Recenti Evidenze sugli Effetti dell Inquinamento Francesco Forastiere Verona Novembre, 2015
68th World Health Assembly May 26, 2015
2015 WHO + OECD 600.000 deaths each year in Europe, Almost 33.000 in Italy. Only for Italy this means 97 billions dollars, 4,7% of GIP.
IARC Monographs
GBD 2010: Air pollution is a major risk factor for public health Lancet, 2012 Fonte: Lancet 2012
GBD 2010 - Italy Fonte: Lancet 2012
What is the state of the air?
Science 307:1857-1861, News Focus, March 2005
mass, dm/dlogdp, µg/m3 70 60 50 PM2.5 40 30 20 10 Ultrafines (<0.1 µm) C SO 4 NH 4 NO 3 C Al Ca Fe O Si 0 0.01 0.1 1 10 100 Local Long-distance Soil combustion transport particle aerodynamic diameter, µm
Particles Does Size Matter? Or Mass? Or Number? Or What? Mass Diameter Number Surface Area ( g/m 3 ) ( ) (per ml) ( 2 /ml) 10 2 1.2 24 10 0.5 153 120 10 0.02 2,400,000 3016 Adapted from Donaldson K et al. Occup Environ Med 2001;58:211-216
Osservazioni satellitari Environ Health Perspect 118:847 855 (2010).
Satellite-derived map of PM 2.5 averaged over 2001-2006. Credit: Dalhousie University, Aaron van Donkelaar
WHO AQG Summary (2005) Pollutant Averaging time AQG value EU standard (target or limit value) Particulate matter PM 2.5 1 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 3 120 µg/m 3 *** Nitrogen dioxide, NO 2 1 year 1 hour 40 µg/m 3 200 µg/m 3 40 µg/m 3 200 µg/m 3 *** Sulfur dioxide, SO 2 24 hour 10 minute 20 µg/m 3 500 µg/m 3 125 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
The Impact of Air Pollution in Italy: PM 2.5 and NO 2 Roma, 4 giugno 2015
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
Scenario Target 2 Per ciascun inquinante, la concentrazione media annua diminuita del 20% al 2020
Concentrazioni medie annue di PM 2.5 2005 2010 2020 CLE 2020 + T1 2020 + T2
Concentrazioni medie annue di NO 2 2005 2010 2020 CLE 2020 + T1 2020 + T2
What about the health effects?
Organs of the human body affected by particulate air pollution Modified after Peters et al. JOEM 2011 23
Organs and disorders related to air pollution, 2015
Short-term health effects
MED-PARTICLES: the issues Fine and coarse PM Desert dust Forest fires PM components
MED-PARTICLES: the cities
Effects of PM 2.5 and PM 2.5-10 on mortality, EHP 2013
Effects of PM 2.5 and PM 2.5-10 on admissions, EHP 2013
Saharan dust: frequency ef events 50N 55N 45N 50N 40N 24 18 30 23 17 23 17 26 17 24 29 24 21 45N 35N 37 30 40N 30N 31 34 35N 25N African dust frequency (% over annual days) 30N 5W 0 5E 10E 15E 20E 25E 30E Pey et al. Atmos Chemistry Physics (2013)
Saharan dust: PM 10 contribution 50N 55N 45N 50N 1.5 1.1 40N 3.0 2.8 5.0 2.6 1.5 2.9 2.0 1.9 2.2 2.8 1.7 45N 35N 40N 4.4 5.1 30N 7.3 8.4 35N 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)
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 0-1 0.53 (0.23, 0.83) 32 0.147 0.66 (0.27, 1.06) 0 0.748 Cardiovascular 0-5 0.47 (-0.39, 1.33) 46 0.045 1.10 (0.15, 2.05) 0 0.766 Respiratory 0-5 2.43 (0.94, 3.95) 41 0.073 1.28 (-0.42, 3.01) 0 1.000 Hospital admissions Cardiovascular, age 15+ 0-1 0.36 (-0.02, 0.75) 59 0.016 0.23 (-0.30, 0.76) 0 0.503 Respiratory, age 15+ 0-5 0.67 (0.14, 1.19) 21 0.266 0.67 (-0.48, 1.83) 10 0.352 Respiratory, age 0-14 0-5 1.76 (0.60, 2.94) 24 0.235 2.38 (0.09, 4.71) 9 0.363 Stafoggia et al, EHP 2015
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 (0.27-1.06) Milan Turin Emilia-Romagna 0.24 (-0.30, 0.77) 0.76 (0.08, 1.44) 0.39 (-0.93, 1.73) 15.89 12.22 4.40 No heterogeneity Bologna -0.09 (-1.26, 1.10) 5.37 Marseille -1.15 (-3.13, 0.87) 2.05 Rome 0.49 (-0.16, 1.13) 12.91 Barcelona 1.36 (0.70, 2.02) 12.63 Thessaloniki 0.05 (-1.18, 1.29) 4.97 Madrid 0.33 (-0.08, 0.75) 20.01 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) 7.58 1.98 100.00 city %IR (95% CI) % Weight -3-2 -1 0 1 2 3 Anthropogenic PM 10 IR% = 0.53 (0.23-0.83) Little heterogeneity Milan Turin Emilia-Romagna Bologna Marseille Rome Barcelona Thessaloniki Madrid Athens Palermo D-L Overall (I-squared=0.00%, p=0.748) -3-2 -1 0 1 2 3 0.07 (-1.72, 1.90) 0.71 (-1.77, 3.26) -2.77 (-9.35, 4.28) -1.34 (-7.17, 4.85) -1.06 (-3.81, 1.76) 0.39 (-1.19, 1.99) -0.16 (-1.57, 1.27) -0.83 (-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) 4.76 2.50 0.32 0.42 1.96 6.23 7.68 0.82 26.04 41.07 8.19 100.00
% 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 3 8.00 8.00 7.50 7.50 7.00 7.00 6.50 6.50 6.00 6.00 5.50 5.50 5.00 5.00 4.50 4.50 4.00 4.00 3.50 3.50 3.00 3.00 2.50 2.50 2.00 2.00 1.50 1.50 1.00 1.00 0.50 0.50 0.00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Anthropogenic PM 10 (μg/m 3 ) 0.00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Desert PM 10 (μg/m 3 )
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
Long-term health effects
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) 6.41 10.72 3.00 4.03 0.90 18.57 1.24 6.10 9.96 6.00 19.60 8.08 2.17 3.22 100.00.5.67 1 1.5
Air pollution in the Rome Longitudinal Study EHP 2013 Average exposure at baseline: 43.6 μg/m 3 NO2 23.0 μg/m 3 PM2.5
The air pollution maps in Rome
The map of socioeconomic position in Rome
The Rome Longitudinal Study 17% of residents live at <50 m from a road with >10,000 vehicles/day Cesaroni et al. EH, 2010
The Rome Longitudinal Study Cesaroni et al. EH, 2010
Air pollution and mortality in the Rome Longitudinal Study EHP 2013 10 ug/m 3 NO2 10 ug/m 3 PM2.5 Cases HR 95%CI HR 95%CI Non accidental mortality 144,441 1.03 1.02 1.03 1.04 1.03 1.05 Cardiovascular mortality 60,318 1.03 1.02 1.04 1.06 1.04 1.08 IHD mortality 22,562 1.05 1.03 1.06 1.10 1.06 1.13 Respiratory mortality 8,825 1.03 1.00 1.06 1.03 0.97 1.08
The ESCAPE project (www.escapeproject.eu) 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 (2008 2012) 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
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
The ESCAPE project
The ESCAPE project
The ESCAPE project PM 10 (10 ug/m 3 ) PM 2.5 (5 ug/m 3 ) Non accidental mortality 1.04 (1.00 1.09) 1.07 (1.02 1.13) CV mortality 1.02 (0.92 1.14) 0,99 (0.91 1.08) Incidence of acute coronary events 1.12 (1.04-1.28) 1.13 (0.98-1.30) Incidence of stroke 1.02 (0.90-1.16) 1.19 (0.88-1.62) Lung cancer incidence 1.22 (1.03 1.45) 1.18 (0.96 1.46)
Results. Incidence of acute coronary events Thresholds analysis
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)
The Impact of Air Pollution in Italy: PM 2.5 and NO 2 Roma, 4 giugno 2015 www.viias.it
Mortalità per cause non accidentali attribuibile a PM 2.5 2005 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 100.000) IC95% Frazione di mortalità attribuibile (%) IC95% Mesi di vita persi ITALIA 40,077,488 20.1 527,193 34,552 20,608 43,215 86 51 108 7 4 8 9.7 NORD 18,847,023 24.5 249,518 22,485 13,447 28,075 119 71 149 9 5 11 14.0 Area geografica CENTRO 8,858,531 17.1 119,756 5,513 3,253 6,942 62 37 78 5 3 6 6.6 SUD e ISOLE 12,371,934 16.1 157,918 6,554 3,909 8,198 53 32 66 4 2 5 5.7 Macroarea URBANO 14,251,369 27.3 182,325 19,358 11,615 24,120 136 81 169 11 6 13 17.2 NON URBANO 25,826,119 16.2 344,867 15,194 8,994 19,095 59 35 74 4 3 6 5.8
Tasso di mortalità attribuibile (per 100.000) Decessi per cause non accidentali attribuibili a PM2.5 per 100.000 residenti per macro area geografica e regione 180 160 2005 140 120 100 80 60 40 20 0
Mortality rate attributable to PM 2.5 2005 2010 2020 CLe 2020 + T1 2020 + T2
Months of life lost due to PM2.5
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 (www.viias.it)