1. AMGI/EURASAP workshop, Zagreb 25 May 2007 Nenad Kezele, Ruđer Bošković Institute, Bijenička 54, Zagreb, Croatia Effect of O 3 and PM10 on mortality increase during a heat-wave

2. AMGI/EURASAP workshop, Zagreb 25 May 2007 HEAT RELATED DEATHS Heat-wave conditions cause excess mortality in exposed population – hyperthermia, cardiovascular disease Daily mortality trend follows temperature trends, with peaks in deaths occuring not more than 2 days after temperature peak

3. AMGI/EURASAP workshop, Zagreb 25 May 2007 PARTICLE POLLUTION Sources: vehicle exhaust, road dust, smokestacks, forest fires ect. PM consists of hundreds of liquid and solid chemicals Researchers still does not know what make fine particles toxic. Whether it is their size or the chemistry (PAH and transition metals)

4. AMGI/EURASAP workshop, Zagreb 25 May 2007 OZONE OR PHOTOSMOG POLLUTION Sources in urban environment: cycle of photochemical reactions

5. AMGI/EURASAP workshop, Zagreb 25 May 2007 OZONE POLLUTION Begin of modern measurements in Croatia 1975 - first modern continuous instrumental monitoring of tropospheric ozone in Croatia at 65 m height in the city of Zagreb

6. AMGI/EURASAP workshop, Zagreb 25 May 2007 Are some of the heat related excess deaths attributable to concurrent increases in air pollution? and What is the percentage of air pollution related deaths in total excess deaths during a heatwave?

7. AMGI/EURASAP workshop, Zagreb 25 May 2007 Up to now several studies (McMichael et al., 1996; Rooney et al., 1998; Stedman, 2004) indicated that a significant part (40 to 60%) of excess mortality during the heat wave could be the result of air pollution.

8. AMGI/EURASAP workshop, Zagreb 25 May 2007 We use this estimate here on the basis of the published dose- response coefficients for PM10 and ozone (Stedman 2004; COMEAP 1998). Table 2.1. Dose Response Coefficients PollutantHealth Outcome Dose-response coefficient (24 hour mean) PM 10 Deaths brought forward (all causes) Respiratory hospital admissions + 0.75% per 10 µg/m 3 + 0.80% per 10 µg/m 3 Ozone Deaths brought forward (all causes) Respiratory hospital admissions + 0.6% per 10 µg/m 3 +0.7 % per 10 µg/m 3 Source: COMEAP (1998)

9. AMGI/EURASAP workshop, Zagreb 25 May 2007 Analysed period: Heat wave, 8. – 14. August, 2003. Data: Average daily values for ozone and PM10 DAYZAGREBRIJEKA O 3 (μg/m 3 )PM 10 (μg/m 3 )O 3 (μg/m 3 )PM 10 (μg/m 3 ) 8. 170.320.585.661.9 9. 8.171.523.084.186.8 10. 8.207.816.988.854.6 11. 8184.424.380.177.2 12. 8197.735.472.548.0 13. 8239.120.685.4105.6 14. 8245.418.390.284.1

10. AMGI/EURASAP workshop, Zagreb 25 May 2007 For these seven days the average mortality for Zagreb corresponds (very roughly) to 9710 × 7/365 = 186 and Rijeka to 1559 × 7/365 = 29. With the assumption of independence i.e. additivity of health effects of these pollutants the calculated excess deaths for Zagreb and Rijeka based on mentioned dose-response functions are shown in next slide.

11. AMGI/EURASAP workshop, Zagreb 25 May 2007 ZagrebRijeka PM 10 ozone PM 10 + ozone PM 10 ozone PM 10 + ozone With limiting value 311141.60 Without limiting value 322251.61,53.1 Calculated excess deaths for Zagreb and Rijeka based on mentioned dose-response functions and for analysed 7 days period during the heat wave in August 2003.

12. AMGI/EURASAP workshop, Zagreb 25 May 2007 Conclusion: According to the Zagreb results and assuming identical conditions for all Croatia during the same period of 7 days in August we come to an estimate of 70 excess deaths caused by combined effects of PM10 and ozone assuming the suggested threshold value of 100  g m –3 for ozone, or of 125 excess deaths without using a threshold. These numbers accounts only for about 40 to 60 % of total excess death during the heath wave (Rooney et al., 1998). This analysis is performed in analogy to much better evaluations supported by data shows that increased mortality existed and, if we want to get a handle on preventing excess death cases in the future, a much better assessment of the relevant factors such as air pollution, epidemiological and mortality statistics on a daily basis in Croatia is needed.