Human health may be at risk from long-term exposure to air pollution below current air quality standards and guidelines
Growing evidence that current pollution standards are insufficient and need to be revised, suggests study
Peer-Reviewed PublicationLong-term exposure to air pollution appears to still be linked to higher mortality despite the existence of air quality standards that restrict levels of pollution, suggests a study published online in The BMJ today.
Researchers found evidence of higher death rates amongst people who had been exposed to more air pollution even though the levels were allowed under current official standards.
Previous studies have found an association between long term exposure to outdoor air pollution such as those in the form of fine particles in the air (known as particulate matter or PM2.5) and nitrogen dioxide (NO2) and poor health or death.
Air pollution concentrations have fallen substantially in Europe since the 1990s, but it is unclear whether there still is a link between pollution and ill health or death at concentrations of pollution that are below current permitted limits.
Therefore, an international team of researchers led by the Institute for Risk Assessment Sciences at Utrecht University in the Netherlands, set out to investigate if there was an association between low levels of air pollution concentrations and natural and cause specific deaths.
Low level air pollution was defined as concentrations below current limit values as set by the European Union, US Environmental Protection Agency and the World Health Organization (WHO) air quality guidelines.
The researchers analysed data on eight groups of people within six European countries – Sweden, Denmark, France, the Netherlands, Germany and Austria – totalling 325,367 adults collectively.
Their study, known as the Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) recruited participants in the 1990s or 2000s.
Of the 325,367 participants who were followed up over an almost 20-year period, around 14.5% (47,131 people) died during the study period.
Analysis of the results showed that people who had higher exposure to particulate matter (PM2.5), nitrogen dioxide, and black carbon were more likely to die.
An increase of 5 µg/m3 (a concentration measure of particulate matter) in PM2.5 was associated with a 13% increase in natural deaths while the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6%. Associations with PM2.5 and nitrogen dioxide were largely independent of each other.
Moreover, associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low to very low concentrations.
For people who were exposed to pollution levels below the US standard of 12 µg/m3, an increase of 5 µg/m3 in PM2.5 was associated with a 29.6% increase in natural deaths. People exposed to nitrogen dioxide at less than half the current EU standard of 40 µg/m3, a 10 µg/m3 increase in nitrogen dioxide was associated with a 9.9% increase in natural deaths.
This is an observational study, and as such, can’t establish cause.
The study also has some limitations, say the authors, such as the fact that it focused on exposure in 2010 which was towards the end of the follow-up period for most participants and, given the downward trend in air pollution, this measure might not exactly reflect the concentrations experienced during follow-up.
However, this was a large study from multiple European groups of people with detailed information provided.
As such, the authors conclude: “Our study contributes to the evidence that outdoor air pollution is associated with mortality even at levels below the current European and North American standards and WHO guideline values.
“These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines and standards, and future assessments by the Global Burden of Disease [study].”
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JOURNAL
BMJ
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis
ARTICLE PUBLICATION DATE
31-Aug-2021
Less air pollution and more access to green or blue spaces: A recipe to improve the life quality of people with COPD
Air pollution and greater distance with green of blue spaces negatively impact the health-related quality of life in patients with chronic obstructive pulmonary disease (COPD), according to a new study led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by ”la Caixa” Foundation. The findings highlight the need for implementing urban policies that improve the life quality of a great number of people living with respiratory diseases across the world.
The health-related quality of life has become one of the most relevant parameters to measure the progression of chronic obstructive pulmonary disease (COPD). “We know that several clinical and psychological factors can affect this parameter, but little is known on the effect of environmental factors,” explains Judith Garcia-Aymerich, ISGlobal researcher. Thus, Garcia-Aymerich and her team assessed, for the first time, the association between health-related quality of life and exposure to different environmental factors in over 400 COPD patients with different levels of disease severity, from moderate to high.
The patients, all of them residing in Barcelona, underwent a COPD assessment test and answered a clinical questionnaire. The research team determined the residential exposure of each patient to air pollutants (NO2, PM2.5 and PM10 fine particles, and PM2.5 absorbance), traffic noise, land surface temperatures, and distance to green or blue (water) spaces. They found that exposure to high levels of NO2 and PM2.5 absorbance (an indicator of black carbon emanating from combustion) were associated with worse assessment and mental health questionnaire scores. “This might be explained by the restorative effect of blue and green spaces, although it could also be related to the fact that these spaces encourage greater physical activity,” says Subhabrata Moitra, first author of the study.
The authors acknowledge that, being a cross-sectional study rather than a longitudinal one, they cannot demonstrate causality, and that further studies are needed to better understand the contribution of each pollutant. “However, this study, performed for the first time on a Mediterranean population, provides evidence that air pollutants (particularly NO2 and black carbon) and the distance to green or blue spaces negatively affects the health-related quality of life in COPD patients,” says Garcia-Aymerich.
These results can help clinicians to provide recommendations that improve the quality of life of their COPD patients, for example by avoiding traffic zones or being close to blue and green spaces. They also underline the need to limit air pollution in cities and redefine urban policies that improve the quality of life of the great number of people who live with respiratory diseases across the world.
These findings are published shortly before the celebration of the European Respiratory Society Congress 2021, which will take place virtually September 5-8.
Reference
S Moira, M Foraster, A Arbillaga-Etxarri, et al. Roles of the physical environment in health-related quality of life in patients with chronic obstructive pulmonary disease. Env Res. Jan 2022, 11828. https://doi.org/10.1016/j.envres.2021.111828
JOURNAL
Environmental Research
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Roles of the physical environment in health-related quality of life in patients with chronic obstructive pulmonary disease
ARTICLE PUBLICATION DATE
7-Aug-2021
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