The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own Over the last few decades, the evidence on the adverse programme geared to the particular health conditions of the countries it serves. effects on health of air pollution has been mounting. A broad range of adverse health outcomes due to short- Member States and long-term exposure to air pollutants, at levels Albania Andorra usually experienced by urban populations throughout Armenia the world, are established. Austria H Azerbaijan EALTH HEALTH IMPACT OF Belarus This report estimates the health impact of PM10 and Belgium Bosnia and Herzegovina ozone on urban populations of 13 large Italian cities. To Bulgaria do so, concentration–response risk coefficients were I Croatia MPACT PM10 AND OZONE Cyprus derived from epidemiological studies, and 25 adverse Czech Republic health outcomes and different exposure scenarios were Denmark Estonia considered. Average PM levels for the years 10 OF IN 13 ITALIAN CITIES Finland 2002–2004 ranged from 26.3 µg/m3 to 61.1 µg/m3. The France PM Georgia health impact of air pollution in Italian cities is large: Germany Greece 8220 deaths a year, on average, are attributable to PM10 10 Hungary 3 concentrations above 20 µg/m . This is 9% of the Iceland AND Ireland mortality for all causes (excluding accidents) in the Israel population over 30 years of age; the impact on short O Italy 3 Kazakhstan term mortality, again for PM10 above 20 µg/m , is 1372 ZONE Kyrgyzstan deaths, which is 1.5% of the total mortality in the whole Latvia Lithuania population. Hospital admissions attributable to PM10 are Luxembourg IN Malta of a similar magnitude. Also, the impact of ozone at 13 I Monaco concentrations higher than 70 µg/m3 amounts to 0.6% BY Netherlands of all causes of mortality. Higher figures were obtained Norway TALIAN Poland for the effects on heath that result in morbidity. Portugal Republic of Moldova Marco Martuzzi Romania The magnitude of the health impact estimated for the 13 C Russian Federation San Marino Italian cities underscores the need for urgent action to ITIES Francesco Mitis Serbia and Montenegro reduce the health burden of air pollution. Compliance Slovakia Slovenia with European Union legislation can result in substantial Ivano Iavarone Spain savings, in terms of ill health avoided. Also, local Sweden Maria Serinelli Switzerland authorities, through policies that aim mainly to reduce Tajikistan The former Yugoslav emissions from urban transport and energy production, Republic of Macedonia can achieve sizeable health gains. Turkey Turkmenistan Ukraine United Kingdom World Health Organization Uzbekistan Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark ISBN 92 890 2293 0 Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. WHOLIS number E88700 E-mail: [email protected] Web site: www.euro.who.int HEALTH IMPACT OF PM10 AND OZONE IN 13 ITALIAN CITIES By MARCO MARTUZZI Special Programme on Health and Environment WHO Regional Office for Europe FRANCESCO MITIS Special Programme on Health and Environment WHO Regional Office for Europe IVANO IAVARONE Italian National Institute of Health Department of Environment and Primary Prevention Environmental Epidemiology Unit MARIA SERINELLI Lecce University Abstract Over the last few decades, the evidence on the adverse effects on health of air pollution has been mounting. A broad range of adverse health outcomes due to short- and long-term exposure to air pollutants, at levels usually experienced by urban populations throughout the world, are established. This report estimates the health impact of PM10 and ozone on urban populations of 13 large Italian cities. To do so, concentration-response risk coefficients were derived from epidemiological studies, and 25 adverse health outcomes and different exposure scenarios were considered. Average PM10 levels for the years 2002–2004 ranged from 26.3 μg/m3 to 61.1 μg/m3. The health impact of air pollution in Italian cities is large: 8220 deaths a year, on average, are attributable to PM10 concentrations above 20 μg/m3. This is 9% of the mortality for all causes (excluding accidents) in the population over 30 years of age; the impact on short-term mortality, again for PM10 above 20 μg/m3, is 1372 deaths, which is 1.5% of the total mortality in the whole population. Hospital admissions attributable to PM10 are of a similar magnitude. Also, the impact of ozone at concentrations higher than 70 μg/m3 amounts to 0.6% of all causes of mortality. Higher figures were obtained for the effects on heath that result in morbidity. The magnitude of the health impact estimated for the 13 Italian cities underscores the need for urgent action to reduce the health burden of air pollution. Compliance with European Union legislation can result in substantial savings, in terms of ill health avoided. Also, local authorities, through policies that aim mainly to reduce emissions from urban transport and energy production, can achieve sizeable health gains. Keywords ENVIRONMENTAL EXPOSURE; ENVIRONMENTAL MONITORING; AIR POLLUTANTS – adverse effects; OZONE – adverse effects; RISK ASSESSMENT; HEALTH STATUS INDICATORS; URBAN HEALTH; ITALY. 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Contents Contents Executive Summary................................................................................................................................. v Steering Committee ................................................................................................................................ ix Acknowledgements ................................................................................................................................. ix Abbreviations........................................................................................................................................... x Chapter 1. Introduction ................................................................................................................ 1 Chapter 2. Materials and methods................................................................................................ 5 2.1 Study population and data ................................................................................................. 5 2.2 Health data........................................................................................................................... 6 2.3 Environmental data............................................................................................................. 8 2.4 PM10...................................................................................................................................... 9 2.5 Ozone.................................................................................................................................. 11 2.6 Monitoring stations ........................................................................................................... 13 2.7 Choice of counterfactual concentrations......................................................................... 20 2.8 Concentration–response functions................................................................................... 21 2.9 PM10: health end-points – mortality ................................................................................ 22 2.10 PM10: health end-points – morbidity ............................................................................... 32 2.11 Ozone: health end-points – mortality .............................................................................