The Air quality in Europe – 2016 report

EEA Air quality in Europe 2016 report

Health impacts of exposure to fine particulate matter, nitrogen dioxide and ozone

The health impacts of air pollution can be quantified  and expressed as premature mortality and morbidity.  Mortality reflects reduction in life expectancy owing to  premature death as a result of air pollution exposure,  whereas morbidity relates to occurrence of illness and  years lived with a disease or disability, ranging from  subclinical effects to chronic conditions that may require  hospitalisation. Even less severe effects might have  strong public health implications, because air pollution  affects the whole population on a daily basis, especially  in major cities where concentrations tend to be higher  than in rural areas (with the exception of ozone). Most  of the evidence on the health impacts of pollution tends  to focus on premature mortality, as well as respiratory,  cardiovascular and cerebrovascular effects attributed  to exposure to air pollution (WHO, 2008, 2013b), but  evidence also exists of a range of other effects.  The health impacts from air pollution can be  estimated using different health outcomes (Box 10.1).  The health impacts estimated for this report are  those attributable to exposure to PM2.5, NO2 and O3  in Europe for 2013 (41).

This assessment required  information on air pollution, demographic data  and the relationship between exposure to ambient  pollutant concentrations and a health outcome. The  maps of air pollutant concentrations (annual mean  concentration for PM2.5 and NO2, and SOMO35 for  O3; ETC/ACM, 2016b) are based on the Air Quality  e-Reporting Database (EEA, 2016a) monitoring data  measured at regional and urban background stations  in 2013, auxiliary information, such as meteorological  data, and concentrations modelled with the EMEP  chemical dispersion model. The demographic data  and the health-related data were taken from the  United Nations (UN, 2015) and the WHO (2016),  respectively. The exposure–response relation and the  population at risk have been selected in accordance  with the recommendation given by the Health Risks  of Air Pollution in Europe (HRAPIE) project (WHO,  2013b). For PM2.5, impacts have been estimated for  the full range of observed concentrations, meaning  all PM2.5 is considered, even that of natural origin; for  NO2, impacts have been estimated for levels above  20 μg/m3 (42). A further description and details on the  methodology are given by the ETC/ACM (2016c).

The results of the health impact assessment are  presented in Tables 10.1 and 10.2 for 41 European  countries, for the 41 counties as a whole (‘Total’)  and for the EU‑28. Table 10.1 presents, for each  pollutant, the population-weighted concentration  and the estimated number of premature deaths,  in addition to the population for each country for comparison between countries. In the 41 countries  listed, 467 000 premature deaths are attributed  to PM2.5 exposure, 71 000 to NO2 exposure and  17 000 to O3 exposure. In the EU‑28, the premature  deaths attributed to PM2.5, NO2 and O3 exposure are  436 000, 68 000 and 16 000, respectively (43).  Table 10.2 presents the estimated number of years of  life lost (YLL) and the YLL per 100 000 inhabitants due  to exposure to PM2.5, NO2 and O3 in Europe for 2013.  In total, in the 41 countries assessed, 4 982 000 YLL  are attributed to PM2.5 exposure, 756 000 YLL to NO2  exposure and 192 000 YLL to O3 exposure.

In the EU‑28,  the YLL attributed to PM2.5, NO2 and O3 exposure are  4 668 000, 723 000 and 179 000, respectively (44).  For PM2.5, the highest numbers of YLL are estimated  for the countries with the largest populations  (Germany, Italy, France and the United Kingdom).  However, in relative terms, when considering YLL per  100 000 inhabitants, the largest impacts are observed  in the central and eastern European countries  where the highest concentrations are also observed,  i.e. Kosovo under the UN SCR 1244/99, Bulgaria, the  former Yugoslav Republic of Macedonia, Poland,  Serbia, Hungary, Romania, Greece, the Czech Republic  and Slovakia.

The largest health impacts attributable to NO2 exposure  are seen in Italy, the United Kingdom, Germany and  France. When considering YLL per 100 000 inhabitants,  the highest rates are found in Italy, Belgium, the United  Kingdom and Serbia.  Regarding O3, the countries with the largest impacts  are Italy, Germany, France, Spain and Poland; and  the countries with the highest rates of YLL per  100 000 inhabitants are Greece, Italy, most of the  countries in the Western Balkans and Hungary.  The impacts estimated for each pollutant may not  be added to determine the total impact attributable  to exposure to these three pollutants, because  concentrations are (sometimes strongly) correlated.  This may lead to a double counting of up to 30 % of the  effects of PM2.5 and NO2 (WHO, 2013b). This possible  double counting has not been corrected for.  Variations from one year to another are proportional,  in the case of PM2.5, to the changes in population  and weighted-population concentrations. This is  not the case for NO2, for which only concentrations  above 20 μg/m3 are considered. In this case, the most  determining factor is the percentage of the population  exposed to levels above 20 μg/m3.