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Impactes de la contaminació local en la salud pública
Jordi Sunyer
Gas Natural 2016
Air pollution is increasing
Most of the population lives in
polluted areas
Air pollution (PM10, μg/m3) by
cities (WHO 2011)
• Ahvas (Iran) 327
• Ulam Bator (Mongolia) 279
• Quetta (Pakistan) 263
• Kampur (India) 244
• Gabarone (Botswana) 240
• Barcelona 38
• Stockholm 18
Ischemic heart disease and
PM2.5, globally (World bank 2016)
Ambient Aerosols
Gases and primary particles
Organic compounds
Soot particles
Metals
Secondary particles
Crustal material
Biological material
……
Brook et al. 2004
Ambient particulate matter (PM)
is defined by its size
. .
Bronchial epithelium
10µm 1 µm 0.1µm
Courtesy: K. Donaldson & A. Peters
Size matters for the
translocation
Alveolar
macrophage
Zimmermann
Karg
Cyrys
Behrendt/Allessandrini
Schulz
Peters
Wolff
Schramm
Maier
AndraeWittmaack
Zimmermann
Karg
Cyrys
Behrendt/Allessandrini
Schulz
Peters
Wolff
Schramm
Maier
AndraeWittmaack
1 µm 10 µm
35 30 25 20 15 10
0.9
1.0
1.1
1.2
1.3
• Portage, W • Topeka, KS
• Waterown, MA (Boston)
• Harriman, TN (Knoxville) • St. Louis, MO
• Stebenville, OH
Long-term mortality. 6 cities, Dockery 1993
The six cities study:
PM2.5 –MORTALITY (Dockery , NEJM 1993)
WHO
AQG
EU
Limit
Value
US EPA
Standard
ACS cohort: Guidelines for PM2.5
Pope et al 2002
Insulin Resistance
Type 2 diabetes
Type 1 diabetes
Bone metabolism Skin Aging
Stroke
Neurological development
Mental Health
Neurodegenerative diseases
Cardiovascular Disease Mortality
Cardiovascular Disease Morbidity
Myocardial Infarction
Arrhythmia
Congestive Heart Failure
Changes in Heart Rate Variability
ST-Segment Depression
Premature Birth
Decreased Birth Weight
Decreased foetal growth
In uterine growth retardation
Decreased sperm quality
Preclampsia
High blood pressure
Endothelial dysfunction
Increased blood coagulation
Systemic inflammation
Deep Venous Thrombosis
Respiratory Disease Mortality
Respiratory Disease Morbidity
Lung Cancer
Pneumonia
Upper and lower respiratory symptoms
Airway inflammation
Decreased lung function
Decreased lung growth
Joint ERS / ATS statement (in press)
Air pollution affects multiple organs
immediately and has long-term
consequences
Particulate air pollution causes 3.5 million deaths
WHO 2014
Health Effects of Fine Particles: Lines that Connect (Pope et Dockery 2006)
Mechanisms by which exposure to PM
damages our health
Brook RD 2010.
Long-term Exposure to Fine Particles
and Coronary Artery Calcification
Progression
Kaufmann et al. Lancet 2016
Developing fetus is susceptible to environmental insults
Reproductive and developmental
effects of pre-natal air pollution
- Effects on fetus
Fetal growth
Length of gestation
Congenital anomalies
Stillbirth
Neurodevelopment
Lung function
- Effects on mother
Pregnancy-induced hypertensive disorders
Gestational diabetes
The BREATHE project: BRain dEvelopment and Air polluTion ultrafine particles in scHool childrEn
Pujol
Neuroimage
2016
Economical impact by region, 2013 (World bank 2016)
Interventions: % of days above standards in Los
Angeles (US)
1976 1990 2002
75%
50%
25%
Interventions ‘cars free cities’
• Reduce vehicles in the cities
– green corridors
– Cycling lines
• More and better public transport
• Cleaner transport
Co-benefices of healthy cities
1. Reduce air pollution.
2. Pacify the environment (noise), increase
social contact and physical exercise.
3. Increase greenness and reduce local
temperature.
4. Reduce global warming.
Conclusion
•Air pollution is increasing
•Most of the population lives in polluted areas •Air pollution affects multiple organs immediately and has long-term consequences •There is time for interventions: new urban planning for healthy cities
MOLTES GRÀCIES
Some figures PM air pollution (WHO 2014, World bank 2016)
- Fourth cause of death,
- First environmental risk
- Causes around 5 million deaths (3 million PM AP)
- One out of 10 deaths (6% of deaths PM AP)
- 5.5 trillion $ (3 PM AP)
- 4.8% losses in GDP in Europe
- Reduction of PM in US has been followed of
health improvements, including an increase of life
expectancy
http://www.who.int/phe/health_topic
s/outdoorair/databases/en/ Globally, 7 million deaths were attributable
to the joint effects of household and
ambient air pollution in 2012. The Western
Pacific and South East Asian regions bear
most of the burden with 2.8 and 2.3 million
deaths, respectively. Almost 680’000
deaths occur in Africa, about 400’000 in
editerranean region, 287’000 in Europe
and 131’000 in the Americas.
Fine and ultrafine particles and
ischemic heart disease mortality 100,000 California
teachers aged 30-80
years in 1995
Exposure estimation for
4km grids based on
emission inventories
Follow-up for mortality for
2001-2007
1085 ischemic heart
disease deaths
PM2.5 UFP
Re
lative
Ris
k p
er
IQR
0,8
1,0
1,2
1,4
1,6 Single
Two-pollutant
Ostro et al. EHP 2015
Obesity in children from 5 Euro areas
BIB EDEN KANC MOBA RHEA SAB Total
Obese 4,76 1,46 7,92 0,69 10,05 8,43 5,64
Overweight 9,96 13,66 12,87 7,9 19,6 21,2 14,71
Normal 85,28 84,88 79,21 91,41 70,35 70,36 79,65
0%
20%
40%
60%
80%
100%
WHO Obesity %
Normal Overweight Obese
BIB EDEN KANC MOBA RHEA SAB Total
WtH>0.5 10,87 7,32 20,79 3,09 27,27 24,82 16,07
Normal 89,13 92,68 79,21 96,91 72,73 75,18 83,93
50%
60%
70%
80%
90%
100%
Waist-to-Height ratio >0.5
Normal WtH>0.5