title: Health impact assessment of air pollution in Valladolid, Spain.
abstract: OBJECTIVE
  To estimate the attributable and targeted avoidable deaths (ADs; TADs) of outdoor air pollution by ambient particulate matter (PM10), PM2.5 and O3 according to specific WHO methodology.
  
  
  METHODS
  Health impact assessment.
  
  
  METHODS
  City of Valladolid, Spain (around 300 000 residents).
  
  
  METHODS
  Demographics; mortality; pollutant concentrations collected 1999-2008.
  
  
  METHODS
  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 PM2.5 (>30 years): 326 ADs (95% CI 217 to 422); 231 TADs (95% CI 153 to 301). Cardiopulmonary and lung cancer mortality associated to PM2.5 (>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.
authors.affiliation: Castilla y León Regional Health Service, Valladolid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Cárdaba Arranz
authors.affiliation: Research Support Unit, University Clinical Hospital, Valladolid, Spain.
authors.forename: María Fe
authors.initials: MF
authors.lastname: Muñoz Moreno
authors.affiliation: Allergy Unit, Rio Hortega University Hospital, Valladolid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Armentia Medina
authors.affiliation: Ministry of Health, Social Services and Equality, Madrid, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Alonso Capitán
authors.affiliation: Ministry of Health, Social Services and Equality, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Carreras Vaquer
authors.affiliation: Medical Faculty, University of Valladolid, Valladolid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Almaraz Gómez
mesh_terms: D000397:Air Pollution; D004781:Environmental Exposure; D062489:Health Impact Assessment; D006801:Humans; D009026:Mortality; D010126:Ozone; D052638:Particulate Matter; D013030:Spain
chemical_list: D052638:Particulate Matter; D010126:Ozone
keywords: Air pollution; Health impact assessment; Mortality; Ozone; Particulate matter