Health impact assessment of a reduction in ambient PM(2.5) levels in Spain.
BACKGROUND
Health effects linked to exposure to high air pollutant levels have been described in depth, and many recent epidemiologic studies have also consistently reported positive associations between exposure to air pollutants at low concentrations (particularly PM(2.5)) and adverse health outcomes.


OBJECTIVE
To estimate the number of avoidable deaths associated with reducing PM(2.5) levels in Spain.


METHODS
For exposure assessment, we used the US Environmental Protection Agency's Community Multiscale Air Quality model to simulate air pollution levels with a spatial resolution of 18×18 km(2). Two different scenarios were compared, namely, a baseline 2004 scenario based on Spain's National Emissions Inventory and a projected 2011 scenario in which a reduction in PM(2.5) was estimated on the basis of the benefits that might be attained if specific air quality policies were implemented. Using an 18×18 km(2) grid, air pollution data were estimated for the entire Iberian Peninsula, the Balearic Islands, Ceuta and Melilla. For these strata, crude all-cause mortality rates (ICD-10: A00-Y98) were then calculated for the over-30 and 25-74 age groups, taking into account the 2004 population figures corresponding to these same age groups, selected in accordance with the concentration-response functions (Pope CA 3rd, Burnett RT, Thun MJ, Calle EE, Krewski D, Ito K et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002; 287:1132-41; Laden F, Schwartz J, Speizer FE, Dockery DW. Reduction in fine particulate air pollution and mortality: extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med 2006; 173:667-72.). Health impacts were assessed using the Environmental Benefits Mapping and Analysis Program (BenMAP).


RESULTS
Air quality improvement was defined as an average annual reduction of 0.7 μg/m(3) in PM(2.5) levels. Using long-term health impact assessment analysis, we estimated that 1720 (673-2760) all-cause deaths (6 per 100,000 population) in the over-30 age group and 1450 (780-2108) all-cause deaths (5 per 100,000 population) in the 25-74 age group could be prevented annually.


CONCLUSIONS
The results showed the potential benefits in general mortality which could be expected if pollution control policies were successfully implemented by 2011. A specifically adapted BenMAP could be used as a tool for estimating health impacts associated with changes in air pollution in Spain.
Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain. eiboldo@isciii.es
Elena
E
Boldo
Cristina
C
Linares
Julio
J
Lumbreras
Rafael
R
Borge
Adolfo
A
Narros
Javier
J
García-Pérez
Pablo
P
Fernández-Navarro
Beatriz
B
Pérez-Gómez
Nuria
N
Aragonés
Rebeca
R
Ramis
Marina
M
Pollán
Teresa
T
Moreno
Angeliki
A
Karanasiou
Gonzalo
G
López-Abente
D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000032:analysis*; D000397:Air Pollution / Q000009:adverse effects / Q000517:prevention & control / Q000706:statistics & numerical data*; D003247:Conservation of Natural Resources; D005260:Female; D040362:Geographic Information Systems; D006304:Health Status; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis* / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis*; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D018570:Risk Assessment; D013030:Spain
D000393:Air Pollutants; D052638:Particulate Matter