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Public-health impact of outdoor and traffic-related air pollution: a European assessment
TL;DR: In this paper, the authors estimated the impact of outdoor and traffic-related air pollution on public health in Austria, France, and Switzerland, and found that air pollution contributes to mortality and morbidity.
Abstract: Background: Air pollution contributes to mortality and morbidity. We estimated the impact of outdoor (total) and traffic-related air pollution on public health in Austria, France, and Switzerland. Attributable cases of morbidity and mortality were estimated. Methods: Epidemiology-based exposure-response functions for a 10 μg/m3 increase in particulate matter (PM10) were used to quantify the effects of air pollution. Cases attributable to air pollution were estimated for mortality (adults \textgreater30 years), respiratory and cardiovascular hospital admissions (all ages), incidence of chronic bronchitis (adults \textgreater25 years), bronchitis episodes in children (\textless15 years), restricted activity days (adults \textgreater20 years), and asthma attacks in adults and children. Population exposure (PM10) was modelled for each km2. The traffic-related fraction was estimated based on PM10 emission inventories. Findings: Air pollution caused 6% of total mortality or more than 40 000 attributable cases per year. About half of all mortality caused by air pollution was attributed to motorised traffic, accounting also for: more than 25 000 new cases of chronic bronchitis (adults); more than 290 000 episodes of bronchitis (children); more than 0·5 million asthma attacks; and more than 16 million person-days of restricted activities. Interpretation: This assessment estimates the public-health impacts of current patterns of air pollution. Although individual health risks of air pollution are relatively small, the public-health consequences are considerable. Traffic-related air pollution remains a key target for public-health action in Europe. Our results, which have also been used for economic valuation, should guide decisions on the assessment of environmental health-policy options.
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Jørgen Vestbo1, Suzanne S. Hurd, Alvar Agusti2, Paul W. Jones3, Claus Vogelmeier4, Antonio Anzueto5, Peter J. Barnes6, Leonardo M. Fabbri7, Fernando J. Martinez8, Masaharu Nishimura9, Robert A. Stockley, Don D. Sin10, Roberto Rodriguez-Roisin2 •
University of Manchester1, University of Barcelona2, St George's Hospital3, University of Marburg4, University of Texas Health Science Center at San Antonio5, Imperial College London6, University of Modena and Reggio Emilia7, University of Michigan8, Hokkaido University9, University of British Columbia10
TL;DR: It is recommended that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation.
Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.
17,023 citations
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TL;DR: The evidence for adverse effects on health of selected air pollutants is discussed, and it is unclear whether a threshold concentration exists for particulate matter and ozone below which no effect on health is likely.
4,010 citations
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TL;DR: Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated.
3,654 citations
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TL;DR: Representatives from many countries serve as a network for the dissemination and implementation of programs for diagnosis, management, and prevention of COPD.
Abstract: Representatives from many countries serve as a network for the dissemination and implementation of programs for diagnosis, management, and prevention of COPD. The GOLD Board of Directors is grateful to the many GOLD National Leaders who participated in discussions of concepts that appear in GOLD reports.
3,165 citations
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TL;DR: The purpose of this statement is to provide healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease and practical recommendations for healthcare providers and their patients are outlined.
Abstract: Air pollution is a heterogeneous, complex mixture of gases, liquids, and particulate matter. Epidemiological studies have demonstrated a consistent increased risk for cardiovascular events in relation to both short- and long-term exposure to present-day concentrations of ambient particulate matter. Several plausible mechanistic pathways have been described, including enhanced coagulation/thrombosis, a propensity for arrhythmias, acute arterial vasoconstriction, systemic inflammatory responses, and the chronic promotion of atherosclerosis. The purpose of this statement is to provide healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease. In addition, the implications of these findings in relation to public health and regulatory policies are addressed. Practical recommendations for healthcare providers and their patients are outlined. In the final section, suggestions for future research are made to address a number of remaining scientific questions.
2,213 citations
References
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TL;DR: It is suggested that fine-particulate air pollution, or a more complex pollution mixture associated with fine particulate matter, contributes to excess mortality in certain U.S. cities.
Abstract: Background Recent studies have reported associations between particulate air pollution and daily mortality rates. Population-based, cross-sectional studies of metropolitan areas in the United States have also found associations between particulate air pollution and annual mortality rates, but these studies have been criticized, in part because they did not directly control for cigarette smoking and other health risks. Methods In this prospective cohort study, we estimated the effects of air pollution on mortality, while controlling for individual risk factors. Survival analysis, including Cox proportional-hazards regression modeling, was conducted with data from a 14-to-16-year mortality follow-up of 8111 adults in six U.S. cities. Results Mortality rates were most strongly associated with cigarette smoking. After adjusting for smoking and other risk factors, we observed statistically significant and robust associations between air pollution and mortality. The adjusted mortality-rate ratio for the most po...
7,194 citations
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TL;DR: The evidence for adverse effects on health of selected air pollutants is discussed, and it is unclear whether a threshold concentration exists for particulate matter and ozone below which no effect on health is likely.
4,010 citations
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TL;DR: Increased mortality is associated with sulfate and fine particulate air pollution at levels commonly found in U.S. cities, although the increase in risk is not attributable to tobacco smoking, although other unmeasured correlates of pollution cannot be excluded with certainty.
Abstract: Time-series, cross-sectional, and prospective cohort studies have observed associations between mortality and particulate air pollution but have been limited by ecologic design or small number of subjects or study areas. The present study evaluates effects of particulate air pollution on mortality using data from a large cohort drawn from many study areas. We linked ambient air pollution data from 151 U.S. metropolitan areas in 1980 with individual risk factor on 552,138 adults who resided in these areas when enrolled in a prospective study in 1982. Deaths were ascertained through December, 1989. Exposure to sulfate and fine particulate air pollution, which is primarily from fossil fuel combustion, was estimated from national data bases. The relationships of air pollution to all-cause, lung cancer, and cardiopulmonary mortality was examined using multivariate analysis which controlled for smoking, education, and other risk factors. Although small compared with cigarette smoking, an association between mor...
2,792 citations
01 Jan 1994
TL;DR: In this article, the authors outline the history of air pollution in the UK, describe the types of pollutant now in the atmosphere, and discuss the relation between air pollution and health.
Abstract: This paper outlines the history of air pollution in the UK, describes the types of pollutant now in the atmosphere, and discusses the relation between air pollution and health. The primary pollutants, which are directly discharged into the atmosphere, often from vehicle exhaust emissions, are: (1) sulphur dioxide (SO2); (2) nitrogen oxides (NOx); (3) smoke and particulates; (4) carbon monoxide (CO); (5) carbon dioxide (CO2); (6) organic compounds; and (7) metals, especially lead and calcium. The secondary pollutants, derived from primary pollutants, by chemical changes, include: (1) ground ozone, an important constituent of photochemical smog; and (2) acid aerosols. It is now proved beyond reasonable doubt that sufficiently high concentrations of atmospheric pollution have severe health effects. Various biological and medical methodologies can be used to evaluate their effects on health. Asthma and rhinitis are two important respiratory diseases, whose causes include air pollution. For the covering abstract see IRRD 869702.
1,351 citations
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TL;DR: In this article, the authors carried out a prospective combined quantitative analysis of the associations between all cause mortality and ambient particulate matter and sulphur dioxide and found that the effects of both pollutants were stronger during the summer and were mutually independent.
Abstract: Objectives: To carry out a prospective combined quantitative analysis of the associations between all cause mortality and ambient particulate matter and sulphur dioxide. Design: Analysis of time series data on daily number of deaths from all causes and concentrations of sulphur dioxide and particulate matter (measured as black smoke or particles smaller than 10 μm in diameter (PM10)) and potential confounders. Setting: 12 European cities in the APHEA project (Air Pollution and Health: a European Approach). Main outcome measure: Relative risk of death. Results: In western European cities it was found that an increase of 50 μg/m3 in sulphur dioxide or black smoke was associated with a 3% (95% confidence interval 2% to 4%) increase in daily mortality and the corresponding figure for PM10 was 2% (1% to 3%). In central eastern European cities the increase in mortality associated with a 50 μg/m3 change in sulphur dioxide was 0.8% (-0.1% to 2.4%) and in black smoke 0.6% (0.1% to 1.1%). Cumulative effects of prolonged (two to four days) exposure to air pollutants resulted in estimates comparable with the one day effects. The effects of both pollutants were stronger during the summer and were mutually independent. Conclusions: The internal consistency of the results in western European cities with wide differences in climate and environmental conditions suggest that these associations may be causal. The long term health impact of these effects is uncertain, but today9s relatively low levels of sulphur dioxide and particles still have detectable short term effects on health and further reductions in air pollution are advisable. Key messages Evidence is accumulating that air pollution below the levels of national and international standards has adverse short term health effects In this study data from 12 European cities showed that increases in sulphur dioxide and particulate matter are associated with increased total mortality The effects of the two pollutants seem to be independent Associations were stronger and more consistent in western European cities Current low levelsof sulphur dioxide and particles stillaffect health and further reductions in pollution are needed
889 citations