Tim Nawrot Antwerpen 21 oktober Veilig ademen? Tim Nawrot Antwerpen 21 oktober Universiteit Hasselt Centrum voor Milieukunde School voor levenswetenschappen email: tim.nawrot@uhasselt.be KULeuven Arbeids- en Milieugeneeskunde Eenheid voor longtoxicologie email: tim.nawrot@med.kuleuven.be

Inhoud Geschiedenis Lange en korte termijneffecten Invloed van afstand tot wegverkeer

De Standaard 7-12-1930 oorzaak in den Zuider-wind, die van uit verre streken vreemde microben mede-bracht, die dan in den mist van onze nij-verheidscentra zouden voortwoekeren. Men had reeds de meening geopperd dat het wel giftige oorlogsgassen konden zijn die zich met den mist hadden vermengd.

NEW YORK TIMES Spanish flu? Microbes from the Sahara? 5 Dec 1930 6 Dec 1930 8 Dec 1930 Spanish flu? Microbes from the Sahara? Chemical warfare?

Le Soir Illustré, 13 Dec 1930, N° 147

Rapport Firket

Besluit rapport Firket “Si les mêmes conditions se trouvent réunies, les mêmes accidents se reproduiront” “Si un désastre survenait à Londres dans des conditions analogues on aurait à déplorer 3.179 morts immédiates” Onder dezelfde voorwaarden zijn dezelfde gevolgen te verwachten. Een soortgelijke catastrofe zou in Londen leiden tot 3.179 onmiddellijke doden Nemery, et al. Lancet 2001

London Fog, 5-9 december 1952 Wilkins E.T. Journal of the Royal Sanitary Institute, 1954, 74, 1-21

PM2.5 gradient in Europe* *2002, mean annual PM2.5 gradient From: Clean Air for Europe (CAFE), 6th Environmental action programme of the EU, http://ec.europa.eu/environment/air/cafe/index.htm

Air pollution chronic vs acute effects Event Severity Age

Acute effecten

Daily mortality according to temperature specific* PM10 quartiles *temperature categories based on quintiles. Non-traumatic deaths (n = 354 357) Nawrot, Torfs, Fierens et al. J Epidemiol Comm Health 2007, 61, 146-9

Welke leeftijd? Age classes Mean age Mean daily mortality* +10 µg/m3 (95% CI) p <55 43 10 0.49 (-0.61 to 1.5%) 0.39 55-65 61 12 1.53 (0.57 to 2.46%) 0.0017 >65 81 116 1.29 (0.84 to 1.74) <0.0001 *Mortality (ICD<800) data Flanders (1997-2003) during the warmer period of the year (April to September). Nawrot, Torfs, Fierens et al. J Epidemiol Comm Health 2007, 61, 146-9

Platelet function analyzer (PFA-100) Bloodvessel PFA cartridge Agonist Platelets Collagen Capillar www.milieu-en-gezondheid.be

Plaatjesfunctie bij personen met diabetes PM2.5 increase of 20 µg/m³: -16.3 seconds closure time Effect of medication*: +30.4 seconds closure time *acetylsalicylic acid, clopidogrel, ticlopidine or dipyridamole www.milieu-en-gezondheid.be

Chronische effecten

Voorbeeld van chronische blootstelling op sterfte: is er een drempel? ACS; 1982-98; 500,000 pers. Gemiddeld relatief risico per 10 µg/m3 PM2.5 Alle doodsoorzaken: 1.06 (1.02-1.11) cardiopulmonaire: 1.09 (1.03-1.16) longkanker: 1.14 (1.04-1.23) Alle andere oorzaken: 1.01 (0.95-1.06) Rekening houdend voor geslacht, leeftijd, ras, rookgewoonten, opleiding, BMI, alcohol gebruik, beroep, voedingsgewoonten,… RR voor roken 2.58, 2.89, 14.80 Pope et al. Lung cancer, cardio-pulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002, 287, 1132-41

Atherosclerosis en PM Maakt gebruik van gegevens van twee klinische studies over de preventie van atherosclerose Kaart met PM2.5 concentraties en woonplaats van deelnemers Blootstelling geassocieerd met IMT in a. carotis. Kunzli et al. Environ Health Perspect. 2005;113:201-6.

Atherosclerosis en PM Kunzli et al. Environ Health Perspect. 2005;113:201-6.

Representative Photomicrographs Oil Red-O Staining of Aortic Arch Sections Copyright restrictions may apply. Sun, Q. et al. JAMA 2005;294:3003-3010.

http://europa.eu.int/comm/environment/air/cafe/activities/pdf/cafe_scenario_report_6.pdf

Verkeer en gezondheid

Koolstoflading in longmacrofagen en afstand tot weg p=0.002

Koolstoflading in longmacrofagen en longfunctie bij kinderen Kulkarni et al. N Engl J Med. 2006

Traffic-related pollution and children Gauderman et al. Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet 2007, 369, 571-7 Prospective cohort study (CHS), southern California: 3677 children (10 y) from 12 communities (start 1993 or 1996) 8 y follow-up: yearly questionnaire & spirometry Exposure: model-based estimates of traffic-related pollution + proximity to nearest freeway (motorway) or major road Adjustments for socioeconomic status (low, middle, high), gas stoves, pets, ETS Residence within 500 m of motorway (vs > 1,500 m) : FEV1 -81 mL [-143 – -18] = 97% [94.6-99.4]

Gauderman et al. Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet 2007, 369, 571-7

Traffic-related pollution and children Morgenstern et al. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. AJRCCM 2008, 177, 1331-7 Prospective birth cohort studies, Munich, Germany: 2,860 children (4y) + 3,061 children (6y) Exposure assessment: PM2.5 & NO2 at 40 measurements sites + GIS-based modeling of pollution at residence (birth, 2 or 3 y, 6y) + distance of residence to major roads Adjustments for sex, age, parental atopy, maternal education, siblings, ETS, gas cooking, home dampness, molds, dogs & cats Adjusted OR for “doctor-diagnosed asthmatic bronchitis”: < 50 m to nearest main road: 1.66 [1.01-2.59] (vs > 50 m)

● < 50 m from nearest main road Morgenstern et al. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. AJRCCM 2008, 177, 1331-7 asthma hay fever eczema Doctor-diagnosed Reported symptoms Odds ratio (adjusted) ● < 50 m from nearest main road ▲ 50-250 m ■ 250-1000 m ♦ > 1000 m

PM10 and mortality (long term) Hoek et al. Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet 2002, 360, 1203-9 NCLS: 1986-94; n = 4,492 (55-69 y); 489 † estimation of long-term pollution (BS & NO2): regional + urban background + local exposed to traffic = home (GIS) : < 100 m of freeway (n=132) < 50 m of major urban road (n=77) adj.RR of cardiopulmonary death background BS (/10 µg/m3 ): 1.34 (0.68-2.64) living near major road: 1.95 (1.09-3.51) adjusted for age, sex, education, BMI, occupation, active & passive smoking, neighbourhood SES Risk estimates much lower in full cohort. Beelen et al. Environ Health Persp 2008, 116, 196-202

PM10 and mortality (long term) Finkelstein et al. Traffic air pollution and mortality rate advancement periods. Am J Epidemiol 2004, 160, 173-7 Hamilton, Ontario: 1992-2001: mortality follow-up: n = 5,228 (>40 y); 923 nonaccidental † Postal codes & GIS: household income exposure to traffic: < 100 m of highway or < 50 m of major urban road RR of mortality for living close to major road: 1.18 (1.02-1.38) Rate advanced period: Residence near major road: 2.5 y (0.2-4.8) COPD 3.4 y; Chronic Ischemic Heart Disease: 3.1 y; diabetes: 4.4 y

Pollution (long term) and CV morbidity Hoffman et al. Residential exposure to traffic is associated with coronary atherosclerosis. Circulation 2007, 116, 489-96 Prospective cohort study, Germany: 2000 - : 4494 persons, 45-74 y Coronary artery calcification (CAC) by electron-beam CT Exposure: distance of residence to major roads OR for high CAC (> 75th percentile): > 200 m from major road : 1 (reference) 101-200 m : 1.08 51-100 m : 1.34 < 50 m : 1.63

Conclusies Vlaanderen heeft de hoogste PM2.5 belasting van Europa. De luchtkwaliteit anno 2008 is een relevante factor die de volksgezondheid beïnvloedt. Niet enkel respiratoire gezondheid maar ook cardiovasculaire aandoeningen.

Tim.nawrot@uhasselt.be Tim.nawrot@med.kuleuven.be