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Impact of London's Low Emission Zone on Air Quality and Children's Respiratory Health: a Sequential Annual Cross-Sectional Study

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Impact of London's Low Emission Zone on Air Quality and Children's Respiratory Health: a Sequential Annual Cross-Sectional Study King’s Research Portal DOI: 10.1016/S2468-2667(18)30202-0 Document Version Publisher's PDF, also known as Version of record Link to publication record in King's Research Portal Citation for published version (APA): Mudway, I. S., Dundas, I., Wood, H. E., Marlin, N., Jamaludin, J. B., Bremner, S. A., Cross, L., Grieve, A., Nanzer, A., Barratt, B. M., Beevers, S., Dajnak, D., Fuller, G. W., Font, A., Colligan, G., Sheikh, A., Walton, R., Grigg, J., Kelly, F. J., ... Griffiths, C. J. (2019). Impact of London's low emission zone on air quality and children's respiratory health: a sequential annual cross-sectional study. The Lancet Public Health, 4(1), e28-e40. https://doi.org/10.1016/S2468-2667(18)30202-0 Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. 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Oct. 2021 Articles Impact of London’s low emission zone on air quality and children’s respiratory health: a sequential annual cross-sectional study Ian S Mudway,Isobel Dundas, Helen E Wood, Nadine Marlin, Jeenath B Jamaludin, Stephen A Bremner, Louise Cross, Andrew Grieve, Alex Nanzer, Ben M Barratt, Sean Beevers, David Dajnak, Gary W Fuller, Anna Font, Grainne Colligan, Aziz Sheikh, Robert Walton, Jonathan Grigg, Frank J Kelly, Tak H Lee, Chris J Griffiths Summary Background Low emission zones (LEZ) are an increasingly common, but unevaluated, intervention aimed at Lancet Public Health 2019; improving urban air quality and public health. We investigated the impact of London’s LEZ on air quality and 4: e28–40 children’s respiratory health. Published Online November 14, 2018 http://dx.doi.org/10.1016/ Methods We did a sequential annual cross-sectional study of 2164 children aged 8–9 years attending primary schools S2468-2667(18)30202-0 between 2009–10 and 2013–14 in central London, UK, following the introduction of London’s LEZ in February, 2008. See Comment page e4 We examined the association between modelled pollutant exposures of nitrogen oxides (including nitrogen dioxide Medical Research Council [NO2]) and particulate matter with a diameter of less than 2·5 µm (PM2·5) and less than 10 µm (PM10) and lung (MRC)–Public Health England Centre for Environmental function: postbronchodilator forced expiratory volume in 1 s (FEV1, primary outcome), forced vital capacity (FVC), and respiratory or allergic symptoms. We assigned annual exposures by each child’s home and school address, as well Health, National Institute for Health Research Biomedical as spatially resolved estimates for the 3 h (0600–0900 h), 24 h, and 7 days before each child’s assessment, to isolate Research Centre at Guy’s and long-term from short-term effects. St Thomas’ National Health Service Foundation Trust and Findings The percentage of children living at addresses exceeding the EU limit value for annual NO (40 µg/m³) fell King’s College London, London, 2 UK (I S Mudway PhD, from 99% (444/450) in 2009 to 34% (150/441) in 2013. Over this period, we identified a reduction in NO2 at both H E Wood DPhil, roadside (median –1·35 µg/m³ per year; 95% CI –2·09 to –0·61; p=0·0004) and background locations (–0·97; J B Jamaludin PhD, A Grieve MSc, B M Barratt PhD, S Beevers PhD, –1·56 to –0·38; p=0·0013), but not for PM10. The effect on PM2·5 was equivocal. We found no association between postbronchodilator FEV₁ and annual residential pollutant attributions. By contrast, FVC was inversely correlated with D Dajnak PhD, G W Fuller PhD, A Font PhD, F J Kelly PhD); annual NO2 (–0·0023 L/µg per m³; –0·0044 to –0·0002; p=0·033) and PM10 (–0·0090 L/µg per m³; –0·0175 to –0·0005; Asthma UK Centre for Applied p=0·038). Research, Barts Institute of Population Health Sciences, Interpretation Within London’s LEZ, a smaller lung volume in children was associated with higher annual air Queen Mary University of London, London, UK pollutant exposures. We found no evidence of a reduction in the proportion of children with small lungs over this (I Dundas PhD, N Marlin MSc, period, despite small improvements in air quality in highly polluted urban areas during the implementation of S A Bremner PhD, L Cross RSN, London’s LEZ. Interventions that deliver larger reductions in emissions might yield improvements in children’s A Nanzer PhD, G Colligan MRes, health. R Walton MD, J Grigg MD, C J Griffiths DPhil); Institute for Research in Molecular Medicine Funding National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health (INFORMM), Universiti Sains Service (NHS) Foundation Trust and King’s College London, NHS Hackney, Lee Him donation, and Felicity Wilde Malaysia, Health Campus, Charitable Trust. Kelantan, Malaysia (J B Jamaludin); MRC and Asthma UK Centre in Allergic Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 Mechanisms of Asthma, King’s license. College London, London, UK (J Grigg, T H Lee ScD, C J Griffiths); Asthma UK Centre Introduction linked air pollution with adverse effects across the for Applied Research, Centre for Air pollution is a leading cause of global mortality, with lifecourse,6 from increased risk of preterm birth7 Medical Informatics, Usher WHO estimates of 7 million premature deaths partly and incident childhood asthma,8 to premature cardio­ Institute of Population Health 9 Sciences and Informatics, The attributable to air pollution in 2012, which is pulmonary mortality. Although urban air pollution University of Edinburgh, 1 approximately one in eight global deaths. Of these, reflects contributions from a range of local and regional Edinburgh, UK (A Sheikh MD); 3·7 million relate to outdoor air pollution. With sources, studies and reviews have highlighted the and Allergy Centre, HK increasing population growth and urbanisation, air importance of traffic­related air pollutants on a range of Sanatorium and Hospital, Hong Kong Special quality has emerged as an important determinant of health endpoints, with a particular focus on the Administrative Region, China 2–4 public health within cities, with the health burden contribution of diesel emissions to poor air quality in (T H Lee) falling disproportionately on disadvantaged populations Europe.6,10–12 who are less able to choose the environments in which Childhood and adolescence are periods of rapid growth they live.5 Primary studies and systematic reviews have during which organ systems are particularly susceptible www.thelancet.com/public-health Vol 4 January 2019 e28 Articles Correspondence to: Prof Chris Griffiths, Asthma UK Research in context Centre for Applied Research, Centre for Primary Care and Evidence before this study the introduction of the LEZ. Our study covered the tightening Public Health, Blizard Institute, Exposure to traffic pollutants has been associated with adverse of emission controls within the LEZ in 2012, which occurred Queen Mary University of health effects, especially in children, with the ESCAPE alongside national, regional, and local policies to improve air London, London, UK meta-analysis of data for 5921 children showing that poor air quality. We based our study in four inner-city London boroughs, [email protected] quality was associated with reduced lung function in which were identified as non-compliant with EU annual NO₂ preadolescent children (aged 6–8 years). The introduction of limit values at the start of study. Despite the problems low emission zones (LEZ) has been proposed to improve air associated with vehicle non-compliance with European class quality and improve public health. These operate either by emission standards over this period, we have provided evidence restricting vehicle entry into urban areas, or through fixed of improvements in air quality. We also confirmed the penalties on polluting vehicles to encourage uptake of lower previously reported association between pollutant exposures emission technologies. Despite the political and financial costs and reduced children’s lung volume. We observed some of LEZ implementation, studies on the impact of these schemes evidence of a reduction in rhinitis, but not asthma symptoms on air quality and public health remain scarce. We searched or the proportion of children with small lungs over the study MEDLINE for publications from 2009 until Nov 1, 2017, using period. keywords “low emission zone” AND/OR “traffic”, “air quality”, Implications of all available evidence and “health”. These reviews showed LEZs do not consistently Large-scale LEZs can deliver improvements in urban air quality improve air quality, and effects are small.
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