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Reducing ambient levels of fine particulates could substantially improve health: a mortality impact assessment for 26 European cities

¹ Valencian School of Health Studies (EVES), Valencia, Spain
² CIBER Epidemiology and Public Health (CIBERESP), Spain
³ Institute for Public Health Surveillance, Saint Maurice, France
⁴ Carlos III National Institute of Health, Madrid, Spain
⁵ Dublin Institute of Technology, Dublin, Ireland
⁶ Medical University of Vienna, Austria
⁷ Centre of Research in Environmental Epidemiology CREAL and ICREA, Barcelona, Spain

Correspondence to:
Ferran Ballester, Epidemiology and Statistics Unit, Escola Valenciana d’Estudis en Salut-EVES (Valencian School of Health Studies), c/Joan de Garay 21, 46017 Valencia, Spain; ballester_fer{at}gva.es

Recently new European policies on ambient air quality—namely, the adoption of new standards for fine particulate matter (PM_2.5), have generated a broad debate about choosing the air quality standards that can best protect public health. The Apheis network estimated the number of potential premature deaths from all causes that could be prevented by reducing PM_2.5 annual levels to 25 µg/m³, 20 µg/m³, 15 µg/m³ and 10 µg/m³ in 26 European cities. The various PM_2.5 concentrations were chosen as different reductions based on the limit values proposed by the new European Directive, the European Parliament, the US Environmental Protection Agency and the World Health Organization, respectively. The Apheis network provided the health and exposure data used in this study. The concentration-response function (CRF) was derived from the paper by Pope et al (2002). If no direct PM_2.5 measurements were available, then the PM₁₀ measurements were converted to PM_2.5 using a local or an assumed European conversion factor. We performed a sensitivity analysis using assumptions for two key factors—namely, CRF and the conversion factor for PM_2.5. Specifically, using the "at least" approach, in the 26 Apheis cities with more than 40 million inhabitants, reducing annual mean levels of PM_2.5 to 15 µg/m³ could lead to a reduction in the total burden of mortality among people aged 30 years and over that would be four times greater than the reduction in mortality that could be achieved by reducing PM_2.5 levels to 25 µg/m³ (1.6% vs 0.4% reduction) and two times greater than a reduction to 20 µg/m³. The percentage reduction could grow by more than seven times if PM_2.5 levels were reduced to 10 µg/m³ (3.0% vs 0.4%). This study shows that more stringent standards need to be adopted in Europe to protect public health, as proposed by the scientific community and the World Health Organization.