Assessment of studies on the health risk from particle matter (PM <2.5) from car emissions in relation to other risks in the study population

Transcription

1 Assessment of studies on the health risk from particle matter (PM <2.5) from car emissions in relation to other risks in the study population other aerosols risks gases Dieter Köhler

2 Conflicts of interest? No

3 Solid particles, examples of size range

4 Size of cigarette smoke 10µm Cigarette smoke 0,5µm

5 What is the basis for these calculations?

6 Expert Group on PM, 1 Relative risk st Meeting, May 2005 for all cause mortality and a 10 µg/m 3 increase in daily PM10 in Europe mean PM10 RR Stockholm Birmingham, West Midlands Paris Helsinki London Rouen Basel Zurich Strasbourg Le Havre Geneva Madrid Amsterdam Koln Netherlands Lyon Athens Budapest Huelva Florence Bologna Teplice Seville Palermo Tel Aviv Czech Republic Milano Erfurt Cracow mean PM10 level in µg/m3 RR increase per 10 µg/m3 Rome Barcelona Torino Prague Source: WHO 2004

7 Mortality due to particle matter (PM, Ozone). Summary of the studies till 2004 (PM <10µm) (PM <2,5µm) WHO Report 2008

8 Increasing papers about the risk of PM resp. fine dust 2000

9 PM10, PM2.5, (NO2) positive correlation with (>RR 1,02): Lung cancer Brain tumor Andersen ZJ, 2017 Breast cancer Andersen ZJ, 2017 Liver cancer Andersen ZJ, 2017 Kidney cancer Raaschou Nielsen O, 2017 Monoklonal Gammopathia Orban E, 2017 COPD Cai Y, 2014, Liu J 2016 Lung fibrosis Conti S, 2018 hypertension Cerebrovaskular events Stafoggia M, 2014 Cardiovascular events Dehbi HM, 2017 Diabetes Strak M, 2017, Balti EV, 2014 Effect of walking on lung function neutralized Sinharay R, 2017 Depression Zijlema WL, 2016 Weight of birth Clemens T, 2017 Sperm mobility Jurewicz J, 2015 Lamichhane DK, 2017, Andersen ZJ Wong CM, 2007, 2014, Andersen ZJ

10 PM10, PM2.5, Feinstaub (NO 2 ) no korreliert correlation nicht with mit: (RR <1,01): Rheumatic Arthritis Hart JE, 2013 Autismus Guxens M, 2016

11 PM10, PM2.5, (NO2) positive correlation with (>RR 1,02): Lung cancer Brain tumor Andersen ZJ, 2017 Breast cancer Andersen ZJ, 2017 Liver cancer Andersen ZJ, 2017 Kidney cancer Raaschou Nielsen O, 2017 Monoklonal Gammopathia Orban E, 2017 COPD Cai Y, 2014, Liu J 2016 Lung fibrosis Conti S, 2018 hypertension Cerebrovaskular events Stafoggia M, 2014 Cardiovascular events Dehbi HM, 2017 Diabetes Strak M, 2017, Balti EV, 2014 Effect of walking on lung function neutralized Sinharay R, 2017 Depression Zijlema WL, 2016 Weight of birth Clemens T, 2017 Sperm mobility Jurewicz J, 2015 Lamichhane DK, 2017, Andersen ZJ Wong CM, 2007, 2014, Andersen ZJ

12 RR = 1,014 (=1,4%). What does that mean compared to other risks? (PM <10µm) (PM <2,5µm) WHO Report 2008

13 RR (mortality) 1,7 1,6 1,5 1,4 1,3 Passive smoking (1,3; +30%) 1,2 1,1 RR 1,006 (PM10) RR 1,013 (PM2,5) Aus: Köhler D. Voshaar T, Schönhofer B Pneumologie Thieme 2. Aufl. 2014

14 RR (Relativ Risk) 10 Hypertension (10-12; +1000%) Smoking (8-10; +800%) 7,5 5 2,5 RR 1,006 (PM10) Passive smoking RR 1,013 (PM2,5) Aus: Köhler D. Voshaar T, Schönhofer B; Pneumologie Thieme 2. Aufl. 2014

15 Confounders can not be eliminated if they are huge in relation to the measured variable Variations of <1% in the answers of the questionaires can fully explain the results of PM and NOx on health risks: smoking behavior comorbidities adherence to treatment Consumtion of alcohols Physical activity.

16 Consumption gasoline (l) Correlation and causuality Route (km)

17 Do the storks bring the children? Inhabitants x10³ r=0,89 Storks (n)

18 (Biokost)

19 Extremly strong correlation Life expectency (Germany) (Y) r = r=0,98 P<10 p< ????

20 causal? Life expectency (Germany) (Y) Einfluss der Umweltprämie r = r=0,98 P<10 p< Vehicles in Germany (x 10 3 ) Source: Statistisches und Kraftfahrt Bundesamt

21 Conclusion: we need more cars to get older

22 Verification doesn t support a hypothesis, only falsification helps in science Hypothesis: all swans are white Karl Popper David Hume

23 One black swan and the hypothesis is destroyed Hypothesis: all swans are white Karl Popper David Hume

24 Expert Group on PM, 1 Relative risk for st Meeting, May 2005 all cause mortality and a 10 µg/m 3 increase in daily PM10 in Europe mean PM10 RR mean PM10 RR mean PM10 level in µg/m3 RR increase per 10 µg/m Stockholm Birmingham, West Midlands Paris Helsinki London Rouen Basel Zurich Strasbourg Le Havre Geneva Madrid Amsterdam Koln Netherlands Lyon Athens Budapest Huelva Florence Bologna Teplice Seville Palermo Tel Aviv Czech Republic Milano Erfurt Cracow Rome Barcelona Torino Prague Source: WHO 2004 Hints for a falsification of the hypothesis

25 Smoking is the black swan Karl Popper David Hume

26 Strong hints for falsification about health risk in the low dosis range: The high concentration of PM 2,5 in the cigarette smoke

27 PM (µg/m 3 ) Comparison PM in different places Big cities (3. World) Pollution Workplace till 70th (mining, foundry, Stone pit ) 250 limit fine dust 0 50µg/m³ µg/m³ 2 5mg/m³

28 Exampel: coal worker pneumoconiosis after 30 years of working Healthy Silicosis

29 PM (g/m 3 ) PM of the Mainstream of cigarette smoke is 10Mio higher than the limit of fine dust 750 Cigarette smoke fine dust limit 50µg/m³ Big cities (3. World) 2 400µg/m³ Pollution Workplace (mining, foundry ) 2 4mg/m³ 0,5 1kg/m³

30 Comparison fine dust limit vs cigarette smoke Concentration of Cigarette smoke: g/m³ 215 Balls Cigarettesmoke 1 Ball: 50µm Partikel/m³, (daily limit fine dust Germany)

31 Ca Balls Cigarette smoke (1)

32 Ca Balls Cigarette smoke (2)

33 Ca Balls Cigarette smoke.

34 Ca To achieve 10 Mio Balls, 1000 slides needed

35 e. G. comparison PM fine dust (5µg/m³) to PM cigarette smoke for kidney cancer, a study where a high risk was found

36 PM 5µg/m³ during life in relation to smoking A human is breathing 9m³ air/day or ca m³ air/life. 5µg/m³ Particle Matter (PM) inhaled: 1.25g/life Smoker: 1 cigarette contains 0.7g tobacco; inhaled PM ca. 25mg (and gases). After 50 cigaretts: 1,25g is reached

37 A lot of smokers should develop kidney cancer after smoking of 3 packages??

38 What is the basis for these calculations?

39 Estimates of health impacts of anthropogenic PM in EU Health end-point Units (per year) EU25 Germany Mortality life expectancy Months 8,6 10,2 reduction Mortality long term Life years lost x1, exposure Mortality long term Number of premature exposure deaths x1,000 Infant mortality Cases x1,000 0,6 0,09 Chronic bronchitis Cases x Respiratory hospital cases x admissions Cardiac hospital admissions Cases x Restricted activity days Days x Respiratory medication use Days x (children) Respiratory medication use Days x (adults) Lower respir. symptoms Days x (children) Lower respir. symptoms in adults with chronic disease Days x Source: CAFE 2005

40 After this data: smoker should all die after some packages! <4weeks

41 New NO2 Data. Comparison City vs Countryside

42 Cardiovacular death

43 Myocardial infarction is not included

44 Diabetes caused by a small ph reduction in the bronchial mucus?

45 Cigarette smoke contains huge amounts of NO2 (and NO) up to µg/m³ Beim NO2 ist es ähnlich. Der Rauch einer Zigarette enthält sehr viel NO2, wobei sogar zusätzlich viel vom vasoaktiven NO dabei ist (23). Es werden Konzentrationen im Zigarettenrauch bis zu 200ppm gemessen, was etwa µg/m³ entspricht. Da diese Dosen schon akut toxisch sind, vertragen die Raucher das nur, weil sie immer den Hauptstrom mit Nebenluft verdünnen. Auch hier wird der Grenzwert ständig um mehr das Hundertfache überschritten, wenn man von einer Packung Zigaretten am Tag ausgeht und die inhalierten Mengen von NO2 addiert. Damit ist das oben erwähnte Argument mit der möglichen Toxizität durch eine kumulative Belastung von NO2 widerlegt. Addiert man nun die vermeintliche Toxizität von NO2 zu der des Feinstaubes, müssten die Raucher nochmal um ca. 12% (6000/ Tote) schneller versterben. 23. Rodman A, Perfetti A. The Chemical Components of Tobacco and Tobacco Smoke, Second Edition (2012) CRC Press,London

46 The right tool is not enough

47 Many thanks for your attention