Premature mortality due to air pollution in European cities: a health impact assessment
Premature mortality due to air pollution in European cities: a health impact assessment
复制标题
DOI：
10.1016/s2542-5196(20)30272-2
复制
发表时间：
2021-03-10
影响因子：
25.7
通讯作者：
Nieuwenhuijsen, Mark
中科院分区：
文献类型：
--
作者：
Khomenko, Sasha;Cirach, Marta;Nieuwenhuijsen, Mark
背景环境空气污染是世界范围内发病率和死亡率的主要环境原因。城市通常是空气污染和疾病的热点。然而，城市一级空气污染对健康影响的确切程度在很大程度上仍然未知。我们的目的是估计每年可预防的死亡人数的比例，由于空气污染在欧洲近1000个城市。方法我们做了一个定量的健康影响评估，2015年估计的影响，空气污染暴露（PM2 · 5和NO2）的成年居民（年龄>= 20岁）在欧洲969个城市和47个大城市的自然原因死亡率。我们从Urban Audit 2018数据集中检索了城市和大城市，并基于全球人类住区层居住人口对2015年数据进行了250米网格单元水平的分析。我们估计了如果世界卫生组织推荐的值（即PM2 · 5为10 μ g/m3，NO2为40 μ g/m3），如果空气污染浓度降至2015年欧洲城市测量的最低值，（即PM2 · 5为3 · 7 µ g/m3，NO2为3 · 5 µ g/m3）。我们根据与空气污染暴露相关的人口和年龄标准化死亡率负担对这些城市进行了聚类和排名。此外，我们做了几个不确定性和敏感性分析，以测试我们的estimation.Findings的鲁棒性符合世界卫生组织的空气污染指南可以防止51 213（95%CI 34 036 - 68 682）死亡，每年PM2 · 5暴露和900（0 - 2476）每年的NO2暴露死亡。将空气污染减少到最低测量浓度可以防止每年124 729（83 332 - 166 535）例PM2 · 5暴露死亡和每年79 435（0 - 215 165）例NO2暴露死亡。各城市可预防的死亡负担差异很大，PM2 · 5的死亡人数为每10万人口0至202人，NO2的死亡人数为每10万人口0至73人（考虑最低测量浓度）。据估计，波河流域（北方意大利）、波兰和捷克共和国的城市PM2 · 5死亡率负担最高。据估计，西欧和南欧的大城市和首都城市的NO2死亡率负担最高。敏感性分析表明，结果是特别敏感的暴露反应函数的选择，但不那么选择的基线死亡率值和暴露assessment methods.Interpretation一个相当大的比例在欧洲城市的过早死亡，可以避免每年通过降低空气污染浓度，特别是低于世界卫生组织的指导方针。欧洲城市之间的死亡率负担差异很大，表明哪些城市更迫切需要采取政策行动，以减少空气污染，实现可持续，宜居和健康的社区。应修订现行准则，进一步降低空气污染浓度，以更好地保护城市健康。
SummaryBackground Ambient air pollution is a major environmental cause of morbidity and mortality worldwide. Cities are generally hotspots for air pollution and disease. However, the exact extent of the health effects of air pollution at the city level is still largely unknown. We aimed to estimate the proportion of annual preventable deaths due to air pollution in almost 1000 cities in Europe.Methods We did a quantitative health impact assessment for the year 2015 to estimate the effect of air pollution exposure (PM2 & middot;5 and NO2) on natural-cause mortality for adult residents (aged >= 20 years) in 969 cities and 47 greater cities in Europe. We retrieved the cities and greater cities from the Urban Audit 2018 dataset and did the analysis at a 250 m grid cell level for 2015 data based on the global human settlement layer residential population. We estimated the annual premature mortality burden preventable if the WHO recommended values (ie, 10 & micro;g/m3 for PM2 & middot;5 and 40 & micro;g/m3 for NO2) were achieved and if air pollution concentrations were reduced to the lowest values measured in 2015 in European cities (ie, 3 & middot;7 & micro;g/m3 for PM2 & middot;5 and 3 & middot;5 & micro;g/m3 for NO2). We clustered and ranked the cities on the basis of population and age-standardised mortality burden associated with air pollution exposure. In addition, we did several uncertainty and sensitivity analyses to test the robustness of our estimates.Findings Compliance with WHO air pollution guidelines could prevent 51 213 (95% CI 34 036-68 682) deaths per year for PM2 & middot;5 exposure and 900 (0-2476) deaths per year for NO2 exposure. The reduction of air pollution to the lowest measured concentrations could prevent 124 729 (83 332-166 535) deaths per year for PM2 & middot;5 exposure and 79 435 (0-215 165) deaths per year for NO2 exposure. A great variability in the preventable mortality burden was observed by city, ranging from 0 to 202 deaths per 100 000 population for PM2 & middot;5 and from 0 to 73 deaths for NO2 per 100 000 population when the lowest measured concentrations were considered. The highest PM2 & middot;5 mortality burden was estimated for cities in the Po Valley (northern Italy), Poland, and Czech Republic. The highest NO2 mortality burden was estimated for large cities and capital cities in western and southern Europe. Sensitivity analyses showed that the results were particularly sensitive to the choice of the exposure response function, but less so to the choice of baseline mortality values and exposure assessment method.Interpretation A considerable proportion of premature deaths in European cities could be avoided annually by lowering air pollution concentrations, particularly below WHO guidelines. The mortality burden varied considerably between European cities, indicating where policy actions are more urgently needed to reduce air pollution and achieve sustainable, liveable, and healthy communities. Current guidelines should be revised and air pollution concentrations should be reduced further to achieve greater protection of health in cities.