1. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb Health Impact Assessment of Air Pollution on Zagreb population Krešimir Šega Instiute for Medical Research and Occupational Health, Zagreb

2. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb This investigation was partly presented at: ZAŠTITA ZRAKA '01, Šibenik 26-29. rujan 2001. 15th IUAPPA regional conference - 17th EFCA speciality conference, 5-8 september 2006 Lille, France HEALTH IMPACT ASSESSMENT OF BLACK SMOKE AND AIRBORNE PARTICULATES ON ZAGREB POPULATION, WHO COLABORATING CENTRE FOR AIR QUALITY MANAGEMENT AND AIR POLLUTION CONTROL NEWSLETTER,2006

3. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb HEALTH ENDPOINTS RELATED TO AIR POLLUTION MODELLING Determination of relationship between air pollution levels and negative health effects. Demands: Large and complete databases Control over possible cofounders Educated and well equipped personal ASSESSMENT Use of developed models for health risk evaluation. Enable so called “risk governing”: Cost estimation for pollution level reduction. Estimation of primary and secondary health costs. Adoption of new or improvement of existing air pollution limit values.

4. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb ZAGREB MODELLING Šimic, D., Jazbec, A., Pavlovic, M. et al.: Short term effects of ambient NO 2 on mortality in Zagreb, Croatia. Proceedings of the 20 th International Conference on Information Technology Interfaces, Kalpic Damir, Hljuz-Dobric Vesna (ur.). Pila, Hrvatska: SRCE University Computing Centre, Univerity of Zagreb, 1998., 143-148. Jazbec, A., Šimic, D., Hršak, J. et al.: Short-term effects of ambient nitrogen oxides on the number of emergency asthma cases in Zagreb, Croatia, Arh. hig. rada toksikol. 1999, 50, 171-182. Šimic, D., Pavlovic, M., Jazbec, A. et al.: Short-term effects of air pollution on general mortality in Zagreb, Croatia, Proceedings of the 21 st International Conference on Information Technology Interfaces ITI'99, Kalpic Damir, Hljuz-Dobric Vesna (ur.). Pula, Hrvatska: SRCE University Computing Centre, Univerity of Zagreb, 1999., 169-175. Šimic, D., Pavlovic, M., Jazbec, A. et al.: Utjecaj one … iš ƒ enja zraka na u … estalost pogoršanja simptoma opstruktivne bolesti plu ƒ a un odraslih osoba, Zaštita zraka 99, Vali ƒ Fedor i Šega Krešimir (ur.). Zagreb: Hrvatsko udru ñ enje za zaštitu zraka, 1999., 347-354. Šimic, D., Pavlovic, M., Šega, K. et al.: Is association between mortality and air pollution due to a short temporal displacement? In: D Kalpi ƒ and V Hljuz Dobri ƒ (eds.) Proceedings of the 23rd International Conference on Information Technology Interfaces ITI 2001,Pula, Croatia, June 19-22, 2001. Zagreb: University Computing Centre, University of Zagreb, pp. 279-83, 2001. Šimić, D.: Povezanost onečišćenja zraka i smrtnosti u gradu Zagrebu, Doktorska disertacija, Zagreb 2001.

5. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb ASSESSMENT AirQ - software WHO Regional Office for Europe Evaluation of RR related to mortality or morbidity for toptal population or population subgroup and certain air pollutant Quantification on the basis of atrributable risk proportion (AP) which could be atrribute to the exposure to certain air pollutant by controlling possible cofounders. Main principle: ONE POPULATION- ONE EXPOSURE DATASET RR defined for air pollutant concentartion incerase of 10 μg m -3 Concentration treshold defined at 10 µg m -3, assuming that lower concentrations do not cause observable health effects: - (C < 10 µg m -3 Y RR=1)

6. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb TSP: 2 measuring sites, 1976-2000 BS: 6 measuring sites, 1976-2005 SO 2 : 6 measuring sites, 1976-2000 PM 10 : 1 measuring site, 1999-2005 PM 2.5 : 1 measuring site, 1999-2004 5 measuring sites, 2005 NUMBER OF SASMPLING SITES AND MEASURING PERIODS

7. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb TOTAL SUSPENDED PARTICULATE MATTER Total mortality Cardiovascular moratilty Respiratory mortality COPD

8. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb BLACK SMOKE Total mortality Cardiovascular moratilty Respiratory mortality Hospital admisson – COPD Hospital admisson – respiratory diseases (15-64) Hospital admisson – asthma (<15) Hospital admisson – asthma (15-64) Accute miocard infarction

9. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb SO 2 Total mortality Cardiovascular moratilty Respiratory mortality Hospital admisson – COPD Hospital admisson – respiratory diseases (15-64) Hospital admisson – asthma (<15) Accute miocard infarction

10. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb PM 10 Total mortality Cardiovascular moratilty Respiratory mortality Hospital admisson – cardiovascular diseases Hospital admisson – respiratory diseases PM 2.5 Total mortality

11. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb TSP TOTAL MORTALITY I = 1013 RR = 1.003 (1.002-1.007) PP (%) 4.5 1976. 1.1 2000. RESIRATORY MORTALITY I = 66 RR = 1.008 (1.004-1.018) PP (%) 3.0 1976. 0.7 2000. CARDIOVASCULAR MORTALITY I = 497 RR = 1.002 (1.000-1.006) COPD I = 101.4 RR = 1.0044 (1.0000-1.0094) PP (%) 11.2 1976. 2.7 2000. PP (%) 6.4 1976. 1.6 2000.

12. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb RESPIRATORY MORTALITY I = 66 RR = 1.008 (1.004-1.014) COPD I = 101.4 RR = 1.0061 (1.0020-1.0120) PP (%) 5.2 1976. 1.7 2000. PP (%) 4.0 1976. 1.3 2000. TOTAL MORTALITY I = 1013 RR = 1.0026 (1.0018-1.0034) PP (%) 1.8 1976. 0.5 2000. DIM CARDIOVASCULAR MORTALITY I = 497 RR = 1.004 (1.002-1.008) PP (%) 2.7 1976. 0.8 2000.

13. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb ACCUTE MIOCARD INFARCTION I = 132 RR = 1.016 (1.0053-1.0290) DIM HOSPITAL ADMISSION – RESPIRABLE DISEASES (15-64 years) I = 66 RR = 1.0056 (1.0012-1.0102) HOSPITAL ADMISSION – ASTHMA (<15 years) I = 100 RR = 1.006 (1.000-1.017) HOSPITAL ADMISSION – ASTHMA (15-64 years) I = 66 RR = 1.0042 (1.000-1.0118) PP (%) 3.8 1976. 1.2 2000. PP (%) 4.0 1976. 1.2 2000. PP (%) 1.9 1976. 0.6 2000. PP (%) 4.5 1976. 1.1 2000.

14. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb TOTAL MORTALITY I = 1013 RR = 1.004 (1.003-1.0048) CARDIUOVASCULAR MORTALITY I = 497 RR = 1.012 (1.008-1.020) RESPIRATORY MORTALITY I = 66 RR = 1.010 (1.006-1.014) HOSPITAL ADMISSION – RESPIRABLE DISEASES (15-64 years) I = 66 RR = 1.0018 (1.000-1.005) S0 2 PP (%) 3.7 1976. 0.8 2000. PP (%) 9.2 1976. 2.3 2000. PP (%) 10.9 1976. 2.7 2000. PP (%) 1.8 1976. 0.5 2000.

15. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb COPD I = 101.4 RR = 1.0044 (1.000-1.011) ACCUTE MIOCARD INFARCTION I = 132 RR = 1.0034 (1.0014-1.0052) HOSPITAL ADMISSION – ASTHMA (<15 years) I =100 RR = 1.015 (1.0052-1.0250) S0 2 PP (%) 13.2 1976. 3.3 2000. PP (%) 4.2 1976. 1.0 2000. PP (%) 3.3 1976. 0.8 2000.

16. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb YearNumber of cases in 100 000 /# Attributable proportion /% Total mortality 200010,54,024,11,030,692,38 20018,25,518,90,810,541,87 20029,96,722,90,980,662,26 200312,48,328,51,220,822,81 200411,77,826,91,160,772,66 200511,17,425,61,100,742,54 Cardiovascular mortality 20003,40,010,20,690,002,05 20012,70,08,00,540,001,61 20023,30,09,70,660,001,94 20034,10,012,00,820,002,42 20043,80,011,40,770,002,29 20053,70,010,80,740,002,18 TSP

17. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb TSP YearNumber of cases in 100 000 /# Attributable proportion /% Respiratory mortality 20001,80,93,92,711,375,90 20011,40,73,12,131,084,67 20021,70,93,72,581,305,61 20032,11,14,63,201,626,92 20042,01,04,33,021,546,56 20051,91,04,12,891,476,28 Hospital admission – COPD 20001,50,03,21,510,003,17 20011,20,02,51,180,002,50 20021,50,03,11,430,003,01 20031,80,03,81,780,003,74 20041,70,03,61,690,003,54 20051,60,03,41,610,003,38

18. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb YearNumber of cases in 100 000 /# Attributable proportion /% Total mortality 200023,820,027,62,351,982,72 200121,918,425,42,161,822,51 200222,619,026,12,231,882,59 200323,920,127,72,371,992,74 200420,116,923,31,981,672,30 200524,420,528,22,402,022,78 Cardiovascular mortality 200012,68,027,52,541,605,53 200111,67,325,42,341,475,11 200211,97,526,12,411,525,27 200312,78,027,62,551,615,57 200410,66,723,32,141,354,69 200512,98,128,12,591,645,65 PM10

19. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb YearNumber of cases in 100 000 /# Attributable proportion /% Respiratory mortality 20002,51,07,13,761,5410,74 20012,30,96,63,461,419,96 20022,41,06,73,571,4610,25 20032,51,07,13,781,5510,81 20042,10,96,13,181,309,19 20052,51,77,23,842,5910,97 Hospital admission – respiratory diseases 200022,513,631,31,831,112,55 200119,912,027,71,610,972,23 200220,912,629,01,701,032,37 200322,613,731,51,841,112,55 200417,610,624,51,450,872,01 200532,719,845,32,591,573,59 PM10

20. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb YearNumber of cases in 100 000 /# Attributable proportion /% Hospital admission – cardiovascular diseases 200012,48,317,72,841,914,06 200111,47,716,32,621,763,74 200211,87,916,82,701,823,86 200312,48,417,82,861,934,08 200410,5 7,0 15,02,401,613,43 200512,5 8,5 18,12,911,964,15 Asthma attacks in children 200014,2313,2615,17 200113,2312,3214,12 200213,6112,6714,52 200314,3113,3415,26 200412,2411,3913,07 200514,5113,5315,48 PM10

21. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb YearNumber of cases in 100 000 /# Attributable proportion /% Asthma attacks in adults 20001,280,002,54 20011,180,002,34 20021,220,002,41 20031,290,002,55 20041,080,002,14 20051,310,002,59 PM10

22. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb YearNumber of cases in 100 000 /# Attributable proportion /% Total mortality 200032,223,840,53,182,353,99 200131,723,539,93,142,323,95 200231,623,439,73,122,313,92 200334,725,743,63,432,544,30 200426,519,633,32,982,213,75 2005/136,427,045,73,602,664,51 2005/541,931,052,54,133,065,18 PM2.5

23. 24-26 May 2007AMGI/EURASAP Workshop, Zagreb CONCLUSIONS Results show significant negative trend of health effects incidences related to TSP, black smoke and SO2 as a consequence of the negative concentration trends during the investigated period. Further investigations should be based on PM10/PM2.5 particle fractions and their constituents (metals, sulphates, nitrates, chlorides, polycyclic aromatic hydrocarbons, organic and elemental carbon etc.) and nitrogen oxides. Simultaneously, further development of models based on Zagreb data should be continued so in the future health impact assessment of air pollution in Zagreb could be used on Zagreb population as much more reliable.