Balkan countries and Poland rank highest in lung cancer risk for ages 50 to 69, attributable to air pollution

Posted on September 13, 2021 by Respro® UK Ltd

Five European countries rank highest for lung cancer risk among those aged 50 to 69 years attributable to air pollution, according to research presented in today’s Presidential Symposium Plenary Session at the IASLC 2021 World Conference on Lung Cancer.

Although tobacco smoke is clearly a major cause of lung cancer, a recent analysis determined that worldwide, air pollution accounts for 14% of lung cancers, according to data reported by Christine Berg.

The causal evidence of a link between air pollution and lung cancer has been building for decades, but the risk varies widely in different regions of the world, depending on the age of the population, the amount of tobacco smoking over time, and the amount of air pollution in the country.

Berg and co-researcher Dr. Joan Schiller, an adjunct professor at the University of Virginia and a Board Member of the Lung Cancer Research Foundation, sought to better understand the worldwide variability in air pollution attributable to lung cancer. Berg conducted a review of the literature on the burden of indoor and outdoor air pollution. She assessed the burden of lung cancer by country from air pollution by querying The Global Burden of Disease Compare publicly accessible database. Lung cancer mortality was chosen as the endpoint in an age-standardized population of 100,000. Because the incidence of lung cancer increases with age, two age groups were selected: Ages 50-69, and 70 and older. Both genders were combined in the analysis. Berg ranked the top 15 countries in each age group and compared changes in relative country ranking by age group.

According to her analysis, Serbia (36.88 per 100,000), Montenegro (34.61 per 100,000), North Macedonia (30.67 per 100,000), Bosnia/Herzegovina (30.64 per 100,000), and Poland (27.97 per 100,000) ranked highest for risk of lung cancer attributable to air pollution among ages 50-69.

Among the 70 and older group, China (98.55 per 100,000), Mongolia (71.11 per 100,000), North Korea (63.45 per 100,000), Laos (62.07 per 100,000), and Montenegro (61.80 per 100,000) ranked highest.

“For comparison, in the United States the number of lung cancer deaths per 100,000 attributed to air pollution in ages 50 to 69 is 3.91 and is 13.62 for 70 and older,” Berg said. The Balkans, Poland, Turkey, China, and some southeast Asian countries have the highest attributable risks. Serbia had the highest number of attributable deaths in the 50-69 age group, whereas China had the highest in the 70 and older age group.

“Patterns of cigarette smoking and amounts of pollution from fossil fuel energy sources are most likely the primary drivers of the variability in risk attributable to lung cancer,” said Berg. “As the tobacco epidemic is addressed, we also need to address other preventable causes of lung cancer.”

Balkan countries and Poland rank highest in lung cancer risk for ages 50 to 69, attributable to air pollution
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More than 47,000 Brazilians hospitalised by exposure to wildfire air pollution every year

Posted on September 10, 2021 by Respro® UK Ltd

Last year the number of wildfires in Brazil increased 12.7 percent to a decade-high. Now the largest and most comprehensive study to date of the health effects of wildfires in Brazil reveals the serious health consequences of this burning, linking exposure to wildfire pollutants to increased hospitalisation.

There have been 260 major fires detected in the Amazon this year, burning more than 105,000 hectares (260,000 acres) — an area roughly the size of Los Angeles, California.

More than 75 per cent of these fires blazed in the Brazilian Amazon, in areas where trees have been cut to make way for agriculture, despite a June 27 ban on unauthorized outdoor fires by the Brazilian government.

Professor Yuming Guo and Dr Shanshan Li, from the Monash University School of Public and Preventive Health in Melbourne, Australia, led an international study into the health effects of these wildfires. The results are published today in The Lancet Planetary Health.

The study found between January 1, 2000 and December 31, 2015, a 10 ug/m3 increase in wildfire-related fine particles (PM2.5) in the air was associated with an increase in overall hospitalisations of 0.53 per cent directly related to exposure to wildfire pollutants. This corresponds to 35 cases per 100,000 residents annually, which is over 48,000 Brazilians every year hospitalised by wildfire pollution, mainly in the cities in the north, south and central-west regions. The north east regions of the country had the lowest rates.

The study found that overall hospitalisations were “particularly high in children aged four years or younger, in children aged five to nine years and in people aged 80 years and older”.

The study looked at more than 143 million hospitalisations from 1,814 municipalities covering almost 80 per cent of the Brazilian population for the 16 years of the study to the end of 2015, comparing this data to daily wildfire related PM2.5 levels in the air in each of these municipalities. Even short-term exposure to PM2.5, the small particulate matter within wildfire smoke, can trigger asthma, heart attack, stroke, a decrease in lung function, hospitalisation and premature death.

“This data reveals significant health impacts of wildfires, at a time before the 2019 fires across Brazil captured global attention followed by an equally intense fire period last year,” Professor Guo said.

There have been increased fires across Brazil since the 1990s, largely due to deforestation and forest degradation from human activities such as mining, logging and farming. While fire activities generally occur during the dry season in August to November, the duration of the dry season is lengthening, according to previous studies.

While most wildfires occur in remote areas of Brazil, “toxic smoke from these wildfires in the Amazon region can rise as high as 2,000 to 2,500 km up into the atmosphere and travel great distances, threatening people thousands of miles away,” Professor Guo said.

Number of hospital admissions associated with wildfire-related PM2·5 across 1,814 Brazilian municipalities by region, sex, and age, 2000–15.

DOI: https://doi.org/10.1016/S2542-5196(21)00173-X

Link: http://www.thelancet.com/journals/lanplh/article/S2542-5196(21)00173-X

More than 47,000 Brazilians hospitalised by exposure to wildfire air pollution every year – Medicine, Nursing and Health Sciences
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Air pollution has a more devastating effect on life expectancy than smoking and war

Posted on September 8, 2021 by Respro® UK Ltd
Smoke covers Athens centre, due to fires burning at the foot of Mount Parnes, 30 kilometres north of Athens.

Air pollution is a bigger killer than HIV/AIDS, tuberculosis and malaria combined, according to a recent report from the Air Quality Life Index (AQLI).

Particulate pollution has a more devastating impact on life expectancy than smoking or even war, the scientists say.

It is cutting short the lives of billions of people, with the average global citizen losing 2.2 years of their life to today’s air pollution levels. If nothing changes then that will add up to 17 billion years of life lost around the world.

The problem is being made worse by the climate crisis, with high temperatures leading to wildfires that increase air pollution. This creates a dangerous cycle, the researchers say. Fossil fuel burning – in particular coal – is feeding the problem.

Air pollution is the greatest external threat to human health on the planet.

“Air pollution is the greatest external threat to human health on the planet,” says Professor Micheal Greenstone, one of the scientists who created the AQLI, “and that is not widely recognised, or not recognised with the force and vigour that one might expect.”

Though the scientists say that lockdowns have proven we can reduce pollution and a different future is possible, it all depends on whether governments choose to act.

Mums for Lungs

In the UK, air pollution is thought to be responsible for up to 36,000 deaths every year and some studies say it could be higher. Ruth is one person who has seen the impact of this firsthand.

“My son first started having breathing difficulties in the heatwave of 2018,” she says.

“If you remember that one, it was around 34 degrees (Celsius), some days cooler, for about two and a half months in London and the air quality was really bad.”

Ruth says that by November, her son had seven asthma attacks and they were on their third visit to the hospital. It was then that a paediatric respiratory specialist told her air pollution could be part of the problem. He said that they should avoid walking along busy streets, main roads and next to traffic.

“If you haven’t experienced the impact, people might not be as concerned about it,” she explains. Unlike plastic pollution, where images of a beach covered in waste paint a direct picture of the consequences, the effects on our respiratory health aren’t so visually clear.

“I think because we can’t see air pollution that maybe makes it slightly harder to communicate.”

“It’s very much an issue that is also outside of London and that kind of that surprised me as well when I was first looking into it.”

Though she lives in London, after looking at air quality maps Ruth says she found that levels of PM2.5 and PM10 were high in towns and cities across the UK. It’s not something that can easily be escaped.

Is air pollution the only issue?

It isn’t just air pollution threatening our health but a whole host of other impacts of climate change that could be putting our lungs in danger – many of which we are surprisingly unaware of.

As we emerge from the effects of COVID-19, climate change could be the next biggest threat to our respiratory health according to a new report from the Economist Intelligence Unit (EIU).

The EIU identified five major ways that climate change is damaging our respiratory health:

Higher temperatures can increase ozone levels and how often and how severe respiratory infections can be.

Heatwaves: With every degree of Celsius in temperature increase, it is thought that the risk of premature death for respiratory patients is six times that of the general population.

The amount of pollen in the air: Rising temperatures and carbon dioxide levels are increasing pollen load by expanding the area where plants can grow and extending their season.

How allergic we are to pollen: As well as increasing the amount of pollen in the air, storms can cause pollen grains to burst, allowing them to get deeper into our lungs and cause health issues.

Extreme weather events: Dust storms carry pollen, viruses and fungal spores, particulates from wildfires can travel up to 1,000km and thunderstorms cause pollen levels to rise and lead to asthma epidemics.

Tom Delahoyde is the managing director of Chiesi UK who commissioned the report and he says it was done on behalf of patients suffering the health consequences of climate change, “right here, right now”.

Climate change is disproportionately affecting the economically disadvantaged and those with underlying health conditions, such as asthma or chronic obstructive pulmonary disease (COPD) are most at risk.

“One of the key findings in this report is that respiratory health issues are actually exacerbated by the climate crisis, which is putting vulnerable people at risk, and actually worsening inequality within our society,” he says.

“Heatwave related issues particularly impact the elderly, so the 65 and above age groups, but also infants, where children’s lungs are still developing, can be impacted by this.”

What can be done to prevent this health crisis?

Ruth is a member of Mums for Lungs, a group campaigning for everyone to have clean air as soon as possible.

They want to see elected officials tackle the problem of air pollution through actions such as expanding the Ultra Low Emission Zone (ULEZ) in London, commitment to WHO clean air guidelines as part of the Environment Bill and a reduction in car ownership.

“I think there’s a sense of urgency about it as well because children grow up quickly,” she adds.

“When there are targets being set, you know, we want to get all diesel cars off the road by 2030, I think ‘that’s 10 years’. My son is going to be 15, nearly fully grown and then what difference is that going to make to him? Nothing.

“We want to make a difference to this generation that’s growing up.” Policymakers really need to prioritise respiratory health in the fight against climate change.

A lack of action is a problem around the world, not just in Europe. A recent analysis from the Clean Air Fund found that 20 per cent more global aid goes to fossil fuel projects than it does to tackling the air pollution they cause.

Delahoyde says tackling the impacts of the climate crisis on respiratory health has to be a joint effort between policymakers, businesses and health professionals.

“Policymakers really need to prioritise respiratory health in the fight against climate change and companies need to take meaningful, measurable and independently verified actions,” he concludes.

“Only then can we encourage and track progress towards a greener, healthier society.”

Air pollution has a more devastating effect on life expectancy than smoking and war | Euronews
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Covid: Pollution increases risk of Covid hospitalisation, study finds

Posted on September 6, 2021 by Respro® UK Ltd

Living in areas of high air pollution increases the risk of hospitalisation with Covid-19 a new study has found.

Imperial College London researchers also found evidence people living in polluted areas may have an increased risk of catching the disease.

The review is the most “comprehensive overview” of studies on air pollution and coronavirus, researchers said.

Sadiq Khan said: “We cannot turn a blind eye to the clear evidence showing the dangers of toxic air pollution.”

The London mayor, who commissioned the study, said: “This new review led by Imperial researchers makes it crystal clear that tackling air pollution is a vital part of building our resilience to Covid-19, and other infections like it.

“The decisions we make now to tackle air pollution are truly a matter of life and death,” Mr Khan added.

Long-term exposure to air pollution increases susceptibility to worse outcomes from Covid, the report found.

But researchers found particulate matter – large airborne particles – did not appear to play any important part in transporting Covid-19, as had been suggested by some earlier studies.

In addition, inconsistent results were found for studies of long-term exposure to air pollution and the number of Covid cases.

Scientists said that as the pandemic is less than two years old further research will be necessary “to strengthen these emerging findings”.

The report comes ahead of the planned expansion of London’s Ultra Low Emission Zone next month.

A recent study by City Hall found 98% of schools are in areas with toxic air quality, compared with 24% outside the capital.

Excessive levels of air pollution can stunt lung growth and worsen chronic diseases.

via Covid: Pollution increases risk of Covid hospitalisation, study finds – BBC News

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Forest fires linked to tens of thousands of avoidable deaths

Posted on September 3, 2021 by Respro® UK Ltd

Setting fire to forest and agricultural land in Southeast Asia to prepare it for cultivation or grazing contributes to an estimated 59,000 premature deaths a year, say scientists.

Their analysis reveals that the greatest health impact from the burning, which releases tiny particles into the air which can get into people’s lungs, is felt by some of the poorest communities in the region, in northern Laos and western Myanmar.

In a paper published today in the journal GeoHealth, researchers from Leeds and University of Augsburg in Germany call for measures to curb agricultural and forest burning. They say preventing agricultural and forest fires should be regarded as a “public health priority.”

Dr. Carly Reddington, AIA Research Fellow in the School of Earth and Environment at Leeds, and the study’s lead author, said, “Our investigation quantifies the contribution of an often overlooked source of poor air quality and demonstrates that actions to reduce fire may offer considerable, yet largely unrecognized options for rapid improvements in air quality.

“We found that across Southeast Asia, the amount of air pollution produced by these fires is comparable to that from industry, transport, and power generation.”

Burning releases harmful pollutants

Across Southeast Asia—an area including Myanmar, Thailand, Cambodia, Laos, Vietnam and south east China—farmers burn forest as a way of clearing land for cultivation or to graze animals, often in the pre-monsoon period, usually in February to April.

During this period, the weather patterns over a large part of the region can result in a temperature inversion, a meteorological phenomenon that prevents smoke and emissions from the fires dispersing, particularly at night or during the early mornings.

The fires generate a range of harmful pollutants, including fine particulate matter known as PM2.5—tiny particles that measure 2.5 microns (where a micron is one millionth of a meter or less). According to the World Health Organization (WHO), the particles are a risk factor in cardiovascular and respiratory diseases and cancer.

The researchers used measurements of air pollution along with computer models to measure the impact of the fires on air quality and the prevalence of disease.

Modeling impact of burning

In all the datasets analyzed, the researchers found the greatest pollution emissions from the burning was coming from the northern region of Laos, Cambodia, Thailand, eastern and western Myanmar, and southern Bangladesh, and with lower levels of emissions in central Myanmar, Thailand, north Vietnam, and south eastern China.

The researchers modeled what improvements would be seen in air quality if the burning was stopped.

The concentration of PM2.5—the fine particulates—would fall by between 40% and 70% in those areas experiencing the greatest emissions.

WHO has an interim annual target for maximum levels of PM2.5, which is 25 micrograms per cubic meter.

Burning ‘degrades air quality’

If the practice of burning could be stopped, the researchers argue that the number of people exposed to levels greater than the WHO interim target would drop by 64% in Thailand, 100% in Myanmar, in Laos by 92% and Cambodia by 44%.

Using epidemiological modeling, the scientists calculated the reduction in PM2.5 could reduce premature deaths caused by exposure to air pollution. In Southeast Asia, deaths would fall by 12%, ranging from 5% in Vietnam to 28% in Laos and 3% in southeastern China. In total an estimated 59,000 premature deaths could be prevented each year.

They also mapped poverty data against PM2.5 concentrations and found that poorer, rural populations in Laos, Cambodia and Myanmar were exposed to higher levels of fine particle pollution.

Dr. Reddington said, “This study is the first detailed assessment of the effects of forest and vegetation fires on air quality and human health in Southeast Asia. “

The study shows that air pollution from vegetation and forest fires seriously degrades air quality in Southeast Asia and that by preventing these fires, exposure to harmful air pollutants could be substantially reduced and many premature deaths could be avoided.

“Furthermore, it shows that the poorer populations of Southeast Asia are being disproportionally exposed to the air pollution from these fires.”

New efforts are now needed to reduce forest fires in the region.

Dr. Reddington added, “A complete ban on the use of fire may not be practical for many local farmers who don’t have any alternative. Pollution emissions are dominated by burning of forests, so there needs to be increased effort to reduce fires associated with deforestation.

“Reducing deforestation reduces emissions of carbon dioxide and is a crucial element of efforts to slow global climate change. Our work demonstrates that reducing deforestation and associated fires would also lead to cleaner air and improved public health.

“These local and regional benefits may provide a powerful incentive to reduce deforestation. Increased support for community-protected forests and other protected areas, where forest clearance fires are less prevalent, are an important way to reduce fires.”

The paper, Air pollution from forest and vegetation fires in Southeast Asia disproportionately impacts the poor, is published in GeoHealth.

Forest fires linked to tens of thousands of avoidable deaths
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Air pollution is slashing years off the lives of billions, report finds

Posted on September 1, 2021 by Respro® UK Ltd

Dirty air is a far greater killer than smoking, car crashes or HIV/Aids, with coal burning the leading cause

Air pollution is cutting short the lives of billions of people by up to six years, according to a new report, making it a far greater killer than smoking, car crashes or HIV/Aids.

Coal burning is the principal culprit, the researchers said, and India is worst affected, with the average citizen dying six years early. China has slashed air pollution in the last seven years, but dirty air is still cutting 2.6 years from its people’s lifespan.

Fossil fuel burning is causing air pollution and the climate crisis, but nations have much greater power to cut dirty air within their own borders. The climate crisis is now also adding to air pollution by driving wildfires, completing a vicious circle, the scientists said.

The team said recent events had illustrated the different futures possible depending on whether governments act or not. Coronavirus lockdowns cut pollution, revealing the Himalayas to some Indian city dwellers, while wildfires in the western US caused serious pollution on the other side of the continent in New York City.

“Air pollution is the greatest external threat to human health on the planet, and that is not widely recognised, or not recognised with the force and vigour that one might expect,” said Prof Michael Greenstone at the University of Chicago. Greenstone and colleagues developed the Air Quality Life Index (AQLI), which converts air pollution levels into their impact on life expectancy.

The average global citizen loses 2.2 years of life with today’s levels of air pollution and, if nothing changes, that adds up to 17bn lost years, Greenstone said. “What else on the planet is causing people to lose 17bn years of life?”

“Furthermore, we’re not just letting it happen, we’re actually causing it,” he said. “The most striking thing is that there are big countries where, effectively, a combination of the government and [societal] norms are choosing to allow people to live really dramatically shorter and sicker lives.” He said switching to cleaner energy and enforcing air quality measures on existing power plants have cut pollution in many countries.

The report estimated the number of additional years of life people would gain if air pollution levels in their country were reduced to World Health Organization guidelines. In India, the figure is 5.9 years – in the north of the country 480 million people breathe pollution that is 10 times higher than anywhere else in the world, the scientists said. Cutting pollution would add 5.4 years in Bangladesh and Nepal, and 3.9 years in Pakistan.

In central and west Africa, the impacts of particulate pollution on life expectancy are comparable to HIV/Aids and malaria, but receive far less attention, the report said. For example, the average person in the Niger delta stands to lose nearly six years of life, with 3.4 years lost by the average Nigerian.

China began a “war against pollution” in 2013 and has reduced levels by 29%. This is adding an average of 1.5 years on to lives, assuming the cuts are sustained, the scientists said, and shows rapid action is possible.

“Coal is the source of the problem in most parts of the world,” said Greenstone. “If these [health] costs were embedded in prices, coal would be uncompetitive in almost all parts of the world.”

Fossil gas is significantly less polluting than coal and Japan said in June that it would offer $10bn in aid for energy decarbonisation projects in southeast Asia, including gas power stations. But gas burning still drives global heating and Christiana Figueres, former UN climate chief, said on Sunday: “Let’s be clear, gas is not an alternative to coal and nor is it a transition fuel. Investments in new gas must stop immediately if carbon neutrality is to be reached by 2050.”

The AQLI report is based on research comparing the death rates of people living in more and less polluted places, with heart and lung problems being the largest source of early deaths. The analysis is based on small particle pollution, but is likely to include the effects of other air pollutants as these all tend to be high in the same locations. The estimates of air pollution around the world were derived from satellite data at 3.7-mile (6km) resolution.

Air pollution is slashing years off the lives of billions, report finds | Air pollution | The Guardian

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How people respond to wildfire smoke

Posted on August 31, 2021 by Respro® UK Ltd

As wildfires become commonplace in the western U.S. and around the world, checking the daily air quality warning has become as routine as checking the weather. But what people do with that data — whether it drives them to slip on a mask before stepping outside or seal up their homes against smoke — is not always straightforward or rational, according to new Stanford research.

In a case study of Northern California residents, Stanford researchers explored the psychological factors and social processes that drive responses to wildfire smoke. The research, which ultimately aims to uncover approaches for helping people better protect themselves, shows that social norms and social support are essential for understanding protective health actions during wildfire smoke events. The findings appeared this month in the journal Climate Risk Management.

“It’s important to understand how people behave so that public health communications professionals can potentially intervene and promote safer behavior that mitigates risk,” said lead study author Francisca Santana, a PhD student in the Emmett Interdisciplinary Program in Environment and Resources (E-IPER). “This kind of qualitative work is a first step so that we can learn how people are using information and interacting to make decisions. We can then look at where there might be leverage points or opportunities to promote more protective behavior.”

Exposure to wildfire smoke can irritate the lungs, cause inflammation, impact the immune system and increase susceptibility to lung infections, including the virus that causes COVID-19, according to the Centers for Disease Control and Prevention. While other studies have examined how people respond to evacuation orders, little has been done to understand what’s happening with wildfire smoke exposure if people don’t — or can’t — leave the area, according to senior study author Gabrielle Wong-Parodi, an assistant professor of Earth system science at Stanford’s School of Earth, Energy & Environmental Sciences (Stanford Earth).

“It resonated with me, the things that people were doing to try to protect themselves in the absence of access to effective ways to reduce their wildfire smoke exposure,” Wong-Parodi said, referring to a resident who breathed through a wet bandana in an attempt to filter out toxic smoke particles. “It’s urgent that we come up with strategies that are realistic for what people are going through.”

Study authors Santana and David Gonzalez, who worked on the study as a PhD student at Stanford, interviewed residents across age, race and income demographics who were affected by wildfire smoke from the 2018 Camp Fire that destroyed Paradise, California, and subsequent fires in 2019 in Fresno, Santa Clara and Sacramento counties.

They found that individuals responded to wildfire smoke events in three main ways: interpreting information together, protecting vulnerable others and questioning protective actions. Their responses were influenced not only by the Air Quality Index (AQI) but also by what they were personally experiencing — whether they smelled, saw or tasted smoke in the air.

Just as important were the social factors at play, the researchers found. “Social norms and social support were really influencing how people chose to act on their perceptions of threat,” Santana said. “For example, a lot of people talked about observing others wearing masks, and in some cases that observation was enough for them to act by wearing a mask themselves.”

Their discussions revealed that the shared rules or standards of behavior within a social group — social norms — were a common pathway driving behavior change, in addition to the act of assisting or comforting others within your social group — social support.

“There were only a handful of people who described looking at the AQI and then changing their behavior based on just that — it was almost always a conversation they were having with one another,” Santana said. “It was very much a social exercise of making sense of limited information or information that was not at the right scale for their community.”

The study provides a framework for better understanding wildfire smoke responses by examining social processes while acknowledging that cultural and political contexts, as well as factors like demographics, health status and previous exposure to smoke and air pollution, may also influence individual behaviors.

In the western U.S., climate change has contributed to the risk and extent of wildfires, bringing smoke to regions like the Bay Area, which has historically been less affected than the rest of the state. In some cases, the researchers found that residents were unable to protect themselves because they couldn’t access N95 masks or air purifiers or properly seal their homes.

“This research is also important for epidemiologists trying to understand how wildfire smoke affects health,” said Gonzalez, who is now a postdoctoral researcher at the University of California, Berkeley. “This can help us to look at disparities in who’s exposed to smoke and whether that leads to poorer health for some populations.”

As these events become more common, there could be an opportunity to find policy synergies that help prepare communities for future smoke events, according to the co-authors. For example, programs that are designed to improve household comfort and increase energy efficiency could also include measures to reduce smoke intrusion during wildfire smoke events, Wong-Parodi suggested.

Some of the interviews revealed that residents simply didn’t know what to do while experiencing a novel extreme event. But even that revealed how processing uncertainty is a social exercise, not just a cognitive one.”

This piece shows that social norms may be an effective lever for encouraging the pro-health change that we’d like to see,” Wong-Parodi said. “That is actually a really promising sign for thinking about how to adapt and mitigate our risk as we’re facing increasing threats from climate change.”

Story Source:Materials provided by Stanford University. Original written by Danielle Torrent Tucker. Note: Content may be edited for style and length.

How people respond to wildfire smoke — ScienceDaily
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Air pollution linked to more severe mental illness – study

Posted on August 27, 2021 by Respro® UK Ltd

Exclusive: research finds small rise in exposure to air pollution leads to higher risk of needing treatment

Exposure to air pollution is linked to an increased severity of mental illness, according to the most comprehensive study of its kind.

The research, involving 13,000 people in London, found that a relatively small increase in exposure to nitrogen dioxide led to a 32% increase in the risk of needing community-based treatment and an 18% increase in the risk of being admitted to hospital.

The researchers said the findings were likely to apply to most cities in developed nations, and cutting air pollution could benefit millions of people.

“Air pollution is modifiable, and on a big scale as well, reducing population-level exposure,” said Joanne Newbury, of the University of Bristol, who led the research. “We know there are interventions that can be used, such as expanding low-emission zones. Mental health interventions at the individual level are actually quite difficult.”

The study used the frequency of admission to hospital or visits to community doctors and nurses as a measure of severity. The researchers calculated that a small reduction in one pollutant alone could reduce illness and save the NHS tens of millions a year.

Levels of air pollution in London have fallen in recent years but there is no safe level, said Ioannis Bakolis, of King’s College London, who was part of the research team. “Even at low levels of air pollution, you can observe this kind of very important effect.”

Recent research has shown that small increases in air pollution are linked to significant rises in depression and anxiety. It has also linked dirty air to increased suicides and indicated that growing up in polluted places increases the risk of mental disorders. Other research has found that air pollution causes a “huge” reduction in intelligence and is linked to dementia. A global review in 2019 concluded that air pollution may be damaging every organ in the human body.

The new study, published in the British Journal of Psychiatry, tracked patients in south London from their first contact with mental health services and used high-resolution estimates of air pollution at their homes.

The quarterly average NO2 levels in the study area varied by between 18 and 96 micrograms per cubic metre (µg/m³). The researchers found that people exposed to 15µg/m³ higher levels of pollution had an 18% higher risk of being admitted to hospital and a 32% higher risk of needing outpatient treatment after a year.

The link was strongest for NO2, which is largely emitted by diesel vehicles, but was also significant for small particle pollution, which is produced by burning all fossil fuels. The small particle levels varied from 9 to 25 µg/m³ and an increased exposure of 3 units increased hospital admission risk by 11% and outpatient treatment risk by 7%.

The scientists assessed the patient data again seven years after the first treatment and found the link to air pollution was still apparent. The findings were not explained by a range of possible other factors including age, sex, ethnicity, deprivation or population density, although unidentified factors might still play an important role.

“Identifying modifiable risk factors for illness severity and relapse could inform early intervention efforts and reduce the human suffering and high economic costs caused by long-term chronic mental illness,” the researchers said.

The study was not designed to prove a causal link between air pollution and the severity of mental illness – that requires difficult experimental work. But the link is “biologically plausible”, the researchers said, as air pollutants are known to have potent inflammatory properties and inflammation is believed to be a factor in psychotic and mood disorders.

The World Bank has estimated that air pollution costs the global economy $5tn a year, but this includes only the well-known damage caused to heart and lungs.

“Cost evaluations currently only factor in physical health, but we’re seeing more studies demonstrating links with mental health,” said Newbury. “We think it can be important to include these, because it could tip the scales and make it clearer that investing in reducing air pollution is cost-effective.”

The researchers estimated that reducing the exposure of the UK’s urban population to small particle pollution alone by just a few units, to the World Health Organization’s annual limit of 10µg/m³, would cut the use of mental health services by about 2% and save tens of millions of pounds each year.

Prof Kevin McConway of the Open University, who was not part of the study team, said: “This is a good study. The statistical analysis is generally appropriate [and] does increase confidence that there’s at least some element of cause and effect in the association between pollution and mental health.

“But it’s not easy for people to avoid pollution. Reducing air pollution in cities needs communal action on a broad scale.”

A separate new study has shown that heart attacks rise as the level of air pollution rises. The research examined data from southern Lombardy in Italy, an area with 1.5 million inhabitants.

Francesca Gentile, of the IRCCS Policlinico San Matteo Foundation in Pavia, said: “The results could be used to predict the incidence of this life-threatening condition [and] improve health service efficiency by being factored into ambulance forecasting models and warning systems.” The study was presented at the European Society of Cardiology 2021 congress.

Air pollution linked to more severe mental illness – study | Air pollution | The Guardian
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