Policies that stimulate active transportation (walking and bicycling) have been related to heath benefits. This study aims to assess the potential health risks and benefits of promoting active ...transportation for commuting populations (age groups 16-64) in six European cities. We conducted a health impact assessment using two scenarios: increased cycling and increased walking. The primary outcome measure was all-cause mortality related to changes in physical activity level, exposure to fine particulate matter air pollution with a diameter <2.5 μm, as well as traffic fatalities in the cities of Barcelona, Basel, Copenhagen, Paris, Prague, and Warsaw. All scenarios produced health benefits in the six cities. An increase in bicycle trips to 35% of all trips (as in Copenhagen) produced the highest benefits among the different scenarios analysed in Warsaw 113 (76-163) annual deaths avoided, Prague 61 (29-104), Barcelona 37 (24-56), Paris 37 (18-64) and Basel 5 (3-9). An increase in walking trips to 50% of all trips (as in Paris) resulted in 19 (3-42) deaths avoided annually in Warsaw, 11(3-21) in Prague, 6 (4-9) in Basel, 3 (2-6) in Copenhagen and 3 (2-4) in Barcelona. The scenarios would also reduce carbon dioxide emissions in the six cities by 1,139 to 26,423 (metric tonnes per year). Policies to promote active transportation may produce health benefits, but these depend of the existing characteristics of the cities. Increased collaboration between health practitioners, transport specialists and urban planners will help to introduce the health perspective in transport policies and promote active transportation.
The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.
We evaluated the associations of inhalable ...particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM
) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM
) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived.
On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM
concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval CI, 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM
concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations.
Our data show independent associations between short-term exposure to PM
and PM
and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).
Advances in microsensor technologies for air pollution monitoring encourage a growing use of portable sensors. This study aims at testing their performance in the development of exposure surfaces for ...nitrogen dioxide (NO2) and ozone (O3). In Montreal, Canada, a data-collection campaign was conducted across three seasons in 2014 for 76 sites spanning the range of land uses and built environments of the city; each site was visited from 6 to 12 times, for 20 min, using NO2 and O3 sensors manufactured by Aeroqual. Land-use regression models were developed, achieving R 2 values of 0.86 for NO2 and 0.92 for O3 when adjusted for regional meteorology to control for the fact that all of the locations were not monitored at the same time. A total of two exposure surfaces were then developed for NO2 and O3 as averages over spring, summer, and fall. Validation against the fixed-station data and previous campaigns suggests that Aeroqual sensors tend to overestimate the highest NO2 and O3 concentrations, thus increasing the range of values across the city. However, the sensors suggest a good performance with respect to capturing the spatial variability in NO2 and O3 and are very convenient to use, having great potential for capturing temporal variability.
Designing effective public health strategies to prevent adverse health effect of hot weather is crucial in the context of global warming. In Switzerland, the 2003 heat have caused an estimated 7% ...increase in all-cause mortality. As a consequence, the Swiss Federal Office of Public Health developed an information campaign to raise public awareness on heat threats.
For a better understanding on how hot weather affects daily mortality in Switzerland, we assessed the effect of heat on daily mortality in eight Swiss cities and population subgroups from 1995 to 2013 using different temperature metrics (daily mean (Tmean), maximum (Tmax), minimum (Tmin) and maximum apparent temperature (Tappmax)), and aimed to evaluate variations of the heat effect after 2003 (1995–2002 versus 2004–2013).
We applied conditional quasi-Poisson regression models with non-linear distributed lag functions to estimate temperature-mortality associations over all cities (1995–2013) and separately for two time periods (1995–2002, 2004–2013). Relative risks (RR) of daily mortality were estimated for increases in temperature from the median to the 98th percentile of the warm season temperature distribution.
Over the whole time period, significant temperature-mortality relationships were found for all temperature indicators (RR (95% confidence interval): Tappmax: 1.12 (1.05; 1.18); Tmax: 1.15 (1.08–1.22); Tmean: 1.16 (1.09–1.23); Tmin 1.23 (1.15–1.32)). Mortality risks were higher at the beginning of the summer, especially for Tmin. In the more recent time period, we observed a non-significant reduction in the effect of high temperatures on mortality, with the age group > 74 years remaining the population at highest risk.
High temperatures continue to be a considerable risk factor for human health in Switzerland after 2003. More effective public health measures targeting the elderly should be promoted with increased attention to the first heat events in summer and considering both high day-time and night-time temperatures.
•Heat-related mortality was assessed in eight Swiss cities from 1995 to 2013.•Mortality was significantly associated with various temperature metrics.•The strongest increase in mortality risk was found for extreme Tmin.•An insignificant reduction in the effect of heat on mortality was found after 2003.•After 2003, the subgroup at highest risk remained the people > 74 years.
Because older adults are particularly vulnerable to nonoptimal temperatures, it is expected that the progressive population aging will amplify the health burden attributable to heat and cold due to ...climate change in future decades. However, limited evidence exists on the contribution of population aging on historical temperature-mortality trends.
We aimed to
) assess trends in heat- and cold-related mortality in Switzerland between 1969 and 2017 and
) to quantify the contribution of population aging to the observed patterns.
We collected daily time series of all-cause mortality by age group (
, 65-79, and 80 y and older) and mean temperature for each Swiss municipality (1969-2017). We performed a two-stage time-series analysis with distributed lag nonlinear models and multivariate longitudinal meta-regression to obtain temperature-mortality associations by canton, decade, and age group. We then calculated the corresponding excess mortality attributable to nonoptimal temperatures and compared it to the estimates obtained in a hypothetical scenario of no population aging.
Between 1969 and 2017, heat- and cold-related mortality represented 0.28% 95% confidence interval (CI): 0.18, 0.37 and 8.91% (95% CI: 7.46, 10.21) of total mortality, which corresponded to 2.4 and 77 deaths per 100,000 people annually, respectively. Although mortality rates for heat slightly increased over time, annual number of deaths substantially raised up from 74 (12;125) to 181 (39;307) between 1969-78 and 2009-17, mostly driven by the
age group. Cold-related mortality rates decreased across all ages, but annual cold-related deaths still increased among the
, due to the increase in the population at risk. We estimated that heat- and cold-related deaths would have been 52.7% and 44.6% lower, respectively, in the most recent decade in the absence of population aging.
Our findings suggest that a substantial proportion of historical temperature-related impacts can be attributed to population aging. We found that population aging has attenuated the decrease in cold-related mortality and amplified heat-related mortality. https://doi.org/10.1289/EHP9835.
•Inner-city speed reduction reduces road traffic crashes and noise exposure.•Speed reduction prevents cardiovascular diseases and diabetes.•Speed reduction reduces the number of noise annoyed and ...sleep disturbed people.•For road traffic crashes, speed limits on major roads are most relevant.•Overall, health benefit from noise reduction is more relevant than safety benefits.
Reductions of speed limits for road traffic are effective in reducing casualties, and are also increasingly promoted as an effective way to reduce noise exposure.
The aim of this study was to estimate the health benefits of the implementation of 30 km/h speed limits in the city of Lausanne (136′077 inhabitants) under different scenarios addressing exposure to noise and road crashes.
The study followed a standard methodology for quantitative health impact assessments to derive the number of attributable cases in relation to relevant outcomes. We compared a reference scenario (without any 30 km/h speed limits) to the current situation with partial speed limits and additional scenarios with further implementation of 30 km/h speed limits, including a whole city scenario.
Compared to the reference scenario, noise reduction due to the current speed limit situation was estimated to annually prevent 1 cardiovascular death, 72 hospital admissions from cardiovascular disease, 17 incident diabetes cases, 1′127 individuals being highly annoyed and 918 individuals reporting sleep disturbances from noise. Health benefits from a reduction in road traffic crashes were less pronounced (1 severe injury and 4 minor injuries). The whole city speed reduction scenario more than doubled the annual benefits, and was the only scenario that contributed to a reduction in mortality from road traffic crashes (one death per two years). Implementing 30 km/h speed limits in a city yields health benefits due to reduction in road traffic crashes and noise exposure. We found that the benefit from noise reduction was more relevant than safety benefits.
Temporal variation of temperature-health associations depends on the combination of two pathways: pure adaptation to increasingly warmer temperatures due to climate change, and other attenuation ...mechanisms due to non-climate factors such as infrastructural changes and improved health care. Disentangling these pathways is critical for assessing climate change impacts and for planning public health and climate policies. We present evidence on this topic by assessing temporal trends in cold- and heat-attributable mortality risks in a multi-country investigation.
Trends in country-specific attributable mortality fractions (AFs) for cold and heat (defined as below/above minimum mortality temperature, respectively) in 305 locations within 10 countries (1985–2012) were estimated using a two-stage time-series design with time-varying distributed lag non-linear models. To separate the contribution of pure adaptation to increasing temperatures and active changes in susceptibility (non-climate driven mechanisms) to heat and cold, we compared observed yearly-AFs with those predicted in two counterfactual scenarios: trends driven by either (1) changes in exposure-response function (assuming a constant temperature distribution), (2) or changes in temperature distribution (assuming constant exposure-response relationships). This comparison provides insights about the potential mechanisms and pace of adaptation in each population.
Heat-related AFs decreased in all countries (ranging from 0.45–1.66% to 0.15–0.93%, in the first and last 5-year periods, respectively) except in Australia, Ireland and UK. Different patterns were found for cold (where AFs ranged from 5.57–15.43% to 2.16–8.91%), showing either decreasing (Brazil, Japan, Spain, Australia and Ireland), increasing (USA), or stable trends (Canada, South Korea and UK). Heat-AF trends were mostly driven by changes in exposure-response associations due to modified susceptibility to temperature, whereas no clear patterns were observed for cold.
Our findings suggest a decrease in heat-mortality impacts over the past decades, well beyond those expected from a pure adaptation to changes in temperature due to the observed warming. This indicates that there is scope for the development of public health strategies to mitigate heat-related climate change impacts. In contrast, no clear conclusions were found for cold. Further investigations should focus on identification of factors defining these changes in susceptibility.
•Evidence on adaptation is crucial for the assessment of climate change impacts.•Most of the studied countries showed a strong reduction in heat vulnerability.•We found more diffuse patterns on cold-mortality trends.•Pace of decrease in heat susceptibility was faster than the observed warming.•There is scope for development of mitigation strategies of climate change impacts.
Heat-waves have a substantial public health burden. Understanding spatial heterogeneity at a fine spatial scale in relation to heat and related mortality is central to target interventions towards ...vulnerable communities.
To determine the spatial variability of heat-wave-related mortality risk among elderly in Paris, France at the census block level. We also aimed to assess area-level social and environmental determinants of high mortality risk within Paris.
We used daily mortality data from 2004 to 2009 among people aged >65 at the French census block level within Paris. We used two heat wave days' definitions that were compared to non-heat wave days. A Bernoulli cluster analysis method was applied to identify high risk clusters of mortality during heat waves. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the mortality risk.
The spatial approach revealed a spatial aggregation of death cases during heat wave days. We found that small scale chronic PM10 exposure was associated with a 0.02 (95% CI: 0.001; 0.045) increase of the risk of dying during a heat wave episode. We also found a positive association with the percentage of foreigners and the percentage of labor force, while the proportion of elderly people living in the neighborhood was negatively associated. We also found that green space density had a protective effect and inversely that the density of constructed feature increased the risk of dying during a heat wave episode.
We showed that a spatial variation in terms of heat-related vulnerability exists within Paris and that it can be explained by some contextual factors. This study can be useful for designing interventions targeting more vulnerable areas and reduce the burden of heat waves.
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•We found a spatial aggregation of death cases during heat wave days in the city of Paris.•Spatial variation in heat-related vulnerability can be explained by PM10 levels, some social factors and micro-heat islands.•Living in an area with high proportion of elderly people may reduce risks for heat-related mortality among elderly people.•This study can be useful for designing interventions targeting more vulnerable areas and reduce the burden of heat waves.
Air temperature has been the most commonly used exposure metric in assessing relationships between thermal stress and mortality. Lack of the high-quality meteorological station data necessary to ...adequately characterize the thermal environment has been one of the main limitations for the use of more complex thermal indices. Global climate reanalyses may provide an ideal platform to overcome this limitation and define complex heat and cold stress conditions anywhere in the world. In this study, we explored the potential of the Universal Thermal Climate Index (UTCI) based on ERA5 – the latest global climate reanalysis from the European Centre for Medium-Range Weather Forecasts (ECMWF) – as a health-related tool. Employing a novel ERA5-based thermal comfort dataset ERA5-HEAT, we investigated the relationships between the UTCI and daily mortality data in 21 cities across 9 European countries. We used distributed lag nonlinear models to assess exposure-response relationships between mortality and thermal conditions in individual cities. We then employed meta-regression models to pool the results for each city into four groups according to climate zone. To evaluate the performance of ERA5-based UTCI, we compared its effects on mortality with those for the station-based UTCI data. In order to assess the additional effect of the UTCI, the performance of ERA5-and station-based air temperature (T) was evaluated. Whilst generally similar heat- and cold-effects were observed for the ERA5-and station-based data in most locations, the important role of wind in the UTCI appeared in the results. The largest difference between any two datasets was found in the Southern European group of cities, where the relative risk of mortality at the 1st percentile of daily mean temperature distribution (1.29 and 1.30 according to the ERA5 vs station data, respectively) considerably exceeded the one for the daily mean UTCI (1.19 vs 1.22). These differences were mainly due to the effect of wind in the cold tail of the UTCI distribution. The comparison of exposure-response relationships between ERA5-and station-based data shows that ERA5-based UTCI may be a useful tool for definition of life-threatening thermal conditions in locations where high-quality station data are not available.
•The suitability of ERA5-based UTCI for health-related studies was demonstrated.•ERA5-based UTCI was evaluated with respect to station-based observations.•ERA5-and station-based air temperature was assessed as a reference thermal metric.•Consistent exposure-response relationships were modelled by ERA5 and station data.•The effect of wind on mortality in cold environments calls for future investigation.
This study's objective was to determine whether socioeconomically deprived populations are exposed to greater levels of environmental noise.
Indicators of socioeconomic status were correlated with ...LAeq24h noise levels estimated with a land-use regression model at a small geographic scale.
We found that noise exposure was associated with all socioeconomic indicators, with the strongest correlations found for median household income, proportion of people who spend over 30% of their income on housing, proportion of people below the low income boundary and with a social deprivation index combining several socio-economic variables.
Our results were inconsistent with a number of studies performed elsewhere, indicating that locally conducted studies are imperative to assessing whether this double burden of noise exposure and low socioeconomic status exists in other contexts. The primary implication of our study is that noise exposure represents an environmental injustice in Montreal, which is an issue that merits both investigation and concern.
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