Ambient Particulate Matter and Public Health

Transcription

1 Ambient Particulate Matter and Public Health PD Dr. Annette Peters GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany

2 Ambient Particulate Matter (Example diesel particles) Fine Particulate Matter PM 10 : mass < 10 µm PM 2.5 : mass < 2.5 µm Ultrafine Particles UFP: number < 100 nm Daily average PM 10 in Leipzig, : 27 µg/m : 12 µg/m 3 Kreyling et al., GSF-IHB

3 Cohort study in North Rhine-Westphalia Women age were recruited between 1985 and 1994 Follow-up until 2003 Alive (N=4353) Dead (N=399) Modelling of exposure at residential address Gehring et al, Epidemiology, 2006

4 Adjusted Relative Risk of Mortality for IQR $ -Increase of Air Pollutants and Living Close to Busy Roads RR (95%CI) 2 education and smoking; PM 10 : 7 µg/m 3 ; PM 10 = 0.71*TSP $ IQR NO2=16 µg/m All Cause Cardiopulmonary Close to the busy road NO 2 (5 years) PM 10 (5 years) Gehring et al, Epidemiology, 2006

5 Who is susceptible and why? Inhalation of ambient particles Local Effects Inflammation Systemic Effects Acute phase proteins Cytokines Asthma attacks Bronchitis Ischemia Arrhythmia

6 Myocardial Infarction: Occlusion of the Coronary Arteries Healthy heart Occlusion Re-Perfusion

7 Women Health Study Cohort Study of 66,000 women across the US Recruited 1994 to 1998 Median Followup 6 years 1816 women had one or more fatal or nonfatal cardiovascular events Hazard ratio: 1.24 (1.09 to 1.41) per 10 µg/m 3 PM 2.5 Miller et al., NEJM 2007

8 HEAPSS: Follow-up of Myocardial Infarction Survivors City Period of Follow up Persons followed Augsburg Barcelona Helsinki Rome Stockholm *hospital admissions for acute angina, acute myocardial infarction, dysrhythmia or heart failure Cardiac readmissions* Klot et al. Circulation 2005

9 Air pollution and cardiac readmission in myocardial infarction survivors 1,20 1,15 Risk Ratio 1,10 1,05 1,00 0,95 0,90 PNC PM10 CO NO2 SO2 Klot et al. Circulation 2005

10 Particles and Myocardial Infarction HEAPSS-Follow-up Augsburg, Change [%] PM 10 Change [%] Particle number (estimated) Incident MI Secondary MI Death -20 Incident MI Secondary MI Death Klot et al. Circulation 2005

11 Increase in severity of the effects Health effects of particulate air pollution based on epidemiological studies CVD Mortality CVD Hospital admissions CVD Emergency room visits Changes in cardiac function (heart rate variability, repolarization), cardiac symptoms, pro-thrombotic status and increase in inflammatory markers in subjects with cardio-pulmonary disease Sub-clinical effects in healthy subjects Proportion of the population affected

12 Today: Loss in life expectancy Scenario for the year 2000: Loss in life expectancy attributable to anthropogenic PM2.5 (in months) Ammann et al. CAFE Scenario Analysis Report Nr. 6, June 2005 europa.eu.int/comm/environment/cafe/activities/pdf/cafe_scenario_report_6.pdf

13 Tomorrow: Reduced Impact of Particles? Scenario under current EU regulation for the year 2020: Loss in life expectancy attributable to anthropogenic PM2.5 (in months) Ammann et al. CAFE Scenario Analysis Report Nr. 6, June 2005 europa.eu.int/comm/environment/cafe/activities/pdf/cafe_scenario_report_6.pdf

14 Summary Fine ambient particles are associated with increased mortality predominately due to cardiovascular diseases Subjects with underlying disease are at higher risk for subsequent hospitalisation Further research is needed to guide the measures to most effectively protect public health in Europe

15 Thank you to Research Unit Health Effects of Particles : S. Breitner, I. Brüske-Hohlfeld, J. Cyrys, S. Greven, A. Henneberger, A. Ibald-Mulli, M. Marowsky-Köppl, M. Pitz, A. Peters, R. Rückerl, A. Schaffrath Rosario, M. Stölzel, W. Yue GSF-Institut of Epidemiology: J. Heinrich, H. E. Wichmann, G. Wölke GSF-Focus Network Aerosols and Health: J. Heyder, W. Kreyling, J. Schnelle-Kreis, H. Schulz, K. Wittmaack, R. Zimmermann KORA Coronary Event Registry: H. Löwel, M. Heier, I. Trentinglia, C. Winter, G. Orlik, P. Friedmann, G. Zimmermann, A. Hörmann, G. Kaup, C. Meisinger HEAPSS Study Group: F. Forastiere, Rome (Coordinator), T. Bellander, Stockholm, M. Kulmala, Helsinki, J. Pekkanen, Helsinki, A. Peters, Munich, J. Sunyer, Barcelona

16 Questions? München, Leopoldstr