title: Air quality modeling and mortality impact of fine particles reduction policies in Spain.
abstract: BACKGROUND
  In recent years, Spain has implemented a number of air quality control measures that are expected to lead to a future reduction in fine particle concentrations and an ensuing positive impact on public health.
  
  
  OBJECTIVE
  We aimed to assess the impact on mortality attributable to a reduction in fine particle levels in Spain in 2014 in relation to the estimated level for 2007.
  
  
  METHODS
  To estimate exposure, we constructed fine particle distribution models for Spain for 2007 (reference scenario) and 2014 (projected scenario) with a spatial resolution of 16×16km(2). In a second step, we used the concentration-response functions proposed by cohort studies carried out in Europe (European Study of Cohorts for Air Pollution Effects and Rome longitudinal cohort) and North America (American Cancer Society cohort, Harvard Six Cities study and Canadian national cohort) to calculate the number of attributable annual deaths corresponding to all causes, all non-accidental causes, ischemic heart disease and lung cancer among persons aged over 25 years (2005-2007 mortality rate data). We examined the effect of the Spanish demographic shift in our analysis using 2007 and 2012 population figures.
  
  
  RESULTS
  Our model suggested that there would be a mean overall reduction in fine particle levels of 1µg/m(3) by 2014. Taking into account 2007 population data, between 8 and 15 all-cause deaths per 100,000 population could be postponed annually by the expected reduction in fine particle levels. For specific subgroups, estimates varied from 10 to 30 deaths for all non-accidental causes, from 1 to 5 for lung cancer, and from 2 to 6 for ischemic heart disease. The expected burden of preventable mortality would be even higher in the future due to the Spanish population growth. Taking into account the population older than 30 years in 2012, the absolute mortality impact estimate would increase approximately by 18%.
  
  
  CONCLUSIONS
  Effective implementation of air quality measures in Spain, in a scenario with a short-term projection, would amount to an appreciable decline in fine particle concentrations, and this, in turn, would lead to notable health-related benefits. Recent European cohort studies strengthen the evidence of an association between long-term exposure to fine particles and health effects, and could enhance the health impact quantification in Europe. Air quality models can contribute to improved assessment of air pollution health impact estimates, particularly in study areas without air pollution monitoring data.
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: eiboldo@isciii.es.
authors.forename: Elena
authors.initials: E
authors.lastname: Boldo
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: clinares@isciii.es.
authors.forename: Cristina
authors.initials: C
authors.lastname: Linares
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: naragones@isciii.es.
authors.forename: Nuria
authors.initials: N
authors.lastname: Aragonés
authors.affiliation: Department of Chemical & Environmental Engineering, Technical University of Madrid (UPM). José Gutiérrez Abascal, 2, 28006 Madrid, Spain. Electronic address: julio.lumbreras@upm.es.
authors.forename: Julio
authors.initials: J
authors.lastname: Lumbreras
authors.affiliation: Department of Chemical & Environmental Engineering, Technical University of Madrid (UPM). José Gutiérrez Abascal, 2, 28006 Madrid, Spain. Electronic address: rborge@etsii.upm.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Borge
authors.affiliation: Department of Chemical & Environmental Engineering, Technical University of Madrid (UPM). José Gutiérrez Abascal, 2, 28006 Madrid, Spain. Electronic address: dpaz@etsii.upm.es.
authors.forename: David
authors.initials: D
authors.lastname: de la Paz
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: bperez@isciii.es.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Gómez
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: pfernandezn@isciii.es.
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernández-Navarro
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: jgarcia@isciii.es.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Pérez
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: mpollan@isciii.es.
authors.forename: Marina
authors.initials: M
authors.lastname: Pollán
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: rramis@isciii.es.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramis
authors.affiliation: Institute of Environmental Assessment and Water Research (IDAEA-CSIC). C/Jordi Girona, 18-26, 08034 Barcelona, Spain. Electronic address: teresa.moreno@idaea.csic.es.
authors.forename: Teresa
authors.initials: T
authors.lastname: Moreno
authors.affiliation: Institute of Environmental Assessment and Water Research (IDAEA-CSIC). C/Jordi Girona, 18-26, 08034 Barcelona, Spain. Electronic address: angeliki.karanasiou@idaea.csic.es.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Karanasiou
authors.affiliation: Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: glabente@isciii.es.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: López-Abente
mesh_terms: D000397:Air Pollution / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D017202:Myocardial Ischemia / Q000401:mortality*; D052638:Particulate Matter / Q000009:adverse effects*; D013030:Spain / Q000453:epidemiology
chemical_list: D052638:Particulate Matter
keywords: Air quality models; Air quality policies; Fine particles; Ischemic cardiac events; Lung cancer