Air quality and health - indicators based assessment

Simona Perčič dr.med.Peter Otorepec dr.med.

There are four indicators in Slovenia relateing air quality and health based assessment:

•Post neonatal infant death due to respiratory disease

•Asthma and allergic diseases in children

•Exposure of people and children to air pollution with PM10

•Mortality due to respiratory diseases

Post neonatal infant death due to respiratory disease

•in EU 12,3% of all deaths of infants (28 to 364 days old) is due to respiratory diaseases

•in Slovenia 8,7% of all deaths of infants (28 to 364 days old) is due to respiratory diaseases (2013)

•Researches have shown association between air pollution and infant mortality due to respiratory disease, but it is very complicated especially because other outdoor/indoor pollutants and factors (effect of other allergens, cigarete smoking, microbes, socioeonomic status, life style,…)

Percentage of infants mortality in Slovenia, aged from 28 to 364 days, due to respiratory diseases (J00-J99), 2002-2014

Infant mortality (number of deaths/1.000 live-born infants) due to respiratory diseases, aged from 28 to 364 days in Slovenia, 2002 -2013

Post-neonatal infant death rates due to respiratory diseases in EU Member States, most recent year since 2004

• The rate of infants death due to respiratory diseases dependes on many factors also on air pollution (indoor and out door)

• The most common cause of infants mortality due to respiratory diseases is infection of the lower respiratory

tract (viruses in developed countries, bacterias in

developing countries)

• Children are very sensitive on efects of air pollution. 80% of lung tissue is under development during first years of life, so in this periode lung are especially sensitive on toxic substances in the air.

• A study made in USA estimated that increase in concentrations of PM10 for 10m3/µ increases mortality rate of infants due to respiratory disease for 16%, and Nox and CO in the air also increases death rate.

• The mean rate of infant mortality due to respiratory disease in EU is 0,5 on 1000 life born infants. But there are huge differences between countries; Austria 0,013,

Romenia 3,0. West countries are much better than east, probably due to better economic and social status and the law about pollution.

• For Slovenia, the mortality of infants due to respiratory diseases has not incresed. For example 2 infants died in the year 2013. We are in the midle conserning EU.

Asthma and allergic diseases in children

•Asthma has become the most common chronic disease among children and is one of the major causes of hospitalization to the fifteenth year of age. In EU countries in the last decade the prevalence was 5% to 20% of children suffering from asthma.

•Recent evidences support relationship between exposure to air pollution and exacerbation of asthma, mainly due to exposure to particulate matter (PM10)

• In the pathogenesis of asthma and allergic diseases, there are complicated interactions between effects of environment, genetics and host immune response

• Asthma is a chronical inflammation of respiratory tract and lung due to allergy, virus infections and irritants in the air (tobbaco, moulds, ….., hair of domestic pats, air pollutans like O3,CO, NOx, PM10, PM2,5 )

• Asthma development in newborens and children is also associated with other factors like: brestfeed, nutrition of mother and child, obesity during childhood, psiho-social factors, life style and the awerness of the family.

Percentage of children aged 0-14 years, admitted to the hospital due to asthma, 2002 to 2013

Percentage of children admitted to hospital due to asthma regarding age groups, 2013

Percentage of patients with asthma, allergic rhinitis and allergic conjunctivitis in the selected European countries, 2004

• In Slovenia data about hospitalization due to asthma and other respiratory diseases are available (NIJZ)

• In Maribor and Celje there are the most hospitalizations due to asthma, Ljubljana is better in the last years

• The percentage of hospitalization due to asthma in Slovenia in the years from 2002 to 2013 is:

0%-1,8% for the 0-4years old 0%-1,5% for the 5-9years old 0%- 1,1% for the 10-14 years old• The indicator shows that children with asthma are

well guided in the primary care, and receive good medicine

• In EU countries the most children with asthma was in UK : 20% 6-7years old, and 25%13-14 years old.

• The differences between the EU countries is mainly due to different life style,nutrition habits, socioeconomic status and the diferences in the environmental (air pollution) and meterological factors.

The prevalence of allergic diseases is increasing all over the world, especially in developed countries, and this phenomenom is mainly due to environmental pollution. Traffic pollution is one of the main factor in air pollution. Living close to the main roads is associated with increased prevalence of asthma, decreased lung functions and increased allergic rhinitis prevalence among children. In general the scientists found out that living 75 m beside main road is associated with 50% chanches more to develop asthma, then when living 150m distance along the main road.

Exposure of people and children to air pollution with PM10

•The concentration of PM10 is a good indicator of exposure to the particles from the outside world.

•Many epidemiological studies have showen association between exposure to PM10 and morbidity of the children.

•Partcles are everywhere where people live (traffic, industry, energy consuming, heating private houses,…)

•Particles <PM10 and ozone are the most dangerous for respiratory diseases as they reach deep lung tissue.

•By the WHO reccomendations, the mean year concentration shoulden´ t exceed 20µg/m3 PM10

•By the EU reccomendations, the mean year concentration shoulden´ t exceed 40µg/m3

PM10

Mechanism of action of PM10

•Oxidative stress ( damage of DNA with radicals or damaged processes in the cell wich lead to cell death, epigenetic factors)

•Chronic inflammatory response (inflammatory mediators localy in lung and sistematically in other tissue; the consequence are numerous)

•Autonomic system imbalance (favours the sypathethic over the parasymphatetic limb, concequences are numerous (e.g., alteration in heart rate, blood pressure, electrocardiographic change)).

• Long-term of exposure to PM is asocciated with increased mortality in morbidity due to respiratory and cardiovascular diseases. Higher PM10 concentratrations increase the risk for lung development, worsening the asthma, and cause brathing problems. The risk for mortality begins in the childhood, and for every increase in PM10 for 10µg/m3 represents 0,5%.

• The effect is dependent on concentrationc of PM and the duration of exposure

Exposure of children (0-15 years old) in Slovenia to exceeded PM10 concentrations, from 2002 to 2012 (WHO recommended air quality level is 20 µg g/m3, the EU limit value is 40 µg/m3 of PM10)

Percentage of children (from 0 to 15 years old) that were hospitalized because of respiratory diseases, from 2002 to 2013 in the administrative unit of birth

Exposure of people to PM10 in European cities, 2010 (WHO air quality guideline level is 20 µg /m3, the European Union limit value is 40 µg /m3 of PM10)

Percentage of children exposed to PM10, for 2009 (WHO air quality guideline level is 20 µg /m3, the European Union limit value is 40 µg /m3 of PM10)

• In Slovenia, the children (0-15 years old) are mainly exposed to mean anual concentrations of PM10 about 20-30µg/m3 , which is higher than WHO reccomendations.

• In the year 2013 85% of children were exposed to the mean anual concentrations between 20-30µg/m3 which is above WHO recomendations, and below EU recomendations. 15% of children were exposed to mean anual concentrations above 40µg/m3

• The highest mean anual concentration of PM10 was in Ljubljana-center, which is expected due to havy traffic (41µg/m3 )

• Data of hospitalization show, that in the periode from 2002 to 2013 in Celje, Nova Gorica and Murska Sobota there is the highist rate of hospitalization due to respiratory disease (children 0-15 years old)

• In general in Slovenia there is about 15% children hospitalized due to respiratory disease.

• By the WHO in Slovenia, the number of hospitalization due to respiratory disease would fall for 200, if we reach the mean annual concentrations of 20µg/m3

• By the data from EEA 18% to 41% of european urban population in the years from 2002 to 2010 were exposed to mean anual concetrations of PM10 higher than EU reccomendations (40µg/m3 ), and 82,2% to mean anual concetrations of PM10 higher than WHO reccomendations (20µg/m3 )

• By the WHO estern and southern EU countries have more problems with air pollution (geographical factors, law about envronmental factors, …)

• We reccomend anual mean concentrations of PM10 not to exceed 20µg/m3

Mortality due to respiratory diseases

•Respiratory diseases presents more than 6% of total burden of diseases in the world and are the cause for mortality and morbidity of about 13% of all causes.

•They are mainly dependant on risk factors like: air pollutionindoor/outdoor), life style, overcrouding, socioeconomic factors, tobacco,…

•Studies have showen, that long term exposure to air pollution can cause asthma, allergic diseases, COPD and lung cancer (especially in children and elderly).

Mortality rate (number of deaths/100.000 residents) due to respiratory diseases, Slovenia, 1999-2013

Mortality rate (number of deaths/100000) due to respiratory diseases, Slovenia, statistical regions, from 2006 to 2008, and from 2009 to 2013

Mortality rate (number of deaths/100.000) due to respiratory diseases in selected European countries

• Mortality due to respiratory diseases in Europa is decreasing, but in Ireland (especially in winter) and UK is still very high.

• Extreme weather conditions (fog, inversion, cold) are associated with increased mortality and morbidity.

• In Slovenia the mortality due to respiratory diseases is decreasing.

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