/m3 is very high compared to the American standard of 12 microgram/m3 and the WHO Guideline of 10 microgram/m3. The Americans have been able to reduce PM2.5 in most areas to levels below this standard. There must be something that we’re doing wrong here in Europe as we can’t seem to get our concentrations down.
Figure from Pope, JAWMA 2006 6

7. ESCAPE study PM / NOx monitoring & modeling in 20 / 36 EU areas
> 30 existing cohorts
Birth and pregnancy outcomes
Respiratory morbidity
Cardiovascular morbidity
Cancer & mortality
PM / NOx monitoring & modeling in 20 / 36 EU areas

8. Chronic Bronchitis
COPD
Coronary events
Stroke
Non-accidental Mortality
IgE, Asthma, Lung Function
Respiratory infections
Birth weight
Lung Function
Asthma
Child development
Systemic Inflammation
Blood Pressure, IMT
Respiratory Mortality
Cardiovascular,
Lung Cancer Incidence

9. ESCAPE study areas in
EUROPE
PM+NOx
NOx only

10. Lancet
Respiratory
Medicine
2013;1:

11. NO2 exposures in pregnancy outcome cohorts
EU Limit Value

12. Birth head circumference
Effect estimates for Term Low Birth Weight and Birth Head Circumference
Term low birth weight
Birth head circumference
Pollutant N RR
95% CI
ß* (cm)
NO2 (per 10 µg/m3)
52,291
1.09
36,010
-0.08
-0.10 to -0.07
NOX (per 20 µg/m3)
51,150
1.04
34,818
-0.06
-0.07 to -0.05
PM10 (per 10 µg/m3)
40,947
1.16
25,022
-0.13
-0.18 to -0.09
PM2.5 (per 5 µg/m3)
1.18
-0.12 to -0.03
PM-C (per 5 µg/m3)
40,914
1.01
24,988
-0.09
-0.12 to -0.05
PM2.5 absorbance (per /m)
41,727
1.17
25,724
-0.18
-0.22 to -0.13

13. EU Limit
Value

14. Associations between PM2
Associations between PM2.5 exposure during pregnancy and term low birth weight in analyses restricted to levels below certain values
15 µg/m3
OR for
PM2.5 per
5 μg/m3
20 µg/m3
25 µg/m3
None

15. Infections in children up to 3 years in relation to air pollution exposure in ten European birth cohorts
Pneumonia
MacIntyre et al. EHP 2014;122:107-13

16. Lung function in children at 8 years in relation to air pollution exposure in five European birth cohorts
NO2
NOx
PM2.5
PM2.5abs
PM10
PMcoarse
Traffic street
Traffic buffer
FEV1 (OR <85% predicted)
Gehring et al. EHP 2013:121:

17. Effect estimates for Asthma at age 8
Molter et al., ERJ 2015;45:610-24

18. Gruzieva, JACI 2014

19. Effects on lung function in adults
Adam et al., ERJ 2015;45:38-50

20. Jacquemin et al., EHP 2015

21. Raaschou-Nielsen, Lancet Oncol 2013

23. ESCAPE effects on Coronary Events
Pollutant
Relative Risk (95% C.I.)
PM10 (per 10 µg/m3)
1.12 ( )
PM2.5 (per 5 µg/m3)
1.13 ( )
PM absorbance (per m-1)
1.10 ( )
NO2 (per 10 µg/m3)
1.03 ( )
Cesaroni, BMJ 2014 Jan 21;348:f7412