The mortality impacts of fine particles in France

doi:10.1016/j.scitotenv.2016.06.213

Science of The Total Environment

Volume 571, 15 November 2016, Pages 416-425

https://doi.org/10.1016/j.scitotenv.2016.06.213 Get rights and content

Highlights

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A fine-scale air quality model was used to assess the mortality impact of PM_2.5 in France.
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Anthropogenic PM_2.5 are responsible for 9% of the total mortality in France.
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Results are consistent with previous assessments while using different methods and datasets.
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Further actions to improve air quality in France would substantially improve health.

Abstract

Introduction

Worldwide, air pollution has become a main environmental cause of premature mortality. This burden is largely due to fine particles. Recent cohort studies have confirmed the health risks associated with chronic exposure to PM_2.5 for European and French populations. We assessed the mortality impact of PM_2.5 in continental France using these new results.

Methods

Based on a meta-analysis of French and European cohorts, we computed a shrunken estimate of PM_2.5–mortality relationship for the French population (RR 1.15 [1.05:1.25] for a 10 μg/m³ increase in PM_2.5). This RR was applied to PM_2.5 annual concentrations estimated at a fine spatial scale, using a classical health impacts assessment method. The health benefits associated with alternative scenarios of improving air quality were computed for 36,219 French municipalities for 2007–2008.

Results

9% of the total mortality in continental France is attributable to anthropogenic PM_2.5. This represents > 48,000 deaths per year, and 950,000 years of life lost per year, more than half occurring in urban areas larger than 100,000 inhabitants. If none of the municipalities exceeded the World Health Organization guideline value for PM_2.5 (10 μg/m³), the total mortality could be decreased by 3%, corresponding to 400,000 years of life saved per year.

Conclusion

Results were consistent with previous estimates of the long-term mortality impacts of fine particles in France. These findings show that further actions to improve air quality in France would substantially improve health.

Graphical abstract

Introduction

Chronic exposure to urban air pollutants, especially fine particles (PM), favors the development of lung cancer, cardiovascular and respiratory diseases, leading to premature mortality and a significant loss of life expectancy (Beelen et al., 2014, Centre International de recherche contre le cancer, 2013, Hoek et al., 2013, Jerrett et al., 2009, Pope et al., 2002, Pope et al., 2004). Worldwide, air pollution has become a main environmental cause of premature mortality (World Health Organisation, 2014a). In Europe, there is a growing demand from the population and from stakeholders to be informed on the health consequences of chronic exposure to air pollution. Health impact assessments (HIA) have been largely used to answer this demand by quantifying the public health burden of air pollution for a given population at a given time (Medina et al., 2013).

In France, the first nationwide HIA in 1996 estimated that PM₁₀ were causing about 32,000 premature deaths per year (Kunzli et al., 2000). The European program Clean Air for Europe (Cafe) concluded in 2000 that 42,000 premature deaths per year could be attributed to anthropogenic PM_2.5 (Amann et al., 2004). In 2010, the global burden of disease estimated that 16,900 premature deaths could be avoided each year in France if PM_2.5 complied with the World Health Organization (WHO) guideline value of 10 μg/m³ (Institute for Health Metrics and Evaluation, 2014). These examples assessed the total impacts of air pollution over the country, using a combination of observed and modeled PM concentrations, on grids ranging from 10 to 50 km.

In addition, HIA centered on urban areas also provided an insight into the burden of air pollution. For instance, in 2004–2006, about 3000 deaths per year were attributed to levels of PM_2.5 exceeding the WHO guideline value in nine French urban areas participating in the Aphekom project (Pascal et al., 2013).

All these HIAs have used different spatial scales, study periods, environmental data, health data, methods, and scenarios. In particular, most of them applied relative risks (RR) derived from North American cohort studies. For instance, the Aphekom project used the RR estimated by the American Cancer Society Cohort study, an RR equal to 1.06 [1.02:1.11] of total mortality for a 10 μg/m³ increase in PM_2.5 (Pope III et al., 2002).

In the recent years, an increasing number of cohort studies have investigated the mortality impact of long-term exposure to PM_2.5 in the European population (Beelen et al., 2008, Bentayeb et al., 2015, Carey et al., 2013, Cesaroni et al., 2013)). Two of these studies included French participants. The European Study of Cohorts for Air Pollution Effects (Escape) performed a meta-analysis of 22 European cohorts, resulting in a follow-up of 367,251 European citizens over 14 years. Within Escape, the E3N cohort followed 14,313 women from the cities and suburbs of Paris, Grenoble, Lyon, and Marseille. For all the cohorts participating to Escape, exposure to air pollutants was estimated using land use regression models (Eeftens et al., 2012), and annual PM_2.5 concentrations varied from 6 to 31 μg/m³ between the less and the most polluted areas. In the E3N cohort, an RR of 1.24 [0.79 ; 1.94] was associated to a 10 μg/m³ increase in PM_2.5. The meta-analysis of the 22 cohorts included in Escape estimated that total mortality over 30 years old increased by 14% for a 10 μg/m³ increase in PM_2.5 annual mean concentration (RR 1.14 [1.04:1.27] (Beelen et al., 2014)).

The Gazel cohort investigated the mortality impact of long-term exposure to air pollution for 20,327 participants recruited among the employees of the French National Electricity and Gas Company and followed between 1989 and 2013. Cohort participants were geographically distributed throughout the country. Exposure assessment was based on a nationwide air quality model providing annual PM_2.5 concentrations on a grid with a resolution of 2 km over continental France (Gazel-air model) (Bentayeb et al., 2014). The study found an RR of 1.15 [0.98:1.35] for a 10 μg/m³ increase in PM_2.5 (Bentayeb et al., 2015).

We coupled the new RR from the Escape and Gazel cohorts with the fine-scale air quality model Gazel-air to assess the mortality impact of PM_2.5 in France at a fine scale, i.e., the municipality level. This new HIA provides an insight of the nationwide-public health burden of PM_2.5 on total mortality, updates previous estimates, and illustrates regional differences.

Section snippets

Study period and study area

The study period was constrained by the availability of environmental data. The Gazel-air model provided annual concentrations between 1989 and 2008. We used the most recent years, 2007–2008, to assess the impacts of PM_2.5 on total mortality for each municipality in continental France (i.e. excluding Corsica and other smaller islands, as well as the French oversea territories). In France, what we call a municipality (municipalité) is the first level of administrative geographical zoning. For

PM_2.5 impact on mortality and life expectancy

36,219 municipalities hosting 38.7 million inhabitants aged 30 and over (61.6 million inhabitants in total) were included in this HIA. Eighty percent of the municipalities were classified as rural, representing 24% of the population aged 30 and over. Four percent of the municipalities belonged to urban areas hosting > 100.000 inhabitants, representing 30% of the population aged 30 and over (Table 1). Age-standardized mortality rates were lower in the largest urban areas (Table 1).

Fig. 1

Discussion

This HIA assessed the global burden of PM_2.5 in continental France, using a consistent method across the whole country. Compared with previously published estimates, it has the advantage of using a recent RR derived from European and French cohort studies and fine-scale environmental and mortality data. It also achieves a good consistency between the method used to assess exposure in the cohort studies and in the HIA. Results confirmed that PM_2.5 have a large impact on mortality in France,

Acknowledgments

This study was possible thanks to the helpful expertise of the French air quality monitoring networks.

We also thank Gerard Hoek, who shared the relative risks from Escape individual cohorts, and Aaron Cohen and Michael Brauer, who shared the global burden of disease exposure data for France.

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Air pollution keeps affect the human health by triggering many diseases (Leclercq et al., 2016) and acts as the largest environmental risk to health (World Health Organization, 2016). Many papers have been published and found association between air pollution and cardiovascular disease (CVD) (Phung et al., 2016; Rodopoulou et al., 2015; Yorifuji et al., 2014), respiratory disease (Faustini et al., 2013; Rodriguez-Villamizar et al., 2012), bronchitis symptoms (Berhane et al., 2016), mortality (Pascal et al., 2016), and other adverse outcomes. Most of the air pollution papers mentioned above are from west countries rather than Asia even though the excessive concentrations of air pollution are usually monitored in Asia (Jonathan A. Patz, David Engelberg, 2000).
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The mortality impacts of fine particles in France

Highlights

Abstract

Introduction

Methods

Results

Conclusion

Graphical abstract

Introduction

Section snippets

Study period and study area

PM2.5 impact on mortality and life expectancy

Discussion

Acknowledgments

Lancet

Atmos. Environ.

Environ. Int.

Lancet

Sci. Total Environ.

The “Current Legislation” and the “Maximum Technically Feasible Reduction” Cases for the CAFE Baseline Emission Projection. CAFE Scenario Analysis Report Nr.2, 1–41

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Environ. Sci. Technol.

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Am. J. Respir. Crit. Care Med.

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Risk of Nonaccidental and Cardiovascular Mortality in Relation to Long-Term Exposure to Low Concentrations of Fine Particulate Matter: A Canadian National-Level Cohort Study

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PM_2.5 impact on mortality and life expectancy