Short-term effects of ultrafine, fine and coarse particles on cause-specific mortality in 7 European cities Massimo Stafoggia

Transcription

1 Short-term effects of ultrafine, fine and coarse particles on cause-specific mortality in 7 European cities Massimo Stafoggia Dresden, Nov 28 th 2014

2 BACKGROUND Conflicting evidence on UF effects, often based on single-centre studies or short/discontinuous time-series Existence of long time series from previous projects (HEAPSS, AIRGENE, RUPIO) Lack of a EU-wide study on the short-term effects of UF

3 OBJECTIVES To collect existing time-series data on mortality/morbidity, UF, PM and meteorological pars. in multiple European cities To compare UF and PM concentrations across Europe To estimate short-term effects of UF and PM on causespecific mortality and emergency hospitalizations To evaluate two-pollutant models, effect modification by age/gender/season, sensitivity to adjustment model To inform policy makers on the need of implementing routine and standardized monitoring campaigns of UF in Europe

4 STUDY AREA and GROUPS INVOLVED Helsinki: National Institute of Health, Kuopio Stockholm: Karolinska Inst. Copenhagen: Univ. Copenhagen Augsburg: Helmholtz Zentrum, Munich Barcelona: CREAL Rome: Dep. Epidemiology Lazio Region Athens: University of Athens London: St George s University Ruhr area: IUF, Duesseldorf

5 DATA OVERVIEW Air pollutants concentrations: PM 10, PM , PM 2.5, gases Mortality 0+: natural, CVD, RESP Hospitalizations (4 cities): CVD 15+, RESP 15+, RESP 0-14 PNC data: daily PNC counts from existing monitors Meteorological parameters: temperature, humidity, barometric pressure, wind speed/direction 7 CITIES Helsinki, Stockholm, Copenhagen, Augsburg, Barcelona, Rome, Athens + (possibly) London, Ruhr area Study periods between 1999 and 2010 (3 1 years)

6 DATA COVERAGE Summary of data availability: % of coverage refer to # days with both mortality and PNC data C W C W C W C W C W C W C W C W C W C W C W C W Athens Augsburg Barcelona Copenhagen Helsinki Rome Stockholm C = Cold Season (October to March); W = Warm season (April to September) Legend No data (or coverage < 5%) Coverage 5-25% Coverage 25-50% Coverage 50-75% Coverage > 75%

7 METHODS City-specific analysis, followed by meta-analysis Time-series framework: City-specific over-dispersed Poisson model, adjusted for time trend (penalized splines), low and high temperatures (natural splines), flu epidemics and holidays Distributed lags Two-pollutant models with PM and gases Effect modification by age, gender and season (cold, warm) Sensitivity analyses on time trend adjustment and period inclusions

8 μg/m 3 (1000/cm 3 for PNC) PNC and PM: means and correlations Highest values (and variability) of PNC in Rome due to traffic sources Increasing values of all PM fractions North to South Different fine-to-coarse PM ratio across cities PNC PM10 PM2.5 PM Low correlations between PNC and PM High correlations between PNC and gases (especially NO2 and CO) PNC PM (0.08 ; 0.51) PM (0.01 ; 0.56) PM (0.09 ; 0.41) NO (0.28 ; 0.69) CO PNC PM 10 PM 2.5 PM NO 2 CO O (-0.04 ; 0.67) O (-0.52 ; 0.07) 0.78 (0.63 ; 0.88) 0.79 (0.57 ; 0.94) 0.39 (0.09 ; 0.72) 0.23 (-0.10 ; 0.65) 0.09 (-0.19 ; 0.44) 0.26 (0.08 ; 0.42) 0.39 (0.16 ; 0.66) 0.26 (-0.08 ; 0.69) 0.00 (-0.36 ; 0.31) 0.25 (0.00 ; 0.60) 0.12 (-0.07 ; 0.54) 0.15 (-0.24 ; 0.50) 0.39 (-0.14 ; 0.72) (-0.42 ; -0.04) (-0.56 ; 0.02)

9 Health data City (Study period) Natural mortality Cardiovascular mortality Respiratory mortality # deaths mean # deaths mean % # deaths mean % Helsinki ( ) 62, , , Stockholm 1 ( ) 67, , , Stockholm 2 ( ) 43, , , Copenhagen ( ) 54, , , Augsburg ( ) 26, , , Barcelona ( ) 53, , , Rome ( ) 128, , , Athens ( ) 48, , ,

10 FUTURE PERSPECTIVES PRELIMINARY RESULTS Higher concentrations of PNC and PM in Mediterranean cities Weak and delayed effects of PNC, immediate effects of PM Weak effects on respiratory mortality FUTURE PERSPECTIVES Two-pollutant models Effect modification by age, gender, season Sensitivity models on included peiods and time trend adjustment Include London and Ruhr Area Analyze cardio-respiratory hospitalizations for 5 cities

11 SOME LIMITATIONS Different PNC instruments and size fractions Different representativeness of PNC data across cities Discontinuity in PNC data of most of the cities Lack of data from Eastern Europe and other EU areas Need of implementing daily routine and standardized PNC measurements across Europe