Recenti Evidenze sugli Effetti dell Inquinamento Francesco Forastiere

Transcription

1 Recenti Evidenze sugli Effetti dell Inquinamento Francesco Forastiere Verona Novembre, 2015

2 68th World Health Assembly May 26, 2015

3 2015 WHO + OECD deaths each year in Europe, Almost in Italy. Only for Italy this means 97 billions dollars, 4,7% of GIP.

4 IARC Monographs

5 GBD 2010: Air pollution is a major risk factor for public health Lancet, 2012 Fonte: Lancet 2012

6 GBD Italy Fonte: Lancet 2012

7 What is the state of the air?

8 Science 307: , News Focus, March 2005

9 mass, dm/dlogdp, µg/m PM Ultrafines (<0.1 µm) C SO 4 NH 4 NO 3 C Al Ca Fe O Si Local Long-distance Soil combustion transport particle aerodynamic diameter, µm

10 Particles Does Size Matter? Or Mass? Or Number? Or What? Mass Diameter Number Surface Area ( g/m 3 ) ( ) (per ml) ( 2 /ml) ,400, Adapted from Donaldson K et al. Occup Environ Med 2001;58:

11 Osservazioni satellitari Environ Health Perspect 118: (2010).

12 Satellite-derived map of PM 2.5 averaged over Credit: Dalhousie University, Aaron van Donkelaar

13 WHO AQG Summary (2005) Pollutant Averaging time AQG value EU standard (target or limit value) Particulate matter PM year 24 hour (99 th percentile) 10 µg/m 3 25 µg/m 3 25 µg/m 3 -- PM 10 1 year 24 hour (99 th percentile) 20 µg/m 3 50 µg/m 3 40 µg/m 3 50 µg/m 3 *** Ozone, O 3 8 hour, daily maximum 100 µg/m µg/m 3 *** Nitrogen dioxide, NO 2 1 year 1 hour 40 µg/m µg/m 3 40 µg/m µg/m 3 *** Sulfur dioxide, SO 2 24 hour 10 minute 20 µg/m µg/m µg/m 3 *** 350 µg/m 3 *** (1 hr) WHO levels are recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution ***Permitted exceedances each year

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15 The Impact of Air Pollution in Italy: PM 2.5 and NO 2 Roma, 4 giugno 2015

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18 Scenario Target 1 PM 2.5 ai residenti con concentrazioni medie annue stimate al 2020 superiori al limite delle direttive CE - 25 µg/m 3 - è stata attribuita un esposizione pari a 25 µg/m 3 NO 2 ai residenti con concentrazioni medie annue stimate al 2020superiori al limite della soglia stabilita dalla CE/OMS 40 µg/m 3 - è stata attribuita un esposizione pari a 40 µg/m 3

19 Scenario Target 2 Per ciascun inquinante, la concentrazione media annua diminuita del 20% al 2020

20 Concentrazioni medie annue di PM CLE T T2

21 Concentrazioni medie annue di NO CLE T T2

22 What about the health effects?

23 Organs of the human body affected by particulate air pollution Modified after Peters et al. JOEM

24 Organs and disorders related to air pollution, 2015

25 Short-term health effects

26 MED-PARTICLES: the issues Fine and coarse PM Desert dust Forest fires PM components

27 MED-PARTICLES: the cities

28 Effects of PM 2.5 and PM on mortality, EHP 2013

29 Effects of PM 2.5 and PM on admissions, EHP 2013

30 Saharan dust: frequency ef events 50N 55N 45N 50N 40N N 35N N 30N N 25N African dust frequency (% over annual days) 30N 5W 0 5E 10E 15E 20E 25E 30E Pey et al. Atmos Chemistry Physics (2013)

31 Saharan dust: PM 10 contribution 50N 55N 45N 50N N N 35N 40N N N African dust in PM 10 (µg/m 3 ) 25N 30N 5W 0 5E 10E 15E 20E 25E 30E Pey et al. Atmos Chemistry Physics (2013)

32 Effects of two PM 10 sources: Anthropogenic and Saharan dust Percent increase (95% CI) in mortality and hospital admissions associated with 10 μg/m 3 increase in anthropogenic/desert PM 10: Results of two-pollutant models Anthropogenic PM 10 Desert PM 10 Outcome Lag % IR (95% CI) I 2 Χ 2 % IR (95% CI) I 2 Χ 2 p value p value Mortality Natural (0.23, 0.83) (0.27, 1.06) Cardiovascular (-0.39, 1.33) (0.15, 2.05) Respiratory (0.94, 3.95) (-0.42, 3.01) Hospital admissions Cardiovascular, age (-0.02, 0.75) (-0.30, 0.76) Respiratory, age (0.14, 1.19) (-0.48, 1.83) Respiratory, age (0.60, 2.94) (0.09, 4.71) Stafoggia et al, EHP 2015

33 RESULTS: Forest plots for natural mortality city Anthr. PM 10 (10 g/m 3 increase) - Natural mortality %IR (95% CI) % Weight Desert PM 10 IR% = 0.66 ( ) Milan Turin Emilia-Romagna 0.24 (-0.30, 0.77) 0.76 (0.08, 1.44) 0.39 (-0.93, 1.73) No heterogeneity Bologna (-1.26, 1.10) 5.37 Marseille (-3.13, 0.87) 2.05 Rome 0.49 (-0.16, 1.13) Barcelona 1.36 (0.70, 2.02) Thessaloniki 0.05 (-1.18, 1.29) 4.97 Madrid 0.33 (-0.08, 0.75) Desert PM 10 (10 g/m 3 increase) - Natural mortality Athens Palermo D-L Overall (I-squared=31.59%, p=0.147) 1.09 (0.14, 2.06) 1.26 (-0.80, 3.36) 0.53 (0.23, 0.83) city %IR (95% CI) % Weight Anthropogenic PM 10 IR% = 0.53 ( ) Little heterogeneity Milan Turin Emilia-Romagna Bologna Marseille Rome Barcelona Thessaloniki Madrid Athens Palermo D-L Overall (I-squared=0.00%, p=0.748) (-1.72, 1.90) 0.71 (-1.77, 3.26) (-9.35, 4.28) (-7.17, 4.85) (-3.81, 1.76) 0.39 (-1.19, 1.99) (-1.57, 1.27) (-5.07, 3.60) 0.62 (-0.15, 1.40) 1.02 (0.40, 1.65) 1.11 (-0.28, 2.51) 0.66 (0.27, 1.06)

34 % increase (95% CI) % increase (95% CI) RESULTS: C-R shape for natural mortality Concentration response relationship between anthropogenic PM 10 (left) and desert PM 10 (right) with natural mortality, lag 0-1. Values are percent increase (95% CI) of mortality associated with increases of PM 10 levels relative to 5 μg/m Anthropogenic PM 10 (μg/m 3 ) Desert PM 10 (μg/m 3 )

35 Forest Fires: Effects on mortality Higher cardiovascular mortality on fires days Higher PM10 effect on cause-specific mortality on fires days Results not affected by concurrent desert dust episodes Faustini et al, OEM 2015

36 Long-term health effects

37 Updated long-term effects of PM2.5 on natural mortality. 14 studies PM 2.5 (10 g/m 3 increase) and Natural Mortality Study HR (95% CI) % Weight Harvard six cities ACS study ACS LA sub-cohort study Netherlands Cohort Study Nurses Health Study Medicare national cohort Health professionals follow-up study US trucking industry cohort Canadian national cohort California teachers study Rome longitudinal study ACS California subcohort National English cohort Escape D-L Overall (I-squared=60.8%, p=0.0016) 1.14 (1.07, 1.22) 1.06 (1.02, 1.11) 1.17 (1.05, 1.30) 1.06 (0.97, 1.16) 1.26 (1.03, 1.55) 1.04 (1.03, 1.06) 0.86 (0.72, 1.02) 1.10 (1.03, 1.18) 1.10 (1.05, 1.15) 1.01 (0.94, 1.08) 1.04 (1.03, 1.05) 1.06 (1.00, 1.12) 1.11 (0.98, 1.26) 1.14 (1.03, 1.27) 1.07 (1.04, 1.09)

38 Air pollution in the Rome Longitudinal Study EHP 2013 Average exposure at baseline: 43.6 μg/m 3 NO μg/m 3 PM2.5

39 The air pollution maps in Rome

40 The map of socioeconomic position in Rome

41 The Rome Longitudinal Study 17% of residents live at <50 m from a road with >10,000 vehicles/day Cesaroni et al. EH, 2010

42 The Rome Longitudinal Study Cesaroni et al. EH, 2010

43 Air pollution and mortality in the Rome Longitudinal Study EHP ug/m 3 NO2 10 ug/m 3 PM2.5 Cases HR 95%CI HR 95%CI Non accidental mortality 144, Cardiovascular mortality 60, IHD mortality 22, Respiratory mortality 8,

44 The ESCAPE project ( ESCAPE - European Study of Cohorts for Air Pollution Effects Objective: «to investigate long-term effects on human health of exposure to air pollution in Europe» Structure 25 european partners Duration: 4 years ( ) 7 work-packages Exposure assessment 3 measurements campaigns in 1 year, same instruments, same protocols to develop land use regression models Standardized protocols of analysis

45 Air pollution measurements ~400 PM, ~1,500 NOx locations Measurement of fine particles with pump and sampling head Measurement of nitrogen oxides with passive samplers

46 The ESCAPE project

47 The ESCAPE project

48 The ESCAPE project PM 10 (10 ug/m 3 ) PM 2.5 (5 ug/m 3 ) Non accidental mortality 1.04 ( ) 1.07 ( ) CV mortality 1.02 ( ) 0,99 ( ) Incidence of acute coronary events 1.12 ( ) 1.13 ( ) Incidence of stroke 1.02 ( ) 1.19 ( ) Lung cancer incidence 1.22 ( ) 1.18 ( )

49 Results. Incidence of acute coronary events Thresholds analysis

50 Adjusted effects of NO 2 and Traffic on Full scale IQ and Verbal IQ. Seven year old, GASPII cohort (Rome). Porta et al, Epidemiology (in press)

51 The Impact of Air Pollution in Italy: PM 2.5 and NO 2 Roma, 4 giugno

52 Mortalità per cause non accidentali attribuibile a PM Pop>30 anni Pop W Exp media ( µg/m 3 ) Numero di decessi osservati Numero di decessi attribuibili N IC95% Tasso di mortalità attribuibile (per ) IC95% Frazione di mortalità attribuibile (%) IC95% Mesi di vita persi ITALIA 40,077, ,193 34,552 20,608 43, NORD 18,847, ,518 22,485 13,447 28, Area geografica CENTRO 8,858, ,756 5,513 3,253 6, SUD e ISOLE 12,371, ,918 6,554 3,909 8, Macroarea URBANO 14,251, ,325 19,358 11,615 24, NON URBANO 25,826, ,867 15,194 8,994 19,

53 Tasso di mortalità attribuibile (per ) Decessi per cause non accidentali attribuibili a PM2.5 per residenti per macro area geografica e regione

54 Mortality rate attributable to PM CLe T T2

55 Months of life lost due to PM2.5

56 Conclusions There is huge evidence on detrimental effects of air pollution Throughout the world, particulate air pollution is estimated to cause 3.1 million deaths a year. In 2005, more than 16 million of Italian residents were exposed to annual PM2.5 levels above 25 µg/m 3, we estimated 34,552 (CI 95% 20,608-43,215) annual premature deaths attributable to PM2.5. The largest impact was in Northern Italy, especially in the Po Valley (

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