Health impact assessment of air pollution in Valladolid, Spain

BMJ Open 2014;4:e005999 doi:10.1136/bmjopen-2014-005999

• Public health

1. Mario Cárdaba Arranz1, 
2. María Fe Muñoz Moreno2, 
3. Alicia Armentia Medina3,
4. Margarita Alonso Capitán4, 
5. Fernando Carreras Vaquer4, 
6. Ana Almaraz Gómez5

+Author Affiliations

1. ¹Castilla y León Regional Health Service, Valladolid, Spain
2. ²Research Support Unit, University Clinical Hospital, Valladolid, Spain
3. ³Allergy Unit, Rio Hortega University Hospital, Valladolid, Spain
4. ⁴Ministry of Health, Social Services and Equality, Madrid, Spain
5. ⁵Medical Faculty, University of Valladolid, Valladolid, Spain

1. Correspondence toDr Mario Cárdaba Arranz; mario00med@yahoo.es

• Received 1 July 2014
• Revised 3 September 2014
• Accepted 23 September 2014
• Published 17 October 2014

Abstract

Objective To estimate the attributable and targeted avoidable deaths (ADs; TADs) of outdoor air pollution by ambient particulate matter (PM₁₀), PM_2.5 and O₃ according to specific WHO methodology.

Design Health impact assessment.

Setting City of Valladolid, Spain (around 300 000 residents).

Data sources Demographics; mortality; pollutant concentrations collected 1999–2008.

Main outcome measures Attributable fractions; ADs and TADs per year for 1999–2008.

Results Higher TADs estimates (shown here) were obtained when assuming as ‘target’ concentrations WHO Air Quality Guidelines instead of Directive 2008/50/EC. ADs are considered relative to pollutant background levels. All-cause mortality associated to PM₁₀ (all ages): 52 ADs (95% CI 39 to 64); 31 TADs (95% CI 24 to 39).All-cause mortality associated to PM₁₀ (-5 years): 0 ADs (95% CI 0 to 1); 0 TADs (95% CI 0 to 1). All-cause mortality associated to PM_2.5 (>30 years): 326 ADs (95% CI 217 to 422); 231 TADs (95% CI 153 to 301). Cardiopulmonary and lung cancer mortality associated to PM_2.5 (>30 years):

▸ Cardiopulmonary: 186 ADs (95% CI 74 to 280); 94 TADs (95% CI 36 to 148).

▸ Lung cancer : 51 ADs (95% CI 21 to 73); 27 TADs (95% CI 10 to 41).All-cause, respiratory and cardiovascular mortality associated to O₃ (all ages):

▸ All-cause: 52ADs (95% CI 25 to 77) ; 31 TADs (95% CI 15 to 45).

▸ Respiratory: 5ADs (95% CI −2 to 13) ; 3 TADs (95% CI −1 to 8).

▸ Cardiovascular: 30 ADs (95% CI 8 to 51) ; 17 TADs (95% CI 5 to 30).

Negative estimates which should be read as zero were obtained when pollutant concentrations were below counterfactuals or assumed risk coefficients were below one.

Conclusions Our estimates suggest a not negligible negative impact on mortality of outdoor air pollution. The implementation of WHO methodology provides critical information to distinguish an improvement range in air pollution control.

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