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Transcript of Impactes de la contaminaciأ³ local en la salud pأ؛ ... 2016/07/02 آ  Ostro et al. EHP 2015...

  • 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)

  • NO2

    results

    Cyrys, Atm Env

    2012

    EU Limit Value

    http://www.riskmanagementsolutions.co.za/Escape.jpg

  • 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

    http://upload.wikimedia.org/wikipedia/en/e/e9/European_Research_Council_logo.svg

  • 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

    jordi.sunyer@isglobal.org

  • 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

    R e

    la ti v e

    R is

    k p

    e r

    IQ R

    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