Burden of Disease Due to Ambient Particulate Matter in Germany-Explaining the Differences in the Available Estimates.

Ambient particulate matter (PM2.5) pollution is an important threat to human health. The aim of this study is to estimate the environmental burden of disease (EBD) for the German population associated with PM2.5 exposure in Germany for the years 2010 until 2018. The EBD method was used to quantify relevant indicators, e.g., disability-adjusted life years (DALYs), and the life table approach was used to estimate the reduction in life expectancy caused by long-term PM2.5 exposure. The impact of varying assumptions and input data was assessed. From 2010 to 2018 in Germany, the annual population-weighted PM2.5 concentration declined from 13.7 to 10.8 µg/m3. The estimates of annual PM2.5-attributable DALYs for all disease outcomes showed a downward trend. In 2018, the highest EBD was estimated for ischemic heart disease (101.776; 95% uncertainty interval (UI) 62,713-145,644), followed by lung cancer (60,843; 95% UI 43,380-79,379). The estimates for Germany differ from those provided by other institutions. This is mainly related to considerable differences in the input data, the use of a specific German national life expectancy and the selected relative risks. A transparent description of input data, computational steps, and assumptions is essential to explain differing results of EBD studies to improve methodological credibility and trust in the results. Furthermore, the different calculated indicators should be explained and interpreted with caution.

[Environmental burden of disease in Germany]. / Umweltbedingte Krankheitslasten in Deutschland.

BACKGROUND: Environmental risk factors can have a substantial impact on population health. With the environmental burden of disease (EBD) approach, the health losses attributable to environmental risk factors can be quantified using disability-adjusted life years (DALY). OBJECTIVES: The aim of this article is to present and discuss available EBD estimates with a focus on Germany. MATERIALS: Using current EBD studies, the share of the burden of disease attributable to environmental risk factors globally and DALYs for Germany are presented. Ambient particulate matter (PM), water-related risks and environmental noise are used as examples to emphasize the importance of availability and quality of input data for burden of disease assessments. RESULTS: The share of the global burden of disease attributable to environmental risk factors varies according to the available studies and lies between 13 and 22%. For Germany, EBD estimates are available for 12 environmental risk factors. Most estimates are available for particulate matter in ambient air, however, the estimated burden differs greatly. Nonetheless, according to current knowledge, particulate matter pollution is the environmental risk factor with the highest burden of disease in Germany. CONCLUSIONS: Differences in the estimated burden of disease for the considered risk factors are due to varying underlying assumptions, e. g. for life expectancy or counterfactual value and the input data used.

[The Environmental Burden of Disease Concept]. / Das Konzept der umweltbedingten Krankheitslast.

GOAL OF THE STUDY: Environmental risk factors are of great importance for public health with a considerable but often unused potential for prevention. However, knowledge about the complex associations between the environment and health effects is limited for some risk factors. A concept, which is using the existing evidence on associations between the impact of environmental factors and health effects, is the environmental burden of disease (EBD) concept. The aim of this article is to present the quantification method of the EBD concept and to discuss the advantages and its points of criticism. METHODS: The EBD concept combines morbidity and mortality data in a single measure (Disability-Adjusted Life Year, DALY) to enable a comparative description of the burden of disease. Life years are used as measurement unit. The environmental share of the total DALYs is quantified by using the attributable fraction. RESULTS: Despite its increasing application especially in the international context, the method is still criticized, because by summarizing the complex construct of health in one single measurement unit, much important information about quality of life is lost. A further criticism refers to partly arbitrarily set social value choices. Additionally, missing or insufficient data can limit the quality and validity of EBD estimations. CONCLUSION: A scientific discourse is needed to decide to what extent the EBD approach can and should be used in Germany.

Burden of Outdoor Air Pollution in Kerala, India­A First Health Risk Assessment at State Level.

Ambient air pollution causes a considerable disease burden, particularly in South Asia. The objective of the study is to test the feasibility of applying the environmental burden of disease method at state level in India and to quantify a first set of disease burden estimates due to ambient air pollution in Kerala. Particulate Matter (PM) was used as an indicator for ambient air pollution. The disease burden was quantified in Years of Life Lost (YLL) for the population (30 + years) living in urban areas of Kerala. Scenario analyses were performed to account for uncertainties in the input parameters. 6108 (confidence interval (95% CI): 4150-7791) of 81,636 total natural deaths can be attributed to PM, resulting in 96,359 (95% CI: 65,479-122,917) YLLs due to premature mortality (base case scenario, average for 2008-2011). Depending on the underlying assumptions the results vary between 69,582 and 377,195 YLLs. Around half of the total burden is related to cardiovascular deaths. Scenario analyses show that a decrease of 10% in PM concentrations would save 15,904 (95% CI: 11,090-19,806) life years. The results can be used to raise awareness about air quality standards at a local level and to support decision-making processes aiming at cleaner and healthier environments.