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  • 1.
    Azfar, Hossain Syed
    et al.
    Department of Family Medicine, International School of Medicine, Bishkek, Kyrgyzstan.
    Dzhusupov, Kenesh O.
    Department of Public Health, International School of Medicine, Bishkek, Kyrgyzstan.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Orru, Kati
    Institute of Social Studies, University of Tartu, Tartu, Estonia.
    Cardiovascular Disease and Mental Distress Among Ethnic Groups in Kyrgyzstan2021In: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, article id 489092Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to characterize different ethnic groups in Kyrgyzstan regarding cardiovascular disease (CVD) and mental distress, and to investigate the association between CVD and mental distress. The mental distress was measured in terms of sleep disturbance, burnout, and stress.

    Materials and Methods: A cross-sectional study was carried out among six ethnic groups in Kyrgyzstan, aged 18 years and above. The sample was stratified for age, education, family status, and income. We used the Karolinska Sleep Questionnaire to assess sleep disturbance, the physical and emotional subscale of the Shirom Melamed Burnout Questionnaire to assess burnout, and the 10-item Perceived Stress Scale to assess perceived stress.

    Results: The distribution of CVD differed significantly between the six ethnic groups, with higher prevalence among East Europeans, and Western Asians and lower among Other minorities and Central Asians. In all ethnic groups in Kyrgyzstan, individuals with CVD had increased odds of sleep disturbance and burnout. There was a significant difference in burnout and stress between persons with and without CVD in Kyrgyz and East European ethnic groups.

    Conclusion: There was a significant difference in burnout and stress between persons with and without CVD in Kyrgyz and East European ethnic groups. In addition to CVD prevention, mitigating sleep disturbance and preventing burnout in the general population should be aimed at in public health measures.

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  • 2.
    Carlsen, Hanne Krage
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Univ Iceland, Engn & Nat Sci, Reykjavik, Iceland; Univ Gothenburg, Inst Med, Sect Occupat & Environm Med, Dept Publ Hlth & Community Med,Sahlgrenska Acad, Gothenburg, Sweden.
    Bäck, E.
    Eneroth, K.
    Gislason, T.
    Holm, M.
    Janson, C.
    Jensen, S. S.
    Johannessen, A.
    Kaasik, M.
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Segersson, D.
    Sigsgaard, T.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Univ Tartu, Dept Family Med & Publ Hlth, Tartu, Estonia.
    Indicators of residential traffic exposure: Modelled NOX, traffic proximity, and self-reported exposure in RHINE III2017In: Atmospheric Environment, ISSN 1352-2310, Vol. 167, p. 416-425Article in journal (Refereed)
    Abstract [en]

    Few studies have investigated associations between self-reported and modelled exposure to traffic pollution. The objective of this study was to examine correlations between self-reported traffic exposure and modelled (a) NOx and (b) traffic proximity in seven different northern European cities; Aarhus (Denmark), Bergen (Norway), Gothenburg, Ulna and Uppsala (Sweden), Reykjavik (Iceland), and Tartu (Estonia). We analysed data from the RHINE III (Respiratory Health in Northern Europe, www.rhine.nu) cohorts of the seven study cities. Traffic proximity (distance to the nearest road with >10,000 vehicles per day) was calculated and vehicle exhaust (NOx) was modelled using dispersion models and land-use regression (LUR) data from 2011. Participants were asked a question about self-reported traffic intensity near bedroom window and another about traffic noise exposure at the residence. The data were analysed using rank correlation (Kendall's tau) and inter-rater agreement (Cohen's Kappa) between tertiles of modelled NOx and traffic proximity tertile and traffic proximity categories (0-150 metres (m), 150 -200 m, >300 m) in each centre. Data on variables of interest were available for 50-99% of study participants per each cohort. Mean modelled NOx levels were between 6.5 and 16.0 mu g/m(3); median traffic intensity was between 303 and 10,750 m in each centre. In each centre, 7.7-18.7% of respondents reported exposure to high traffic intensity and 3.6-16.3% of respondents reported high exposure to traffic noise. Self-reported residential traffic exposure had low or no correlation with modelled exposure and traffic proximity in all centres, although results were statistically significant (tau = 0.057-0.305). Self reported residential traffic noise correlated weakly (tau = 0.090-0.255), with modelled exposure in all centres except Reykjavik. Modelled NOx\] had the highest correlations between self-reported and modelled traffic exposure in five of seven centres, traffic noise exposure had the highest correlation with traffic proximity in tertiles in three centres. Self-reported exposure to high traffic intensity and traffic noise at each participant's residence had low or weak although statistically significant correlations with modelled vehicle exhaust pollution levels and traffic proximity.

  • 3. Chen, Gongbo
    et al.
    Guo, Yuming
    Yue, Xu
    Tong, Shilu
    Gasparrini, Antonio
    Bell, Michelle L.
    Armstrong, Ben
    Schwartz, Joel
    Jaakkola, Jouni J. K.
    Zanobetti, Antonella
    Lavigne, Eric
    Nascimento Saldiva, Paulo Hilario
    Kan, Haidong
    Royé, Dominic
    Milojevic, Ai
    Overcenco, Ala
    Urban, Aleš
    Schneider, Alexandra
    Entezari, Alireza
    Vicedo-Cabrera, Ana Maria
    Zeka, Ariana
    Tobias, Aurelio
    Nunes, Baltazar
    Alahmad, Barrak
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Pan, Shih-Chun
    Íñiguez, Carmen
    Ameling, Caroline
    De la Cruz Valencia, César
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Houthuijs, Danny
    Van Dung, Do
    Samoli, Evangelia
    Mayvaneh, Fatemeh
    Sera, Francesco
    Carrasco-Escobar, Gabriel
    Lei, Yadong
    Orru, Hans
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia..
    Kim, Ho
    Holobaca, Iulian-Horia
    Kyselý, Jan
    Teixeira, João Paulo
    Madureira, Joana
    Katsouyanni, Klea
    Hurtado-Díaz, Magali
    Maasikmets, Marek
    Ragettli, Martina S.
    Hashizume, Masahiro
    Stafoggia, Massimo
    Pascal, Mathilde
    Scortichini, Matteo
    de Sousa Zanotti Stagliorio Coêlho, Micheline
    Valdés Ortega, Nicolás
    Ryti, Niilo R. I.
    Scovronick, Noah
    Matus, Patricia
    Goodman, Patrick
    Garland, Rebecca M.
    Abrutzky, Rosana
    Garcia, Samuel Osorio
    Rao, Shilpa
    Fratianni, Simona
    Dang, Tran Ngoc
    Colistro, Valentina
    Huber, Veronika
    Lee, Whanhee
    Seposo, Xerxes
    Honda, Yasushi
    Guo, Yue Leon
    Ye, Tingting
    Yu, Wenhua
    Abramson, Michael J.
    Samet, Jonathan M.
    Li, Shanshan
    Mortality risk attributable to wildfire-related PM2·5 pollution: a global time series study in 749 locations2021In: The Lancet Planetary Health, E-ISSN 2542-5196, Vol. 5, no 9, p. e579-e587Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world.

    METHODS: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated.

    FINDINGS: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period.

    INTERPRETATION: Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires.

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  • 4. Choi, Hayon Michelle
    et al.
    Lee, Whanhee
    Roye, Dominic
    Heo, Seulkee
    Urban, Aleš
    Entezari, Alireza
    Vicedo-Cabrera, Ana Maria
    Zanobetti, Antonella
    Gasparrini, Antonio
    Analitis, Antonis
    Tobias, Aurelio
    Armstrong, Ben
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Íñiguez, Carmen
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Indermitte, Ene
    Lavigne, Eric
    Mayvaneh, Fatemeh
    Acquaotta, Fiorella
    Sera, Francesco
    Orru, Hans
    Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia..
    Kim, Ho
    Kyselý, Jan
    Madueira, Joana
    Schwartz, Joel
    Jaakkola, Jouni J. K.
    Katsouyanni, Klea
    Diaz, Magali Hurtado
    Ragettli, Martina S.
    Pascal, Mathilde
    Ryti, Niilo
    Scovronick, Noah
    Osorio, Samuel
    Tong, Shilu
    Seposo, Xerxes
    Guo, Yue Leon
    Guo, Yuming
    Bell, Michelle L.
    Effect modification of greenness on the association between heat and mortality: A multi-city multi-country study2022In: EBioMedicine, E-ISSN 2352-3964, Vol. 84, article id 104251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Identifying how greenspace impacts the temperature-mortality relationship in urban environments is crucial, especially given climate change and rapid urbanization. However, the effect modification of greenspace on heat-related mortality has been typically focused on a localized area or single country. This study examined the heat-mortality relationship among different greenspace levels in a global setting.

    METHODS: We collected daily ambient temperature and mortality data for 452 locations in 24 countries and used Enhanced Vegetation Index (EVI) as the greenspace measurement. We used distributed lag non-linear model to estimate the heat-mortality relationship in each city and the estimates were pooled adjusting for city-specific average temperature, city-specific temperature range, city-specific population density, and gross domestic product (GDP). The effect modification of greenspace was evaluated by comparing the heat-related mortality risk for different greenspace groups (low, medium, and high), which were divided into terciles among 452 locations.

    FINDINGS: Cities with high greenspace value had the lowest heat-mortality relative risk of 1·19 (95% CI: 1·13, 1·25), while the heat-related relative risk was 1·46 (95% CI: 1·31, 1·62) for cities with low greenspace when comparing the 99th temperature and the minimum mortality temperature. A 20% increase of greenspace is associated with a 9·02% (95% CI: 8·88, 9·16) decrease in the heat-related attributable fraction, and if this association is causal (which is not within the scope of this study to assess), such a reduction could save approximately 933 excess deaths per year in 24 countries.

    INTERPRETATION: Our findings can inform communities on the potential health benefits of greenspaces in the urban environment and mitigation measures regarding the impacts of climate change.

    FUNDING: This publication was developed under Assistance Agreement No. RD83587101 awarded by the U.S. Environmental Protection Agency to Yale University. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in this publication was also supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD012769. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Also, this work has been supported by the National Research Foundation of Korea (2021R1A6A3A03038675), Medical Research Council-UK (MR/V034162/1 and MR/R013349/1), Natural Environment Research Council UK (Grant ID: NE/R009384/1), Academy of Finland (Grant ID: 310372), European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655 and 874990), Czech Science Foundation (22-24920S), Emory University's NIEHS-funded HERCULES Center (Grant ID: P30ES019776), and Grant CEX2018-000794-S funded by MCIN/AEI/ 10.13039/501100011033 The funders had no role in the design, data collection, analysis, interpretation of results, manuscript writing, or decision to publication.

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  • 5.
    Dahal, Usha
    et al.
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Institute of Social Science, University of Tartu, Tartu, Estonia.
    Orru, Kati
    Institute of Social Science, University of Tartu, Tartu, Estonia.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Dijst, Martin
    Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg; University of Luxembourg, Esch-sur-Alzette, Luxembourg.
    Green dreams, local realities: Complexities of the European Union's energy transition to ensure local health and well-being in a fossil fuel-based industrial region2024In: Environmental impact assessment review, ISSN 0195-9255, E-ISSN 1873-6432, Vol. 106, article id 107520Article in journal (Refereed)
    Abstract [en]

    European Union's Green Deal is a legal obligation to EU countries to shift towards environment-friendly energy systems from fossil-fuel-based systems. This transition will bring significant global health benefits by combating climate change, but it is crucial to understand the so far understudied impacts on local communities' lives and, thus, on their health and well-being. The study proposes a novel conceptual framework based on socio-technical systems theory and the production of space theory to identify the interacting points between energy systems and health and well-being systems in the energy transition context. This framework is tested in Estonia's transitioning fossil fuel oil-shale-based energy system based on four focus group discussions, ten expert interviews, and document analysis. We innovatively pinpoint pathways, including feedback loops, through a causal loop diagram (CLD) impacting inhabitants' health and well-being from the interplay between energy and health and well-being systems. The analysis indicates that protecting and promoting health and well-being has been a challenge not only due to disruption created by the energy transition process but also due to the accumulated problems regarding socioeconomic conditions, environmental health impacts, and well-being at the local level. The compound effects of multiple existing and emerging issues, including the divergent interpretations of health and the lack of holistic support mechanisms for inhabitants to navigate the changes in sociocultural and economic space, can harm locals' health and well-being. The developed conceptual framework provides an important theoretical background to study the impacts on the mental and physical health, including social health and well-being, of the inhabitants living in the fossil-fuel-based industrial area. The CLD developed using this framework demonstrates the interacting points to avoid unintended consequences of energy transition.

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  • 6.
    Dahal, Usha
    et al.
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Institute of Social Science, University of Tartu, Tartu, Estonia.
    Veber, Triin
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Oudin Åström, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Tamm, Tanel
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Albreht, Leena
    Environmental Health Department, Estonian Health Board, Tallinn, Estonia.
    Teinemaa, Erik
    Estonian Environmental Research Centre, Tallinn, Estonia.
    Orru, Kati
    Institute of Social Science, University of Tartu, Tartu, Estonia.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Perinatal Health Inequalities in the Industrial Region of Estonia: A Birth Registry-Based Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 18, article id 11559Article in journal (Refereed)
    Abstract [en]

    Despite the increasing number of studies on industrially contaminated sites (ICS) and their health effects, there are very few studies on perinatal health outcomes in ICSs. In the present study, we examined the perinatal health inequalities by comparing adverse birth outcomes (ABOs) in the oil shale industry region of Ida-Viru County in Estonia with national-level figures and investigated the effects of maternal environmental and sociodemographic factors. Based on the 208,313 birth records from 2004–2018, Ida-Viru ICS has a birth weight 124.5 g lower than the average of 3544 g in Estonia. A higher prevalence of preterm birth (4.3%) and low birth weight (4.8%) in Ida-Viru ICS is found compared to 3.3% on both indicators at the national level. Multiple logistic regression analysis shows the statistically significant association of ABOs with fine particle (PM2.5) air pollution, mother’s ethnicity, and education throughout Estonia. However, in Ida-Viru ICS, the ABOs odds are remarkably higher in these characteristics except for the mother’s ethnicity. Furthermore, the ABOs are associated with the residential proximity to ICS. Thus, the Ida-Viru ICS has unequally higher odds of adverse perinatal health across the environmental and sociodemographic factors. In addition to reducing the air pollutants, policy actions on social disparities are vital to address the country’s unjustly higher perinatal health inequalities, especially in the Ida-Viru ICS.

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  • 7. Demuzere, M
    et al.
    Orru, K
    Heidrich, O
    Olazabal, E
    Geneletti, D
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. University of Tartu, Department of Public Health, Tartu, Estonia.
    Bhave, AG
    Mittal, N
    Feliu, E
    Faehnle, M
    Mitigating and adapting to climate change: multi-functional and multi-scale assessment of green urban infrastructure2014In: Journal of Environmental Management, ISSN 0301-4797, E-ISSN 1095-8630, Vol. 146, p. 107-115Article in journal (Refereed)
    Abstract [en]

    In order to develop climate resilient urban areas and reduce emissions, several opportunities exist starting from conscious planning and design of green (and blue) spaces in these landscapes. Green urban infrastructure has been regarded as beneficial, e.g. by balancing water flows, providing thermal comfort. This article explores the existing evidence on the contribution of green spaces to climate change mitigation and adaptation services. We suggest a framework of ecosystem services for systematizing the evidence on the provision of bio-physical benefits (e.g. CO2 sequestration) as well as social and psychological benefits (e.g. improved health) that enable coping with (adaptation) or reducing the adverse effects (mitigation) of climate change. The multi-functional and multi-scale nature of green urban infrastructure complicates the categorization of services and benefits, since in reality the interactions between various benefits are manifold and appear on different scales. We will show the relevance of the benefits from green urban infrastructures on three spatial scales (i.e. city, neighborhood and site specific scales). We will further report on co-benefits and trade-offs between the various services indicating that a benefit could in turn be detrimental in relation to other functions. The manuscript identifies avenues for further research on the role of green urban infrastructure, in different types of cities, climates and social contexts. Our systematic understanding of the bio-physical and social processes defining various services allows targeting stressors that may hamper the provision of green urban infrastructure services in individual behavior as well as in wider planning and environmental management in urban areas.

  • 8.
    Ekland, Johan
    et al.
    Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    Research Department, Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    The effect of current and future maternal exposure to near-surface ozone on preterm birth in 30 European countries: an EU-wide health impact assessment2021In: Environmental Research Letters, E-ISSN 1748-9326, Vol. 16, no 5, article id 055005Article in journal (Refereed)
    Abstract [en]

    Preterm birth is the largest contributor to neonatal mortality globally and it is also associated with several adverse health outcomes. Recent studies have found an association between maternal exposure to air pollution and an increased risk for preterm birth. As a constituent of air pollution, ozone is a highly reactive molecule with several negative health effects when present near earth's surface. This health impact assessment aims to estimate the proportion of preterm births - in current and future situations - attributable to maternal ozone exposure in 30 European countries (EU30). A literature search was performed using relevant keywords, followed by meta-analysis with STATA software in which five studies investigating exposure-response relationship of interest were included. The attributable proportion, and number of cases, was modelled with the software AirQ+ against current and future European ozone concentrations. According to our meta-analysis, the relative risk for giving birth preterm was calculated to 1.027 (95% CI 1.009-1.046) per 10 μg m-3 increase in ozone concentration. This rendered 7.1% (95% CI 2.5-11.7) of preterm births attributable to maternal ozone exposure to in EU30 during 2010, which is equal to approximately 27 900 cases. By 2050, the projected decrease in ozone precursor emissions rendered an estimated 30% decrease of ozone attributable preterm births. Not taking emission change into account, due to climate change the ozone-related preterm birth burden might slightly increase by 2050 in Central and Southern Europe, and decrease in Eastern and Northern Europe. In summation, these numbers make a substantial impact on public health.

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  • 9. GBD 2019 Hearing Loss Collaborators,
    Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 20192021In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 397, no 10278, p. 996-1009Article in journal (Refereed)
    Abstract [en]

    Background: Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability.

    Methods: We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050.

    Findings: An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence.

    Interpretation: As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings.

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  • 10.
    Haagsma, Juanita A.
    et al.
    Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Charalampous, Periklis
    Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Ariani, Filippo
    Epidemiology Unit, Central Tuscany Local Health Authority, Florence, Italy.
    Gallay, Anne
    Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France.
    Moesgaard Iburg, Kim
    Department of Public Health, Aarhus University, Aarhus, Denmark.
    Nena, Evangelia
    Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
    Ngwa, Che Henry
    School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
    Rommel, Alexander
    Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
    Zelviene, Ausra
    Institute of Hygiene, Health Information Center, Kaunas, Lithuania.
    Abegaz, Kedir Hussein
    Department of Biostatistics, Near East University, Nicosia, Cyprus; Department of Biostatistics and Health Informatics, Madda Walabu University, Bale Robe, Ethiopia.
    Al Hamad, Hanadi
    Geriatrics and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar.
    Albano, Luciana
    Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
    Liliana Andrei, Catalina
    Cardiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
    Andrei, Tudorel
    Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania.
    Antonazzo, Ippazio Cosimo
    Research Center On Public Health, University of Milan-Bicocca, Monza, Italy.
    Aremu, Olatunde
    Department of Public Health, Birmingham City University, Birmingham, United Kingdom.
    Arumugam, Ashokan
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Atreya, Alok
    Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal.
    Aujayeb, Avinash
    Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom.
    Ayuso-Mateos, Jose Luis
    Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain; Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain.
    Engelbert Bain, Luchuo
    Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, United Kingdom; Global South Health Services and Research, GSHS, Amsterdam, Netherlands.
    Banach, Maciej
    Department of Hypertension, Medical University of Lodz, Lodz, Poland; Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland.
    Winfried Bärnighausen, Till
    Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany; T.H. Chan School of Public Health, Harvard University, MA, Boston, United States.
    Barone-Adesi, Francesco
    Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
    Beghi, Massimiliano
    Department of Mental Health, AUSL Romagna, Cesena, Italy.
    Bennett, Derrick A.
    Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Bhagavathula, Akshaya S.
    Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Social and Clinical Pharmacy, Charles University, Hradec Kralova, Prague, Czech Republic.
    Carvalho, Félix
    Research Unit On Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal.
    Castelpietra, Giulio
    Outpatient and Inpatient Care Service, Central Health Directorate, Friuli Venezia Giulia Region, Trieste, Italy.
    Caterina, Ledda
    Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
    Chandan, Joht Singh
    Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
    Couto, Rosa A. S.
    Department of Chemical Sciences, University of Porto, Porto, Portugal.
    Cruz-Martins, Natália
    Faculty of Medicine, University of Porto, Porto, Portugal; Institute for Research & Innovation in Health (i3S), University of Porto, Porto, Portugal; Institute of Research and Advanced, Training in Health Sciences and Technologies (INFACTS), Gandra, Portugal.
    Damiani, Giovanni
    Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy; Department of Dermatology, Case Western Reserve University, OH, Cleveland, United States.
    Dastiridou, Anna
    Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece.
    Demetriades, Andreas K.
    Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
    Dias-da-Silva, Diana
    Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
    Francis Fagbamigbe, Adeniyi
    Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Fereshtehnejad, Seyed-Mohammad
    Division of Neurology, Department of Medicine, University of Ottawa, ON, Ottawa, Canada; Division of Clinical Geriatrics, Department of Neurobiology, Karolinska Institute, Stockholm, Sweden.
    Fernandes, Eduarda
    Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal.
    Ferrara, Pietro
    Research Center On Public Health, University of Milan-Bicocca, Monza, Italy.
    Fischer, Florian
    Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
    Fra.Paleo, Urbano
    Research Institute for Sustainable Land Development (Interra), University of Extremadura, Caceres, Spain.
    Ghirini, Silvia
    National Center On Addictions and Doping, Istituto Superiore Di Sanità, Rome, Italy.
    Glasbey, James C.
    NIHR Global Health Research Unit On Global Surgery, University of Birmingham, Birmingham, United Kingdom.
    Glavan, Ionela-Roxana
    Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania.
    Gomes, Nelson G. M.
    Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal; Department of Chemistry, University of Porto, Porto, Portugal.
    Grivna, Michal
    Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates.
    Harlianto, Netanja I.
    Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.
    Haro, Josep Maria
    Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain; Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain.
    Hasan, M. Tasdik
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom.
    Hostiuc, Sorin
    Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania.
    Iavicoli, Ivo
    Department of Public Health, University of Naples Federico II, Naples, Italy.
    Ilic, Milena D.
    Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia.
    Ilic, Irena M.
    Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
    Jakovljevic, Mihajlo
    N. A. Semashko Department of Public Health and Healthcare, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; Department of Global Health, Economics and Policy, University of Kragujevac, Kragujevac, Serbia.
    Jonas, Jost B.
    Department of Ophthalmology, Heidelberg University, Mannheim, Germany; Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China.
    Jerzy Jozwiak, Jacek
    Department of Family Medicine and Public Health, University of Opole, Opole, Poland.
    Jürisson, Mikk
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Kauppila, Joonas H.
    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Surgery Research Unit, University of Oulu, Oulu, Finland.
    Kayode, Gbenga A.
    International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, Netherlands.
    Khan, Moien A. B.
    Department of Family Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates; Primary Care Department, NHS North West London, London, United Kingdom.
    Kisa, Adnan
    School of Health Sciences, Kristiania University College, Oslo, Norway; Department of Global Community Health and Behavioral Sciences, Tulane University, LA, New Orleans, United States.
    Kisa, Sezer
    Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
    Koyanagi, Ai
    Biomedical Research Networking Center for Mental Health Network (CiberSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
    Kumar, Manasi
    Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Division of Psychology and Language Sciences, University College London, London, United Kingdom.
    Kurmi, Om P.
    Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada; Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.
    La-Vecchia, Carlo
    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
    Lamnisos, Demetris
    Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus.
    Lasrado, Savita
    Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India.
    Lauriola, Paolo
    Institute of Clinical Physiology, National Research Council, Pisa, Italy.
    Linn, Shai
    School of Public Health, University of Haifa, Haifa, Israel.
    Loureiro, Joana A.
    Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), University of Porto, Porto, Portugal.
    Lunevicius, Raimundas
    Department of General Surgery, School of Medicine, Liverpool University Hospitals NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom.
    Madureira-Carvalho, Aurea
    Institute of Research and Advanced, Training in Health Sciences and Technologies (INFACTS), Gandra, Portugal; Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade Do Porto, Porto, Portugal.
    Mechili, Enkeleint A.
    Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece; Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania.
    Majeed, Azeem
    Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
    Menezes, Ritesh G.
    Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
    Mentis, Alexios-Fotios A.
    Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece; Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
    Meretoja, Atte
    School of Health Sciences, University of Melbourne, VIC, Melbourne, Australia; Neurology Unit, Helsinki University Hospital, Helsinki, Finland.
    Mestrovic, Tomislav
    Clinical Microbiology and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia; University Centre Varazdin, University North, Varazdin, Croatia.
    Miazgowski, Tomasz
    Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland.
    Miazgowski, Bartosz
    Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland.
    Mirica, Andreea
    Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania.
    Molokhia, Mariam
    Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom.
    Mohammed, Shafiu
    Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany; Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria.
    Monasta, Lorenzo
    Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy.
    Mulita, Francesk
    Department of General Surgery, University General Hospital of Patras, Patras, Greece.
    David Naimzada, Mukhammad
    Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation; Experimental Surgery and Oncology Laboratory, Kursk State Medical University, Kursk, Russian Federation.
    Negoi, Ionut
    Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania.
    Neupane, Subas
    Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Gerontology Research Center, Tampere University, Tampere, Finland.
    Oancea, Bogdan
    Administrative and Economic Sciences Department, University of Bucharest, Bucharest, Romania.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Otoiu, Adrian
    Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania.
    Otstavnov, Nikita
    Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation.
    Otstavnov, Stanislav S.
    Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation; Department of Project Management, National Research University Higher School of Economics, Moscow, Russian Federation.
    Padron-Monedero, Alicia
    National School of Public Health, Institute of Health Carlos III, Madrid, Spain.
    Panda-Jonas, Songhomitra
    Department of Ophthalmology, Heidelberg University, Mannheim, Germany.
    Pardhan, Shahina
    Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom.
    Patel, Jay
    Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
    Pedersini, Paolo
    IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
    Pinheiro, Marina
    Department of Chemistry, University of Porto, Porto, Portugal.
    Rakovac, Ivo
    World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation.
    Rao, Chythra R.
    Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India.
    Rawaf, Salman
    Department of Primary Care and Public Health, Imperial College London, London, United Kingdom; Academic Public Health Department, Public Health England, London, United Kingdom.
    Rawaf, David Laith
    World Health Organization (WHO) Collaborating Centre for Public Health Education and Training, Imperial College London, London, United Kingdom; University College London Hospitals, London, United Kingdom.
    Rodrigues, Violet
    Community Nursing Unit, Ireland Hospital, Abbeyleix, Ireland.
    Ronfani, Luca
    Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy.
    Sagoe, Dominic
    Department of Psychosocial Science, University of Bergen, Bergen, Norway.
    Sanmarchi, Francesco
    Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
    Santric-Milicevic, Milena M.
    Faculty of Medicine, University of Belgrade, Belgrade, Serbia; School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia.
    Sathian, Brijesh
    Geriatrics and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar; Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom.
    Sheikh, Aziz
    Centre for Medical Informatics, University of Edinburgh, Edinburgh, United Kingdom; Division of General Internal Medicine, Harvard University, MA, Boston, United States.
    Shiri, Rahman
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Shivalli, Siddharudha
    Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom.
    Dora Sigfusdottir, Inga
    Department of Psychology, Reykjavik University, Reykjavik, Iceland; Icelandic Centre for Social Research and Analysis (ICSRA), Reykjavik, Iceland; Department of Health and Behavior Studies, Teachers College, Columbia University, NY, New York, United States.
    Sigurvinsdottir, Rannveig
    Department of Psychology, Reykjavik University, Reykjavik, Iceland.
    Yurievich Skryabin, Valentin
    Department No.16, Moscow Research and Practical Centre On Addictions, Moscow, Russian Federation.
    Aleksandrovna Skryabina, Anna
    Therapeutic Department, Balashiha Central Hospital, Balashikha, Russian Federation.
    Smarandache, Catalin-Gabriel
    Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
    Socea, Bogdan
    Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
    Sousa, Raúl A. R. C.
    Professional Association of Licensed Optometry Professionals, Linda-a-Velha, Portugal.
    Steiropoulos, Paschalis
    Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, Alexandroupolis, Greece.
    Tabarés-Seisdedos, Rafael
    Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
    Roberto Tovani-Palone, Marcos
    Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil.
    Tozija, Fimka
    Institute of Public Health of Republic of North Macedonia, Saints Cyril and Methodius University of Skopje, Skopje, North Macedonia.
    Van de Velde, Sarah
    Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium.
    Juhani Vasankari, Tommi
    UKK Institute, Tampere, Finland.
    Veroux, Massimiliano
    Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy.
    Violante, Francesco S.
    Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Occupational Health Unit, Sant’Orsola Malpighi Hospital, Bologna, Italy.
    Vlassov, Vasiliy
    Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russian Federation.
    Wang, Yanzhong
    School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom.
    Yadollahpour, Ali
    Psychology Department, University of Sheffield, Sheffield, United Kingdom.
    Yaya, Sanni
    School of International Development and Global Studies, University of Ottawa, ON, Ottawa, Canada; The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
    Sergeevich Zastrozhin, Mikhail
    Laboratory of Genetics and Genomics, Moscow Research and Practical Centre On Addictions, Moscow, Russian Federation; Addictology Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation.
    Zastrozhina, Anasthasia
    Pediatrics Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation.
    Polinder, Suzanne
    Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
    Majdan, Marek
    Department of Public Health, Institute for Global Health and Epidemiology, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia.
    The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study2022In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 80, no 1, article id 142Article in journal (Refereed)
    Abstract [en]

    Background: Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries.

    Methods: We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year.

    Results: In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019.

    Conclusions: Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.

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  • 11. Heidrich, O
    et al.
    Reckien, D
    Olazabal, M
    Foley, A
    Salvia, M
    de Gregorio Hurtado, S
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Flacke, J
    Geneletti, D
    Pietrapertosa, F
    Hamann, J J-P
    Tiwary, A
    Feliu, E
    Dawson, R J
    National climate policies across Europe and their impacts on cities strategies.2016In: Journal of Environmental Management, ISSN 0301-4797, E-ISSN 1095-8630, Vol. 168, p. 36-45Article in journal (Refereed)
    Abstract [en]

    Globally, efforts are underway to reduce anthropogenic greenhouse gas emissions and to adapt to climate change impacts at the local level. However, there is a poor understanding of the relationship between city strategies on climate change mitigation and adaptation and the relevant policies at national and European level. This paper describes a comparative study and evaluation of cross-national policy. It reports the findings of studying the climate change strategies or plans from 200 European cities from Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Italy, Netherlands, Spain and the United Kingdom. The study highlights the shared responsibility of global, European, national, regional and city policies. An interpretation and illustration of the influences from international and national networks and policy makers in stimulating the development of local strategies and actions is proposed. It was found that there is no archetypical way of planning for climate change, and multiple interests and motivations are inevitable. Our research warrants the need for a multi-scale approach to climate policy in the future, mainly ensuring sufficient capacity and resource to enable local authorities to plan and respond to their specific climate change agenda for maximising the management potentials for translating environmental challenges into opportunities.

  • 12. Idavain, J.
    et al.
    Julge, K.
    Rebane, T.
    Lang, A.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. University of Tartu, Institute of Family Medicine and Public Health, Ravila 19, 50411 Tartu, Estonia.
    Respiratory symptoms, asthma and levels of fractional exhaled nitric oxide in schoolchildren in the industrial areas of Estonia2019In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 650, no Pt 1, p. 65-72Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Exposure to air pollutants in the ambient environment has been associated with various respiratory symptoms, and with increased asthma diagnosis, in both children and adults. Most research to date has focussed on core pollutants, such as PM10, PM2.5, SO2 and NO2, and less attention has been given to the effects of industry-specific contamination. The current study aimed to examine the associations between respiratory symptoms, asthma, increased levels of fractional exhaled nitric oxide (FeNO) (as a marker of eosinophilic airway inflammation) and ambient levels of industrial pollutants (such as benzene, phenol, formaldehyde and non-methane hydrocarbons) for schoolchildren living near oil shale industries in Ida-Viru County, Estonia.

    METHODS: A total of 1326 schoolchildren from Ida-Viru, Lääne-Viru and Tartu Counties participated in a cross-sectional study, consisting of questionnaires on respiratory symptoms and asthma, as well as clinical examinations to measure FeNO. Dispersion modelling was used to characterize individual-level exposure to industrial air pollutants at each subject's home address. Associations between exposure and respiratory health were investigated using logistic regression analysis, and differences in results between regions were analysed using the Chi-squared test.

    RESULTS: The prevalence of respiratory symptoms (p < 0.05) in children living near (i.e. within 5 km) of an oil shale industry site in Ida-Viru County was 2-4 times higher than in children living in the reference area of Tartu County. Children exposed to 1 μg/m3 higher levels of benzene and formaldehyde had a higher odds ratio (OR) of having rhinitis without a cold (OR 1.03, 95% confidence interval (CI) 1.01-1.06), of ever having had attacks of asthma (OR 1.05, 95% CI 1.01-1.10) and of having a dry cough a few days per year (OR 1.05, 95% CI 1.01-1.10). Children exposed to 1 μg/m3 higher levels of benzene, formaldehyde, phenol and non-methane hydrocarbons had a higher odds ratio of having high FeNO levels (≥30 ppb): OR and 95% CI of 1.05, 1.01-1.09; 1.22, 1.06-1.41; 1.01, 1.00-1.01; and 1.75, 1.75-2.62, respectively.

  • 13. Idavain, Jane
    et al.
    Lang, Katrin
    Tomasova, Jelena
    Lang, Aavo
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Estonia.
    Cancer Incidence Trends in the Oil Shale Industrial Region in Estonia2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 11, article id 3833Article in journal (Refereed)
    Abstract [en]

    Large oil shale resources are found in Eastern Estonia, where the mineral resource is mined, excavated, and used for electricity generation and shale oil extraction. During industrial activities in the last 100 years, pollutants have been emitted in large amounts, some of which are toxic and carcinogenic. The current study aims to analyse time trends in cancer incidence in the oil shale industry-affected areas and compare them with overall cancer incidence rates and trends in Estonia. We analysed Estonian Cancer Registry data on selected cancer sites that have been previously indicated to have relationships with industrial activities like oil shale extraction. We included lung cancer, kidney cancer, urinary bladder cancer, leukaemia, breast cancer, and non-Hodgkin's lymphoma. A statistically significantly higher lung cancer age-standardized incidence rate (ASIR) was found during the study period (1992-2015) only in males in the oil shale areas as compared to males in Estonia overall: 133.6 and 95.5 per 100,000, respectively. However, there appeared to be a statistically significant (p < 0.05) decrease in the lung cancer ASIR in males in the oil shale areas (overall decrease 28.9%), whereas at the same time, there was a significant increase (p < 0.05) in non-oil shale areas (13.3%) and in Estonia overall (1.5%). Other cancer sites did not show higher ASIRs in the oil shale industrial areas compared to other areas in Estonia. Possible explanations could be improved environmental quality, socio-economic factors, and other morbidities.

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  • 14.
    Kaasik, Marko
    et al.
    Institute of Physics, University of Tartu, Tartu, Estonia.
    Pindus, Mihkel
    Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Tamm, Tanel
    Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Modelling the air quality for assessing the health benefits of urban regeneration: a case of Tallinn city centre, Estonia2019In: International Journal of Environment and Pollution, ISSN 0957-4352, E-ISSN 1741-5101, Vol. 65, no 1-3, p. 246-265Article in journal (Refereed)
    Abstract [en]

    Concentrations of nitrogen dioxide and particulate matter were modelled to assess the health benefits of an urban regeneration scenario for the central part of Tallinn, where the traffic on two of the main streets will be reduced to create a more friendly space for active commuters. To model the air quality the stationary Gaussian plume model AEROPOL was used with a 25 m grid resolution. The model was validated against a stationary air quality monitoring station in the domain. The health benefits of the scenarios were calculated based on the changes in air pollution exposures for residents and daily visitors, using methods of health impact assessment. This research predicts that each year the reduction of exhaust (indicated by NO2) and road dust (indicated by PM10) exposure in the city centre would prevent up to 0.29 premature deaths (-27%) among the general population, 0.57 deaths (-3.6%) among daily visitors, 0.18 deaths (-21.2%) among pedestrians, and 0.03 deaths (-24.7%) among people public transport users.

  • 15. Lee, Jae Young
    et al.
    Kim, Ho
    Gasparrini, Antonio
    Armstrong, Ben
    Bell, Michelle L
    Sera, Francesco
    Lavigne, Eric
    Abrutzky, Rosana
    Tong, Shilu
    Coelho, Micheline de Sousa Zanotti Stagliorio
    Saldiva, Paulo Hilario Nascimento
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Kan, Haidong
    Garcia, Samuel Osorio
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Pascal, Mathilde
    Goodman, Patrick G
    Zeka, Ariana
    Michelozzi, Paola
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado, Magali
    Cruz, Julio
    Seposo, Xerxes
    Nunes, Baltazar
    Teixeira, João Paulo
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Vicedo-Cabrera, Ana Maria
    Ragettli, Martina S
    Guo, Yue-Liang Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Dang, Tran Ngoc
    Do Van, Dung
    Mayvaneh, Fetemeh
    Overcenco, Ala
    Li, Shanshan
    Guo, Yuming
    Predicted temperature-increase-induced global health burden and its regional variability2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 131, article id 105027Article in journal (Refereed)
    Abstract [en]

    An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.

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  • 16. Liu, Cong
    et al.
    Cai, Jing
    Chen, Renjie
    Sera, Francesco
    Guo, Yuming
    Tong, Shilu
    Li, Shanshan
    Lavigne, Eric
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Maasikmets, Marek
    Jaakkola, Jouni J.K.
    Ryti, Niilo
    Breitner, Susanne
    Schneider, Alexandra
    Katsouyanni, Klea
    Samoli, Evangelina
    Hashizume, Masahiro
    Honda, Yasushi
    Ng, Chris Fook Sheng
    Diaz, Magali Hurtado
    Valencia, César De la Cruz
    Rao, Shilpa
    Palomares, Alfonso Diz-Lois
    Silva, Susana Pereira da
    Madureira, Joana
    Holobâc, Iulian Horia
    Fratianni, Simona
    Scovronick, Noah
    Garland, Rebecca M.
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Vicedo-Cabrera, Ana Maria
    Ragettli, Martina S.
    Guo, Yue-Liang Leon
    Pan, Shih-Chun
    Milojevic, Ai
    Bell, Michelle L.
    Zanobetti, Antonella
    Schwartz, Joel
    Gasparrini, Antonio
    Kan, Haidong
    Coarse particulate air pollution and daily mortality: a global study in 205 cities2022In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 206, no 8, p. 999-1007Article in journal (Refereed)
    Abstract [en]

    RATIONALE: The associations between ambient coarse particulate matter (PM2.5-10) and daily mortality is not fully understood at a global scale.

    OBJECTIVES: To evaluate the short-term associations between PM2.5-10 and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide.

    METHODS: We collected daily mortality (total, cardiovascular, respiratory) and air pollution data from 205 cities in 20 countries/regions. Concentrations of PM2.5-10 were computed as the difference between inhalable and fine particulate matter. A two-stage time-series analytic approach was applied, with over-dispersed generalized linear models and multilevel meta-analysis. We fitted two-pollutant models to test the independent effect of PM2.5-10 from co-pollutants (fine particulate matter, nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide). Exposure-response relationship curves were pooled and regional analyses were conducted.

    MEASUREMENTS AND MAIN RESULTS: A 10 μg/m3 increase in PM2.5-10 concentration on lag 0-1 day was associated with increments of 0.51% (95% confidence interval [CI]: 0.18%, 0.84%), 0.43% (95%CI: 0.15%, 0.71%) and 0.41% (95%CI: 0.06%, 0.77%) in total, cardiovascular, and respiratory mortality, respectively. The associations varied by country and region. These associations were robust to adjustment by all co-pollutants in two-pollutant models, especially for PM2.5. The exposure-response curves for total, cardiovascular, and respiratory mortality were positive, with steeper slopes at lower exposure ranges and without discernible thresholds.

    CONCLUSIONS: This study provides novel global evidence on the robust and independent associations between short-term exposure to ambient PM2.5-10 and total, cardiovascular and respiratory mortality, suggesting the need to establish a unique guideline or regulatory limit for daily concentrations of PM2.5-10.

  • 17. Liu, Cong
    et al.
    Chen, Renjie
    Sera, Francesco
    Vicedo-Cabrera, Ana M
    Guo, Yuming
    Tong, Shilu
    Coelho, Micheline S Z S
    Saldiva, Paulo H N
    Lavigne, Eric
    Matus, Patricia
    Valdes Ortega, Nicolas
    Osorio Garcia, Samuel
    Pascal, Mathilde
    Stafoggia, Massimo
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Hurtado-Díaz, Magali
    Cruz, Julio
    Nunes, Baltazar
    Teixeira, João P
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ragettli, Martina S
    Guo, Yue-Leon
    Chen, Bing-Yu
    Bell, Michelle L
    Wright, Caradee Y
    Scovronick, Noah
    Garland, Rebecca M
    Milojevic, Ai
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Indermitte, Ene
    Jaakkola, Jouni J K
    Ryti, Niilo R I
    Katsouyanni, Klea
    Analitis, Antonis
    Zanobetti, Antonella
    Schwartz, Joel
    Chen, Jianmin
    Wu, Tangchun
    Cohen, Aaron
    Gasparrini, Antonio
    Kan, Haidong
    Ambient Particulate Air Pollution and Daily Mortality in 652 Cities2019In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 381, no 8, p. 705-715Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.

    METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) 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.

    RESULTS: On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 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 PM2.5 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.

    CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 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.).

  • 18. Lux, Harald
    et al.
    Baur, Xaver
    Budnik, Lygia Therese
    Heutelbeck, Astrid
    Teixeira, Joao Paulo
    Neumann, Emeri
    Adliene, Diana
    Puiso, Judita
    Lucas, David
    Londahl, Jakob
    Damialis, Athanasios
    Goksel, Ozlem
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Outdoor air pollution from industrial chemicals causing new onset of asthma or COPD: a systematic review protocol2020In: Journal of Occupational Medicine and Toxicology, E-ISSN 1745-6673, Vol. 15, no 1, article id 38Article, review/survey (Refereed)
    Abstract [en]

    Background: Until today, industrial sources contribute to the multifaceted contamination of environmental air. Exposure to air pollutants has the potential to initiate and promote asthma and chronic obstructive pulmonary disease (COPD). At global scale, both entities cause the majority of about 4 million annual deaths by respiratory disease. However, we identified industrial contamination as a subgroup of air pollution that may be associated with this burden and is underinvestigated in research. Therefore, the aim of this study is to investigate associations between substances industrially released into environmental air and the occurrence of asthma and COPD in the human population. Here we present the protocol for our systematic review of the current evidence.

    Methods: The following determinations will be applied during the systematic review process and are specified in the protocol that complies with the PRISMA-P statement. Populations of children and adults, as well as outdoor workers, exposed to industrially released air pollutants are of interest. Eligible studies may include subjects as controls who are non- or less exposed to the investigated air pollutants. The outcomes new-onset asthma and/or COPD investigated with risk ratio, odds ratio, hazard ratio, incidence rate ratio, cumulative incidence, and incidence rate are eligible. We will search the electronic literature databases EMBASE, MEDLINE, and Web of Science for peer-reviewed reports of incidence studies and incidence case-control studies. After systematic sorting of initial records, included studies will be subjected to quality assessment. Data will be synthesized qualitatively and, if appropriate, quantitatively for risk ratio and odds ratio. We will maintain and provide a PRISMA report.

    Discussion: Results of this systematic review may indicate alterations of incidence and risk of asthma and/or COPD in populations within industrial exposure radiuses including outdoor workplaces. Specific causal substances and compositions will be identified, but results will depend on the exposure assessment of the eligible studies. Our approach covers effects of industrial contributions to overall air pollution if studies reportedly attribute investigated emissions to industry. Results of this study may raise the question wether the available higher-level evidence sufficiently covers the current scale of industrial exposure scenarios and their potential harm to respiratory health.

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  • 19. Markevych, Iana
    et al.
    Fuertes, Elaine
    Marcon, Alessandro
    Dadvand, Payam
    Nowak, Dennis
    Aymerich, Judith Garcia
    Vienneau, Danielle
    De Hoogh, Kees
    Jarvis, Deborah
    Abramson, Michael J.
    Accordini, Simone
    Amaral, Andre
    Bentouhami, Hayat
    Bertelsen, Randi Jacobsen
    Boudier, Anne
    Bono, Roberto
    Bowatte, Gayan
    Carsin, Anne-Elie
    Dharmage, Shyamali Chandrika
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gislason, Thorarinn
    Gnesi, Marco
    Holm, Mathias
    Jacquemin, Benedicte
    Janson, Christer
    Jogi, Rain
    Johannessen, Ane
    Keidel, Dirk
    Leynaert, Benedicte
    Perez, Jose Antonio Maldonado
    Marchetti, Piepaolo
    Migliore, Enrica
    Martinez Moratalla, Jesus
    Olsson, David
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Pin, Isabelle
    Potts, James
    Probst-Hensch, Nicole
    Ranzi, Andrea
    Luis Sanchez-Ramos, Jose
    Siroux, Valerie
    Schindler, Christian
    Soussan, David
    Sunyer, Jordi
    Svanes, Cecilie
    Urrutia Landa, Isabel
    Villani, Simona
    Weyler, Joost
    Heinrich, Joachim
    Residential greenness and lung function in a prospective cohort of European adults: The ECRHS study2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54Article in journal (Other academic)
  • 20.
    Markevych, Iana
    et al.
    Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute of Psychology, Jagiellonian University, Krakow, Poland.
    Zhao, Tianyu
    Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
    Fuertes, Elaine
    National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, London, United Kingdom.
    Marcon, Alessandro
    Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
    Dadvand, Payam
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
    Vienneau, Danielle
    Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
    Garcia Aymerich, Judith
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
    Nowak, Dennis
    Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
    de Hoogh, Kees
    Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
    Jarvis, Deborah
    National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, London, United Kingdom.
    Abramson, Michael J.
    School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, Australia.
    Accordini, Simone
    Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
    Amaral, Andre F.S.
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Bentouhami, Hayat
    Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
    Jacobsen Bertelsen, Randi
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
    Boudier, Anne
    Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS, UMR 5309, Université Grenoble Alpes, Grenoble, France; Pediatric Department, CHU Grenoble Alpes, Grenoble, France.
    Bono, Roberto
    Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
    Bowatte, Gayan
    Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Faculty of Allied Health, University of Peradeniya, Kandy, Sri Lanka; National Institute of Fundamental Studies, Kandy, Sri Lanka.
    Casas, Lidia
    Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium.
    Dharmage, Shyamali C.
    Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Gislason, Thorarinn
    Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Gnesi, Marco
    Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
    Holm, Mathias
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jacquemin, Benedicte
    Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Jogi, Rain
    Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Johannessen, Ane
    Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
    Keidel, Dirk
    Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
    Leynaert, Benedicte
    Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, Villejuif, France.
    Maldonado Perez, José Antonio
    Sección de Neumología, Hospital Juan Ramón Jiménez, Huelva, Spain.
    Marchetti, Pierpaolo
    Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
    Migliore, Enrica
    Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy.
    Martínez-Moratalla, Jesús
    Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Pin, Isabelle
    Pediatric Department, CHU Grenoble Alpes, Grenoble, France; CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, Grenoble, France.
    Potts, James
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Probst-Hensch, Nicole
    Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
    Ranzi, Andrea
    Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy.
    Sánchez-Ramos, José Luis
    Department of Nursing, University of Huelva, Huelva, Spain.
    Siroux, Valerie
    Pediatric Department, CHU Grenoble Alpes, Grenoble, France.
    Soussan, David
    Paris Diderot University, Faculty of Medicine, Paris, France; Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France.
    Sunyer, Jordi
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
    Urrutia Landa, Isabel
    Department of Pneumology, Galdakao Hospital, Galdakao, Spain.
    Villani, Simona
    Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
    Heinrich, Joachim
    Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
    Residential greenspace and lung function decline over 20 years in a prospective cohort: the ECRHS study2023In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 178, article id 108036Article in journal (Refereed)
    Abstract [en]

    Background: The few studies that have examined associations between greenspace and lung function in adulthood have yielded conflicting results and none have examined whether the rate of lung function decline is affected.

    Objective: We explored the association between residential greenspace and change in lung function over 20 years in 5559 adults from 22 centers in 11 countries participating in the population-based, international European Community Respiratory Health Survey.

    Methods: Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry when participants were approximately 35 (1990–1994), 44 (1999–2003), and 55 (2010–2014) years old. Greenness was assessed as the mean Normalized Difference Vegetation Index (NDVI) in 500 m, 300 m, and 100 m circular buffers around the residential addresses at the time of lung function measurement. Green spaces were defined as the presence of agricultural, natural, or urban green spaces in a circular 300 m buffer. Associations of these greenspace parameters with the rate of lung function change were assessed using adjusted linear mixed effects regression models with random intercepts for subjects nested within centers. Sensitivity analyses considered air pollution exposures.

    Results: A 0.2-increase (average interquartile range) in NDVI in the 500 m buffer was consistently associated with a faster decline in FVC (−1.25 mL/year [95% confidence interval: −2.18 to −0.33]). These associations were especially pronounced in females and those living in areas with low PM10 levels. We found no consistent associations with FEV1 and the FEV1/FVC ratio. Residing near forests or urban green spaces was associated with a faster decline in FEV1, while agricultural land and forests were related to a greater decline in FVC.

    Conclusions: More residential greenspace was not associated with better lung function in middle-aged European adults. Instead, we observed slight but consistent declines in lung function parameters. The potentially detrimental association requires verification in future studies.

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  • 21. Masselot, Pierre
    et al.
    Sera, Francesco
    Schneider, Rochelle
    Kan, Haidong
    Lavigne, Éric
    Stafoggia, Massimo
    Tobias, Aurelio
    Chen, Hong
    Burnett, Richard T.
    Schwartz, Joel
    Zanobetti, Antonella
    Bell, Michelle L.
    Chen, Bing-Yu
    Leon Guo, Yue-Liang
    Ragettli, Martina S.
    Vicedo-Cabrera, Ana Maria
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Íñiguez, Carmen
    Garland, Rebecca M.
    Scovronick, Noah
    Madureira, Joana
    Nunes, Baltazar
    De la Cruz Valencia, César
    Hurtado Diaz, Magali
    Honda, Yasushi
    Hashizume, Masahiro
    Fook Cheng Ng, Chris
    Samoli, Evangelia
    Katsouyanni, Klea
    Schneider, Alexandra
    Breitner, Susanne
    Ryti, Niilo R. I.
    Jaakkola, Jouni J. K.
    Maasikmets, Marek
    Orru, Hans
    Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Guo, Yuming
    Valdés Ortega, Nicolás
    Matus Correa, Patricia
    Tong, Shilu
    Gasparrini, Antonio
    Differential mortality risks associated with PM2.5 components: a multi-country, multi-city study2022In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 33, no 2, p. 167-175Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between fine particulate matter (PM2.5) and mortality widely differs between as well as within countries. Differences in PM2.5 composition can play a role in modifying the effect estimates, but there is little evidence about which components have higher impacts on mortality.

    METHODS: We applied a two-stage analysis on data collected from 210 locations in 16 countries. In the first stage, we estimated location-specific relative risks (RR) for mortality associated with daily total PM2.5 through time series regression analysis. We then pooled these estimates in a meta-regression model that included city-specific logratio-transformed proportions of seven PM2.5 components as well as meta-predictors derived from city-specific socio-economic and environmental indicators.

    RESULTS: We found associations between RR and several PM2.5 components. Increasing the ammonium (NH4+) proportion from 1% to 22%, while keeping a relative average proportion of other components, increased the RR from 1.0063 (95%CI: 1.0030-1.0097) to 1.0102 (95%CI:1.0070-1.0135). Conversely, an increase in nitrate (NO3-) from 1% to 71% resulted in a reduced RR, from 1.0100 (95%CI: 1.0067-1.0133) to 1.0037 (95%CI: 0.9998- 1.0077). Differences in composition explained a substantial part of the heterogeneity in PM2.5 risk.

    CONCLUSIONS: These findings contribute to the identification of more hazardous emission sources. Further work is needed to understand the health impacts of PM2.5 components and sources given the overlapping sources and correlations among many components.

  • 22. Meng, Xia
    et al.
    Liu, Cong
    Chen, Renjie
    Sera, Francesco
    Vicedo-Cabrera, Ana Maria
    Milojevic, Ai
    Guo, Yuming
    Tong, Shilu
    Coelho, Micheline de Sousa Zanotti Stagliorio
    Saldiva, Paulo Hilario Nascimento
    Lavigne, Eric
    Correa, Patricia Matus
    Ortega, Nicolas Valdes
    Osorio Garcia, Samuel
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Maasikmets, Marek
    Jaakkola, Jouni J. K.
    Ryti, Niilo
    Huber, Veronika
    Schneider, Alexandra
    Katsouyanni, Klea
    Analitis, Antonis
    Hashizume, Masahiro
    Honda, Yasushi
    Ng, Chris Fook Sheng
    Nunes, Baltazar
    Teixeira, João Paulo
    Holobaca, Iulian Horia
    Fratianni, Simona
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ragettli, Martina S.
    Guo, Yue-Liang Leon
    Pan, Shih-Chun
    Li, Shanshan
    Bell, Michelle L.
    Zanobetti, Antonella
    Schwartz, Joel
    Wu, Tangchun
    Gasparrini, Antonio
    Kan, Haidong
    Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: multilocation analysis in 398 cities.2021In: The BMJ, E-ISSN 1756-1833, Vol. 372, article id n534Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the short term associations between nitrogen dioxide (NO2) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol.

    DESIGN: Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis.

    SETTING: 398 cities in 22 low to high income countries/regions.

    MAIN OUTCOME MEASURES: Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018.

    RESULTS: On average, a 10 μg/m3 increase in NO2 concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 μm or ≤2.5 μm (PM10 and PM2.5, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO2 concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities.

    CONCLUSIONS: This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO2 and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO2.

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  • 23. Merisalu, E.
    et al.
    Vähi, M.
    Kinnas, S.
    Oja, M.
    Sarapuu, K.
    Novikov, O.
    Pärnapuu, M.
    Indermitte, E.
    Lea, K.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Estonia.
    Job specific risk factors, demographic parameters and musculoskeletal disorders among military personnel depending on type of service2015In: Agronomy Research, ISSN 1406-894X, Vol. 13, no 3, p. 775-785Article in journal (Refereed)
    Abstract [en]

    Current study aimed to analyse the prevalence of job specific risk factors (JSRF) and musculoskeletal disorders (MSDs) among military personnel depending on demographic factors and type of service. An anonymous questionnaire study was carried out in five departments of Estonian Defence Forces (EDF) among local service personnel (LSP) and the Peace Corp personnel (PCP) arrived back from mission. The average response rate was 38.7% (LSP 31.9% and PCP 77.6%). In LSP group there were 44.7% male participants, with mean age 39.2 ± 11 years, length of service in present position 5.8 ± 4.9 years and work load of 37.9 ± 8.4 hours per week. In PCP group 97.4% were males, with mean age 27.5 ± 5.7 years, service length on present position 3.1 ± 2.6 years and work load of 84.3 ± 60.9 hours per week. The dominant JSRF in LSP was 'demand for constant concentration' (76.5%) and night work (57%) in PCP (group difference p < 0.0001). 'Fast movements' and 'lifting loads >40 kg' were the specific tasks most often reported in mission. 'Job insecurity' was more often reported by the female; 'night work' and 'work-rest disbalance' by the male military personnel (p< 0.001).The prevalence of MSDs was higher among women and LSP than in men and PCP group (p< 0.05). In LSP mild to moderate discomfort reported by 2/3 because of neck-shoulder strain and by ½ because of lower back pain. In conclusion, MSDs seems to depend more on demographic parameters and type of service than JSRFs. Further studies are needed to focus on predictive factors of MSDs among military personnel.

  • 24.
    Nordeng, Zuzana
    et al.
    Norwegian Institute of Public Health, Oslo, Norway.
    Kriit, Hedi K.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Health Economics and Health Financing Group, Institute of Global Health, Heidelberg University, Heidelberg, Germany; Climate-Sensitive Infectious Disease lab, Interdisciplinary Centre of Scientific Computing, Heidelberg University, Heidelberg, Germany; Climate-smart Health Systems, Institute of Global Health, Heidelberg University, Heidelberg, Germany.
    Poltimäe, Helen
    School of Economics and Business Administration, University of Tartu, Tartumaa, Tartu, Estonia.
    Aunan, Kristin
    CICERO Center for International Climate Research, Oslo, Norway.
    Dahl, Miriam S.
    CICERO Center for International Climate Research, Oslo, Norway.
    Jevtic, Marija
    University of Novi Sad, Faculty of Medicine, Institute of Public Health of Vojvodina, Serbia; Université Libre de Bruxelles (ULB), Research Centre on Environmental and Occupational Health, School of Public Health, Brussels, Belgium.
    Matkovic, Vlatka
    Health & Environment Alliance, Brussels, Belgium.
    Sandanger, Gunnell
    CICERO Center for International Climate Research, Oslo, Norway.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Public Health and Clinical Medicine, University of Tartu, Tartumaa, Tartu, Estonia.
    Valuation and perception of the costs of climate change on health2024In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Background and aims: Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context.

    Method: The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach.

    Results: Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams.

    Conclusions: Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

  • 25.
    Olstrup, Henrik
    et al.
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, 10691, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, 500 90, Estonia; Environment Department, City of Malmö, Malmö, 205 80, Sweden..
    Spanne, Mårten
    Environment Department, City of Malmö, 205 80 Malmö, Sweden.
    Nguyen, Hung
    Environmental Administration in Gothenburg, P.O. Box 7012, Gothenburg, 402 31, Sweden.
    Molnár, Peter
    Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, 40530, Sweden..
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, 10691, Sweden; Environment and Health Administration, SLB, P.O. Box 8136, Stockholm, 104 20, Sweden..
    Trends in air pollutants and health impacts in three Swedish cities over the past three decades2018In: Atmospheric Chemistry And Physics, ISSN 1680-7316, E-ISSN 1680-7324, Vol. 18, no 21, p. 15705-15723Article in journal (Refereed)
    Abstract [en]

    Air pollution concentrations have been decreasing in many cities in the developed countries. We have estimated time trends and health effects associated with exposure to NOx, NO2, O3, and PM10 (particulate matter) in the Swedish cities Stockholm, Gothenburg, and Malmö from the 1990s to 2015. Trend analyses of concentrations have been performed by using the Mann–Kendall test and the Theil–Sen method. Measured concentrations are from central monitoring stations representing urban background levels, and they are assumed to indicate changes in long-term exposure to the population. However, corrections for population exposure have been performed for NOx, O3, and PM10 in Stockholm, and for NOx in Gothenburg. For NOx and PM10, the concentrations at the central monitoring stations are shown to overestimate exposure when compared to dispersion model calculations of spatially resolved, population-weighted exposure concentrations, while the reverse applies to O3. The trends are very different for the pollutants that are studied; NOx and NO2 have been decreasing in all cities, O3 exhibits an increasing trend in all cities, and for PM10, there is a slowly decreasing trend in Stockholm, a slowly increasing trend in Gothenburg, and no significant trend in Malmö. Trends associated with NOxand NO2 are mainly attributed to local emission reductions from traffic. Long-range transport and local emissions from road traffic (non-exhaust PM emissions) and residential wood combustion are the main sources of PM10. For O3, the trends are affected by long-range transport, and there is a net removal of O3 in the cities. The increasing trends are attributed to decreased net removal, as NOx emissions have been reduced.

    Health effects in terms of changes in life expectancy are calculated based on the trends in exposure to NOx, NO2, O3, and PM10 and the relative risks associated with exposure to these pollutants. The decreased levels of NOx are estimated to increase the life expectancy by up to 11 months for Stockholm and 12 months for Gothenburg. This corresponds to up to one-fifth of the total increase in life expectancy (54–70 months) in the cities during the period of 1990–2015. Since the increased concentrations in O3 have a relatively small impact on the changes in life expectancy, the overall net effect is increased life expectancies in the cities that have been studied.

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  • 26. Olstrup, Henrik
    et al.
    Hagenbjörk, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
    Ventilation systems and their impact on nanoparticle concentrations in office buildings2021In: Applied Sciences, E-ISSN 2076-3417, Vol. 11, no 19, article id 8930Article in journal (Refereed)
    Abstract [en]

    Nanoparticles (NPs) can infiltrate indoor environments and have a large impact on human health when inhaled. Thus, indoor air quality is highly dependent on the outdoor air and on the filters used in the ventilation systems. In the NanoOffice study, the concentrations and the size distribution of NPs were measured with a five-minute time resolution in twelve office buildings in Umeå. Measurements were taken with an SMPS 3938 during a one-week period in the heating and nonheating seasons. Large differences in ventilation between buildings appeared, despite the fact that similar MVHR ventilation systems were used, and most of them were equipped with F7 filters. The NP concentrations and the simultaneous ventilation flows were measured in buildings with a variable and a more constant ventilation flow. In some cases, an increase in NP concentration could be seen after ventilation turn-on or after an increase in the ventilation flow. There was also one case where the NP concentrations increased in connection with the ventilation being switched off or reducing its flow. However, variable NP concentrations were also shown in buildings with a fairly constant ventilation flow, which was prominent for the two buildings located closest to busy streets. The correlation coefficients between the ventilation flow and particles in different size classes were in general smallest for particles in the smallest size classes, indicating higher filtration efficiency.

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  • 27.
    Olstrup, Henrik
    et al.
    Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, Estonia.
    Johansson, Christer
    Atmospheric Science Unit, Department of Environmental Science, Stockholm University, Stockholm, Sweden; Environment and Health Administration, SLB-analys, Box 8136, Stockholm, Sweden.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Seasonal variations in the daily mortality associated with exposure to particles, nitrogen dioxide, and ozone in stockholm, sweden, from 2000 to 20162021In: Atmosphere, E-ISSN 2073-4433, Vol. 12, no 11, article id 1481Article in journal (Refereed)
    Abstract [en]

    Urban air pollutant emissions and concentrations vary throughout the year due to various factors, e.g., meteorological conditions and human activities. In this study, seasonal variations in daily mortality associated with increases in the concentrations of PM10 (particulate matter), PM2.5–10 (coarse particles), BC (black carbon), NO2 (nitrogen dioxide), and O3 (ozone) were calculated for Stockholm during the period from 2000 to 2016. The excess risks in daily mortality are presented in single and multi-pollutant models during the whole year and divided into four different seasons, i.e., winter (December–February), spring (March–May), summer (June–August), and autumn (September–November). The excess risks in the single-pollutant models associated with an interquartile range (IQR) increase for a lag 02 during the whole year were 0.8% (95% CI: 0.1–1.4) for PM10, 1.1% (95% CI: 0.4–1.8) for PM2.5–10, 0.5% (95% CI: −0.5–1.5) for BC, −1.5% (95% CI: −0.5–−2.5) for NO2, and 1.9% (95% CI: 1.0–2.9) for O3. When divided into different seasons, the excess risks for PM10 and PM2.5–10 showed a clear pattern, with the strongest associations during spring and autumn, but with weaker associations during summer and winter, indicating increased risks associated with road dust particles during these seasons. For BC, which represents combustion-generated particles, the pattern was not very clear, but the strongest positive excess risks were found during autumn. The excess risks for NO2 were negative during all seasons, and in several cases even statistically significantly negative, indicating that NO2 in itself was not harmful at the concentrations prevailing during the measurement period (mean values < 20 µg m−3). For O3, the excess risks were statistically significantly positive during “all year” in both the single and the multi-pollutant models. The excess risks for O3 in the single-pollutant models were also statistically significantly positive during all seasons.

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  • 28.
    Olstrup, Henrik
    et al.
    Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, Estonia.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Orru, Hans
    Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Ravila 19, Tartu, Estonia.
    Daily Mortality in Different Age Groups Associated with Exposure to Particles, Nitrogen Dioxide and Ozone in Two Northern European Capitals: Stockholm and Tallinn2022In: Environments, E-ISSN 2076-3298, Vol. 9, no 7, article id 83Article in journal (Refereed)
    Abstract [en]

    Although the association between air pollution and mortality is well established, less is known about the effects in different age groups. This study analyzes the short-term associations between mortality in different age groups (0–14 years of age, 15–64 years of age, and 65+ years of age) and a number of air pollutants in two relatively clean northern European capitals: Stockholm and Tallinn. The concentrations in PM10 (particles with an aerodynamic diameter smaller than or equal to 10 µm), PM2.5–10 (coarse particles), PM2.5 (particles with an aerodynamic diameter smaller than or equal to 2.5 µm), BC (black carbon), PNC4 (particle number count of particles larger than or equal to 4 nm), NO2 (nitrogen dioxide), and O3 (ozone) were measured during the period of 2000–2016 in Stockholm and 2001–2018 in Tallinn (except for BC and PNC4 which were only measured in Stockholm). The excess risks in daily mortality associated with an interquartile range (IQR) increase in the measured air pollutants were calculated in both single- and multi-pollutant models for lag01 and lag02 (average concentration during the same and the previous day, and the same and the previous two days, respectively) using a quasi-Poisson regression model with a logistic link function. In general, the calculated excess risks per IQR increase were highest in the age group 0–14 years of age in both Stockholm and Tallinn. However, in Stockholm, a statistically significant effect was shown for PM2.5–10, and in Tallinn for O3. In the oldest age group (65+), statistically significant effects were shown for both PM2.5–10, PM10, and O3 in Stockholm, and for O3 in Tallinn.

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  • 29.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Exposure to particulate matter and the related health impacts in major Estonian cities2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Particulate matter (PM) is one of the most studied and problematic pollutants due to its toxicity and relati­vely high concentrations. This thesis aims to clarify the main sources and exposures of PM in Tallinn and Tartu, study the associations with health effects, and estimate the extent of those effects with health impact assessment (HIA).

    It appeared that the main sources of particulate air pollution in Tallinn (the capital of Estonia) and Tartu (the second largest city of Estonia) are local heating and traffic, inclu­ding road dust. In addition to local emissions, particulate levels are affected by transboundary pollution. If the transboundary air masses originated from the Eastern European areas, the concentration as well as the oxidative capacity of fine particles was significantly higher in urban background air in Tartu compared to air masses coming from Scandinavian areas (Paper I).

    During the last 15 years, traffic increase has been very fast in Tartu. However, due to the improvement in vehicle technology during this period, there has been only a slight increase in concentration of exhaust particles (Paper II). Nevertheless, a greater increase in road dust emissions was detected.

    A statistically significant relationship between long-term exposure to those traffic induced par­tic­les and cardiac disease in the RHINE (Respiratory Health in Northern Europe) Tartu cohort was shown (Paper III). However, no significant associations with respira­tory health were found.

    The HIA in Tallinn demonstrated 296 (95% CI = 76–528) premature deaths annually, because of PM (Paper IV). The average decrease in life expectancy was predicted to be 0.64 (95% CI 0.17–1.10) years. However, among risk groups it can be higher. In addi­tion, several cardiovascular hospitalizations are related. The costs to society be­cause of health effects reach up to €150 million annually (95% CI = 40–260) from pre­mature deaths and hospitali­zation constitute an additional €0.3 million (95% CI = 0.2–0.4).

    The special HIA scenario, when more pollution fuel peat will be used in boiler houses was analysed as well (Paper V). It indicated that peat bur­ning would result in up to 55.5 YLL per year within the population of Tartu. However, the health effects of pollution from current traffic, local heating, and industry are at least 28 times bigger.

    In conclusion, exposure to PM cause considerable health effects in the form of cardio­pulmo­nary diseases in main Estonian cities.

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  • 30.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Camilla
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Ebi, Kristie L
    ClimAdapt, Los Altos, California, USA.
    Langner, Joakim
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Impact of climate change on ozone-related mortality and morbidity in Europe2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 41, no 2, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change.Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with MATCH-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied, under greenhouse gas emission scenarios A2 and A1B respectively. We apply a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity.Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, Netherlands and UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increase in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected.The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

  • 31.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu.
    Ebi, K. L.
    Center for Health and the Global Environment, University of Washington, Seattle, WA, USA.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    The interplay of climate change and air pollution on health2017In: Current environmental health reports, ISSN 2196-5412, Vol. 4, no 4, p. 504-513Article in journal (Refereed)
    Abstract [en]

    Purpose of review: Air pollution significantly affects health, causing up to 7 million premature deaths annually with an even larger number of hospitalizations and days of sick leave. Climate change could alter the dispersion of primary pollutants, particularly particulate matter, and intensify the formation of secondary pollutants, such as near-surface ozone. The purpose of the review is to evaluate the recent evidence on the impacts of climate change on air pollution and air pollution-related health impacts and identify knowledge gaps for future research.

    Recent findings: Several studies modelled future ozone and particulate matter concentrations and calculated the resulting health impacts under different climate scenarios. Due to climate change, ozone- and fine particle-related mortalities are expected to increase in most studies; however, results differ by region, assumed climate change scenario and other factors such as population and background emissions.

    Summary: This review explores the relationships between climate change, air pollution and air pollution-related health impacts. The results highly depend on the climate change scenario used and on projections of future air pollution emissions, with relatively high uncertainty. Studies primarily focused on mortality; projections on the effects on morbidity are needed.

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  • 32.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Assessment of long-term health impacts of air quality with different guideline values for NOX in the planned by-pass tunnel Förbifart Stockholm2016Report (Other academic)
    Abstract [en]

    To meet increased needs of transports in the Stockholm region and reduce the problems with traffic congestion in central parts, a 21 km long by-pass (18 km in a tunnel) is planned. The bypass is expected to reduce traffic and emissions in central Stockholm, but at the same time tunnel users could be exposed to high concentrations of air pollutants from traffic. Thus to control the air quality in the tunnel system, air pollution guideline values have been proposed. The current study is initiated and funded by the Swedish Transport Administration (Trafikverket), and the aim is to assess the potential health impacts of applying different NOX guideline values (1000, 2000, 3000 and 4000 μg/m3 as hourly average max values all-over the tunnel system). The passengers’ exposure was estimated based on annual average NOX exposures, time spent in the tunnel and the number of tunnel users. Health impacts were assessed following health impact assessment principles using equations and WHO’s software AirQPlus.

    With minimal ventilation and maximal traffic amounts during rush hours the NOX hourly average concentrations could raise up to 3500 μg/m3 and even when the planned maximum ventilation would be in use, the maximum concentration would stay as high as 1789 μg/m3. Thus, it is in principle with planned the technology impossible to meet the lowest proposed guideline value of 1000 μg/m3 in the whole tunnel system. However, the effects would be with this guideline still the smallest, resulting annually in 22.2 (CI 95% 16.8–30.1) more premature deaths and 480.4 (95% CI 364.1–650.6) years of life lost (assuming travellers to come from the age group 30–74). If the guideline value would be 2000 μg/m3, the exposure would annually in the same age group cause 35.2 (CI 95% 26.7–47.6) premature deaths with 760.9 (480.4–650.6) years of life lost. With the lowest guideline level, passing the whole tunnel during rush hours on working days would increase mortality risk by 7.4% (95% CI 5.5-10.1), on average corresponding to a life expectancy decrease by 0.27 (95% CI 0.20-0.37) years for people aged 30–74 years.

    Among different tunnel links, the biggest exposure is expected in link 5N, where 28.6-37.2% (depending on limit value scenario) of the total health impact could be generated. The link 3N has high NOX concentration, large number of passengers and long exposure time (time spent in the tunnel link). Even the NOX concentrations are expected to be highest in links 411 and 314, the exposure time there would be shorter and the number of exposed passengers smaller. For the separate links the differences in exposure between limit value scenarios could also vary largely: while the difference was big for link 5N, it was rather small for link 7N.

    If we compare these results with the previously estimated beneficial effect on the health of the local population due to decrease of urban air pollution exposure (expecting annually 23.7 (95% CI 17.7–32.3) fewer premature deaths), only with most favourable assumptions as less older persons using tunnel and with highest ventilation the tunnel could have smaller negative health effects compared to the alternative current open road E4. In all other cases the health effects in the by-pass tunnel Förbifart Stockholm are expected to be higher. Also the exposure levels in the tunnel are expected to be somewhat higher compared to previous analysis due to more 5 enhanced dispersion modelling for the tunnel, including also ramps in the impact assessment and predicting higher numbers of cars than previously.

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  • 33.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. University of Tartu, Estonia.
    Guo, JunwenUmeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.Veber, TriinUniversity of Tartu, Estonia.
    Conference on connecting health and climate change: abstracts book2024Conference proceedings (editor) (Other academic)
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  • 34.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
    Hagenbjörk-Gustavsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Olstrup, Henrik
    Indoor and outdoor nanoparticle concentrations in an urban background area in northern Sweden: The NanoOffice study2021In: Environments, E-ISSN 2076-3298, Vol. 8, no 8, article id 75Article in journal (Refereed)
    Abstract [en]

    In recent years, nanoparticles (NPs) have received much attention due to their very small size, high penetration capacity, and high toxicity. In urban environments, combustion-formed nanoparticles (CFNPs) dominate in particle number concentrations (PNCs), and exposure to those particles constitutes a risk to human health. Even though fine particles (<2.5 µm) are regularly monitored, information on NP concentrations, both indoors and outdoors, is still limited. In the NanoOffice study, concentrations of nanoparticles (10–300 nm) were measured both indoors and outdoors with a 5-min time resolution at twelve office buildings in Umeå. Measurements were taken during a one-week period in the heating season and a one-week period in the non-heating season. The measuring equipment SMPS 3938 was used for indoor measurements, and DISCmini was used for outdoor measurements. The NP concentrations were highest in offices close to a bus terminal and lowest in offices near a park. In addition, a temporal effect appeared, usually with higher concentrations of nanoparticles found during daytime in the urban background area, whereas considerably lower nanoparticle concentrations were often present during nighttime. Infiltration of nanoparticles from the outdoor air into the indoor air was also common. However, the indoor/outdoor ratios (I/O ratios) of NPs showed large variations between buildings, seasons, and time periods, with I/O ratios in the range of 0.06 to 0.59. The reasons for high indoor infiltration rates could be NP emissions from adjacent outdoor sources. We could also see particle growth since the indoor NPs were, on average, almost twice as large as the NPs measured outdoors. Despite relatively low concentrations of NPs in the urban background air during nighttime, they could rise to very high daytime concentrations due to local sources, and those particles also infiltrated the indoor air.

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  • 35.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Estonia.
    Idavain, Jane
    Pindus, Mihkel
    Orru, Kati
    Kesanurm, Kaisa
    Lang, Aavo
    Tomasova, Jelena
    Residents' Self-Reported Health Effects and Annoyance in Relation to Air Pollution Exposure in an Industrial Area in Eastern-Estonia2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 2, article id 252Article in journal (Refereed)
    Abstract [en]

    Eastern Estonia has large oil shale mines and industrial facilities mainly focused on electricity generation from oil shale and shale oil extraction, which produce high air pollution emissions. The "Study of the health impact of the oil shale sector-SOHOS" was aimed at identifying the impacts on residents' health and annoyance due to the industrial processing. First, a population-wide survey about health effects and annoyance was carried out. Second, the total and oil shale sectors' emitted concentrations of benzene, phenol, and PM2.5 were modelled. Third, the differences between groups were tested and relationships between health effects and environmental pollution studied using multiple regression analysis. Compared to the control groups from non-industrial areas in Tartu or Laane-Viru, residents of Ida-Viru more frequently (p < 0.05) reported wheezing, chest tightness, shortness of breath, asthma attacks, a long-term cough, hypertension, heart diseases, myocardial infarction, stroke, and diabetes. All health effects except asthma were reported more frequently among non-Estonians. People living in regions with higher levels of PM2.5, had significantly higher odds (p < 0.05) of experiencing chest tightness (OR = 1.13, 95% CI 1.02-1.26), shortness of breath (1.16, 1.03-1.31) or an asthma attack (1.22, 1.04-1.42) during the previous year. People living in regions with higher levels of benzene had higher odds of experiencing myocardial infarction (1.98, 1.11-3.53) and with higher levels of phenol chest tightness (1.44, 1.03-2.00), long-term cough (1.48, 1.06-2.07) and myocardial infarction (2.17, 1.23-3.83). The prevalence of adverse health effects was also higher among those who had been working in the oil shale sector. Next to direct health effects, up to a quarter of the residents of Ida-Viru County were highly annoyed about air pollution. Perceived health risk from air pollution increased the odds of being annoyed. Annoyed people in Ida-Viru had significantly higher odds of experiencing respiratory symptoms during the last 12 months, e.g., wheezing (2.30, 1.31-4.04), chest tightness (2.88, 1.91-4.33 or attack of coughing (1.99, 1.34-2.95).

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  • 36.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jõgi, Rain
    Lung Clinic, Tartu University Hospital.
    Kaasik, Marko
    Institute of Physics, University of Tartu.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Chronic traffic-induced PM exposure and self-reported respiratory and cardiovascular health in the RHINE Tartu cohort2009In: International journal of environmental research and public health, ISSN 1660-4601, Vol. 6, no 11, p. 68p. 2740-2751Article in journal (Refereed)
    Abstract [en]

    The relationship between exposure to traffic induced particles and respiratory health, and cardiac diseases was studied in the RHINE Tartu cohort. A postal questionnaire with commonly used questions regarding respiratory symptoms, cardiac disease, lifestyle as smoking habits, indoor environment, occupation, early life exposure and sleep disorders was sent to 2460 adults. The annual concentrations of local traffic induced particles were modelled with an atmospheric dispersion model with traffic flow data, and obtained PMexhaust concentrations in 40x40 m grids were linked with home addresses with GIS. The relationship between the level of exhaust particles outside home and self-reported health problems were analyzed using a multiple logistic regression model. We found a significant relation between fine exhaust particles and cardiac disease, OR = 1.64 (95% CI 1.12-2.43) for increase in PMexhaust corresponding to the fifth to the 95th percentile range. The associations also were positive but non-significant for hypertension OR = 1.42 (95% CI 0.94-2.13), shortness of breath OR = 1.27 (95% CI 0.84-1.94) and other respiratory symptoms.

  • 37.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaasik, M
    Antov, D
    Forsberg, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Evolution of traffic flows and traffic induced air pollution due to structural changes and development during 1993-2006 in Tartu (Estonia)2008In: Baltic journal of road and bridge engineering, ISSN 1822-427X, Vol. 3, no 4, p. 206-212Article in journal (Refereed)
    Abstract [en]

    Traffic is the main factor affecting air quality in most cities. After the Estonian re-independence in 1991, the increase of motorization has been fast and car usage has intensified. During the same period, the average age of cars has decreased and thanks to improvements in engine technology, the emissions per km have been reduced. The objective was to see how these factors have reflected in air quality. This paper also aim to present an analytical approach to estimate the air pollution levels in recent years, when air quality monitoring has not been conducted, and available traffic data are limited. Based on traffic counts in 25 points across the city the amounts of traffic were modelled for 680 street segments with CUBE software. As air quality is monitored irregularly in Tartu, dispersion modelling was used to estimate pollution levels. Annual concentrations of exhaust particles (PMexhaust), particulate matter (PM10) and nitrogen oxides (NOx) in 1993, 2000 and 2006 were calculated with AEROPOL software. The traffic increase in the city centre of Tartu was especially rapid in the 1990s. In recent years, it has slowed due to congestion. Overall, traffic levels have increased more than 3 times since 1993. In residential areas, the increase is still rapid – up to 6 times from 1993 to 2006. However, the changes in air quality are less dramatic. Increases from 1993 to 2000 were followed by stable or slightly increasing pollution levels in recent years, especially in case of PMexhaust. The study showed that 2 factors, namely, increase of traffic and improvement of vehicles, have been compensating each other in the dynamics of air pollution.

  • 38.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Kaasik, Marko
    Institute of Physics, University of Tartu.
    Merisalu, Eda
    Department of Public Health, University of Tartu.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impact assess­ment in case of peat: co-use of environmental scenarios and exposure-response functions2009In: Biomass and Bioenergy, ISSN 0961-9534, E-ISSN 1873-2909, Vol. 33, no 8, p. 1080-1086Article in journal (Refereed)
    Abstract [en]

    Peat will be used more widely for heating in Tartu (Estonia), therefore the potential health effects needed to be assessed. In transition from today's gas heating to burning of peat, the amount of exhaust gases emitted will increase and more than 100 000 people will be exposed to greater health risks. Based on the peat quality data, the emissions were calculated and their dispersion in Tartu was modelled using the air pollution dispersion and deposition model AEROPOL. The AirQ software, developed by the WHO, was used for calculating the health impacts. The number of years of life lost (YLL) due to the emissions from peat burning was estimated to be up to 55.5 in a year within the population of Tartu (101 000 citizens). However, in perspective, this would be about 28 times less than YLL calculated due to emissions from traffic, local heating etc.

  • 39.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia.
    Kimmel, Veljo
    Estonian University of Life Sciences.
    Kikas, Ülle
    University of Tartu.
    Soon, Argo
    Archimedes Foundation.
    Künzli, Nino
    CREAL.
    Schins, Roel
    University of Dusseldorf.
    Borm, Paul
    Centre of Expertise Life Sciences .
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Elemental composition and oxidative properties of PM2.5 in Estonia in relation to origin of air masses: results from the ECRHS II in Tartu2010In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 408, no 7, p. 1515-1522Article in journal (Refereed)
    Abstract [en]

    Fine particulate matter (PM2.5) was sampled at an urban background site in Tartu, Estonia over one-year period during the ECRHS II study. The elemental composition of 71 PM2.5 samples was analyzed for different chemical elements using energy-dispersive X-ray fluorescence spectrometry (ED-XRF). The oxidative activity of 36 samples was assessed by measuring their ability to generate hydroxyl radicals in the presence of hydrogen peroxide.

    The origin of air masses was determined by computing 96-hour back trajectories of air masses with the HYSPLIT Model. The trajectories of air masses were divided into four sectors according to geographical patterns: “Russia,” “Eastern Europe,” “Western Europe,” and “Scandinavia.”

    During the study period, approximately 30% of air masses originated from “Scandinavia.”  The other three sectors had slightly lower values (between 18 and 22%). In spring, summer, and winter, higher total PM levels originated from air masses from continental areas, namely “Russia” and “Eastern Europe” (18.51±7.33 and 19.96±9.23 μgm-3, respectively). In autumn, the PM levels were highest in “Western Europe”. High levels of Fe, Ti, and AlCaSi (Al, Ca, Si) were also detected in air masses from the Eurasian continent. The oxidative properties were correlated to the origin of air masses. The ∙OH values were approximately 1.5 times higher when air masses originated from the direction of “Eastern Europe” or “Russia.”

    The origin of measured particles was evaluated using principal compo­nent factor analysis. When comparing the PM2.5 elemental composition with seasonal variation, factor scores, and other studies, the factors represent: (1) combustion of biomass; (2) crustal dust; (3) traffic; and (4) power plants and industrial processes associated with oil burning.

    The total PM2.5 is driven mainly by biomass and industrial combustion (63%) and other unidentified sources (23%). Other sources of PM, such as crustal dust and traffic, contribute a total of 13%.

  • 40.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Laukaitiene, Aida
    Zurlyte, Ingrida
    Particulate Air Pollution and Its Impact on Health in Vilnius and Kaunas2012In: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 48, no 9, p. 472-477Article in journal (Refereed)
    Abstract [en]

    Particulate matter in outdoor air has a significant impact on health. Small particles, composed of a variety of organic and inorganic compounds, are inhaled deep into the respiratory tract. The mechanisms and outcomes are manifold, resulting mainly in cardiopulmonary diseases. The current study aimed to quantify the health effects of particulate pollutants in Vilnius and Kaunas. Material and Methods. For risk estimation, the methodology of health impact assessment was employed. The exposure was defined as annual PM2.5 levels for long-term exposure effects and daily PM10 averages for short-term exposure effects. The baseline mortality/morbidity data were retrieved from health registers and exposure-response relationships from previous epidemiological studies. For health impact calculations, the WHO-developed tool AirQ was also applied. Results. The annual average concentration of PM2.5 was 11 mu g/m(3) in Vilnius and 17.5 mu g/m(3) in Kaunas. The exposure above the natural background corresponded annually to 263 (95% CI, 68-464) and 338 (95% CI, 86-605) premature deaths in Vilnius and Kaunas. This resulted in 3438 (95% CI, 905-5952) and 3693 (95% CI, 983-6322) years of life lost and in an average decrease in life expectancy of 0.43 (95% CI, 0.11-0.74) and 0.69 (95% CI, 0.18-1.19) years, respectively. In addition, 143 (95% CI, 86-200) and 129 (95% CI, 78-179) respiratory and 297 (95% CI, 188-377) and 267 (95% CI. 169-338) cardiovascular hospitalizations per year could be expected in Vilnius and Kaunas, respectively. Conclusions. There is substantial exposure to particulate matter in the main Lithuanian cities, which causes considerable adverse health effects. Traffic and domestic heating are considered locally the most important contributing factors to the degradation of air quality.

  • 41.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lövenheim, Boel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Christer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Estimated health impacts of changes in air pollution exposure associated with the planned by-pass Förbifart Stockholm2013Report (Other academic)
    Abstract [en]

    To reduce problems with traffic congestion and meet increased needs of transports, a 21 km long by-pass (18 km in a tunnel) is planned. The by-pass is expected to reduce traffic emissions in central Stockholm but at the same time tunnel users could be exposed to high concentrations of air pollutants from traffic.

    For the reduction in urban air pollution concentrations, the change in annual ambient NOX and PM10 levels were modelled using 100x100 m grids and the population (1 628 528 inhabitants) average exposure was calculated for Greater Stockholm area. The tunnel exposure was estimated based on annual average NOX and PM10 levels, time spent in tunnel and number of persons using the tunnel. Health risks were calculated based on health impact assessment principles using equations and the WHO AirQ software. In these calculations the E-R coefficient for non-external mortality was 8% per 10 μgm-3 increase of NOX (vehicle exhaust indicator) and for daily number of deaths 1.68% per 10 μgm-3 increase of non-exhaust (road dust) PM10.

    It appeared that for the general population there would be annually 23.7 (95% CI 17.7–32.3) premature deaths less; mainly from lower exposure to vehicle exhaust (indicated by NOX) and somewhat from a reduction in coarse particles (indicated by PM10), contributing 23.2 and 0.5 fewer deaths, respectively. Other adverse health effects of exposure are also expected to be reduced. At the same time, tunnel users will be exposed to vehicle exhaust components in terms of NOX up to near 2000 μgm-3 during rush-hours. Passing the whole tunnel twice on working days would correspond to an additional annual NOX exposure of 9.6 μgm-3. Assuming there would be on average approximately 55 000 vehicles per day each way and 1.3 persons in each vehicle from the range 30–74 years of age, this exposure would result in 20.6 (95% CI 14.1–25.6) more premature deaths. If there would be more persons per vehicle or older and more vulnerable people travelling, the adverse effect of exposure in traffic could become larger. Hence, the effects in reality may be different as these results are based on now presented scenarios.

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  • 42.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Estonia.
    Lövenheim, Boel
    Johansson, Christer
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Potential health impacts of changes in air pollution exposure associated with moving traffic into a road tunnel2015In: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 25, no 5, p. 524-531Article in journal (Refereed)
    Abstract [en]

    A planned 21 km bypass (18 km within a tunnel) in Stockholm is expected to reduce ambient air exposure to traffic emissions, but same time tunnel users could be exposed to high concentrations of pollutants. For the health impacts calculations in 2030, the change in annual ambient NOX and PM10 exposure of the general population was modelled in 100 × 100 m(2) grids for Greater Stockholm area. The tunnel exposure was estimated based on calculated annual average NOX concentrations, time spent in tunnel and number of tunnel users. For the general population, we estimate annually 23.7 (95% CI: 17.7-32.3) fewer premature deaths as ambient concentrations are reduced. At the same time, tunnel users will be exposed to NOX levels up to 2000 μg/m(-3). Passing through the whole tunnel two times on working days would correspond to an additional annual NOX exposure of 9.6 μg/m(3). Assuming that there will be ~55,000 vehicles daily each way and 1.3 persons of 30-74 years of age in each vehicle, we estimate the tunnel exposure to result in 20.6 (95% CI: 14.1-25.6) premature deaths annually. If there were more persons per vehicle, or older and vulnerable people travelling, or tunnel dispersion conditions worsen, the adverse effect would become larger.

  • 43.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Maasikmets, Marek
    Estonian Environmental Research Centre Marja 4d Tallinn 10617 Estonia.
    Lai, Taavi
    University of Tartu Department of Public Health Ravila 19 Tartu 50411 Estonia.
    Tamm, Tanel
    University of Tartu Department of Ecology and Geography Vanemuise 46 Tartu 50414 Estonia.
    Kaasik, Marko
    University of Tartu Department of Physics Riia 142 Tartu 50414 Estonia.
    Kimmel, Veljo
    Estonian University of Life Sciences Institute of Agricultural and Environmental Sciences Kreutzwaldi 64 Tartu 50414 Estonia.
    Orru, Kati
    King’s College London Department of Geography Strand London WC2R 2LS UK.
    Merisalu, Eda
    University of Tartu Department of Public Health Ravila 19 Tartu 50411 Estonia.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impacts of particulate matter in five major Estonian towns: main sources of exposure and local differences2011In: Air quality, atmosphere and health, ISSN 1873-9318, E-ISSN 1873-9326, Vol. 4, no 3-4, p. 247-258Article in journal (Refereed)
    Abstract [en]

    Particulate matter (PM) is the major air pollution problem with health impacts in Estonia. The prevailing sources of particles are traffic and local heating. In this study, we quantified the health effects of PM in neighbourhoods of five main cities with a health impact assessment (HIA) approach that uses information on exposure, baseline mortality/morbidity and exposure–response relationships from previous epidemiological studies. The exposure was defined as modelled PM2.5 annual levels and daily averages of PM10 (monitoring data in Tallinn and Kohtla-Järve and modelled levels in Tartu, Narva and Pärnu). The modelled results were validated with data from monitoring stations and additional measuring programmes. The annual average concentration of PM2.5 in the neighbourhoods studied varied from 7.6 to 23.6 μg m−3. The analysis indicated that the exposure above natural background corresponds to 462 [95% confidence interval (CI) 120–815] premature deaths, resulting in 6,034 (95% CI 1,583–10,309) years of life lost per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.63 (95% CI 0.16–1.08) years. In the polluted city centres, this average decrease may reach >1 year and in Pärnu, it may reach 0.95 year. However, in the least polluted neighbourhood, the decrease of life expectancy was only 0.17 years. In addition, 231 (95% CI 145–306) respiratory and 338 (95% CI 205–454) cardiovascular hospitalisations per year could be expected. The majority of the external costs are related to the long-term effects on mortality and amount to €270 (95% CI 190–350) million annually. In comparison, the costs of hospitalisations contribute just €1.1 (95% CI 0.6–1.6) million. The main differences in health impacts were mostly driven by differences in the pollution sources, the magnitude of such sources and distribution patterns in the atmosphere. The smallest health effects, with the exception of the green residential areas, were observed in the industrial cities Kohtla-Järve and Narva (due to the small share contributed by local residential heating and relatively little car traffic). However, it is questionable whether the mass of fine particles is the best indicator of air pollution risk in such areas.

  • 44.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
    Olstrup, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
    Hagenbjörk-Gustavsson, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Orru, Kati
    Institute of Social Studies, University of Tartu, Tartu, Estonia.
    Exposures, Symptoms and Risk Perception among Office Workers in Relation to Nanoparticles in the Work Environment2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 10, article id 5789Article in journal (Refereed)
    Abstract [en]

    Submicroscopic nanoparticles (NPs) in air have received much attention due to their possible effects on health and wellbeing. Adverse health impacts of air pollution may not only be associated with level of exposure, but also mediated by the perception of the pollution and by beliefs of the exposure being hazardous. The aim of this study was to test a model that describes interrelations between NP pollution, perceived air quality, health risk perception, stress, and sick building syndrome. In the NanoOffice study, the level of NPs was measured and a survey on health risk perception was conducted among 260 employees in twelve office buildings in northern Sweden. Path analyses were performed to test the validity of the model. The data refute the model proposing that the NP exposure level significantly influences stress, chronic diseases, or SBS symptoms. Instead, the perceived exposure influences the perceived risk of NP, and the effect of perceived exposure on SBS and chronic disease is mediated by stress. There was little concern about nanoparticles, despite relatively high levels in some facilities. Perceived pollution and health risk perception may explain a large part of the environmentally induced symptoms and diseases, particularly in relatively low levels of pollution. The research results raise important questions on the physiologically or psychologically mediated health effects of air pollution.

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  • 45.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. University of Tartu, Tartu, Estonia.
    Olstrup, Henrik
    University of Tartu, Tartu, Estonia.
    Kukkonen, Jaakko
    Finnish Meteorological Institute, Helsinki, Finland; Centre for Atmospheric and Climate Physics Research, and Centre for Climate Change Research, University of Hertfordshire; College Lane, Hatfield, United Kingdom.
    López-Aparicio, Susana
    Norwegian Institute for Air Research, Kjeller, Norway.
    Segersson, David
    Swedish Meteorological and Hydrological Institute, Norrköping, Sweden.
    Geels, Camilla
    Department of Environmental Science, Aarhus University, Roskilde, Denmark.
    Tamm, Tanel
    University of Tartu, Tartu, Estonia.
    Riikonen, Kari
    Finnish Meteorological Institute, Helsinki, Finland.
    Maragkidou, Androniki
    Finnish Meteorological Institute, Helsinki, Finland.
    Sigsgaard, Torben
    Department of Public Health, Aarhus University, Aarhus, Denmark.
    Brandt, Jørgen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. iClimate – interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark.
    Grythe, Henrik
    Norwegian Institute for Air Research, Kjeller, Norway.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Health impacts of PM2.5 originating from residential wood combustion in four nordic cities2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1286Article in journal (Refereed)
    Abstract [en]

    Background: Residential wood combustion (RWC) is one of the largest sources of fine particles (PM2.5) in the Nordic cities. The current study aims to calculate the related health effects in four studied city areas in Sweden, Finland, Norway, and Denmark.

    Methods: Health impact assessment (HIA) was employed as the methodology to quantify the health burden. Firstly, the RWC induced annual average PM2.5 concentrations from local sources were estimated with air pollution dispersion modelling. Secondly, the baseline mortality rates were retrieved from the national health registers. Thirdly, the concentration-response function from a previous epidemiological study was applied. For the health impact calculations, the WHO-developed tool AirQ + was used.

    Results: Amongst the studied city areas, the local RWC induced PM2.5 concentration was lowest in the Helsinki Metropolitan Area (population-weighted annual average concentration 0.46 µg m− 3) and highest in Oslo (2.77 µg m− 3). Each year, particulate matter attributed to RWC caused around 19 premature deaths in Umeå (95% CI: 8–29), 85 in the Helsinki Metropolitan Area (95% CI: 35–129), 78 in Copenhagen (95% CI: 33–118), and 232 premature deaths in Oslo (95% CI: 97–346). The average loss of life years per premature death case was approximately ten years; however, in the whole population, this reflects on average a decrease in life expectancy by 0.25 (0.10–0.36) years. In terms of the relative contributions in cities, life expectancy will be decreased by 0.10 (95% CI: 0.05–0.16), 0.18 (95% CI: 0.07–0.28), 0.22 (95% CI: 0.09–0.33) and 0.63 (95% CI: 0.26–0.96) years in the Helsinki Metropolitan Area, Umeå, Copenhagen and Oslo respectively. The number of years of life lost was lowest in Umeå (172, 95% CI: 71–260) and highest in Oslo (2458, 95% CI: 1033–3669).

    Conclusions: All four Nordic city areas have a substantial amount of domestic heating, and RWC is one of the most significant sources of PM2.5. This implicates a substantial predicted impact on public health in terms of premature mortality. Thus, several public health measures are needed to reduce the RWC emissions.

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  • 46.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Institute of Family Medicine and Public Health, University of Tartu.
    Pindus, Mihkel
    Harro, Haldo-Rait
    Maasikmets, Marek
    Herodes, Koit
    Metallic Fumes at Indoor Military Shooting Ranges: Lead, Copper, Nickel, and Zinc in Different Fractions of Airborne Particulate Matter2018In: Propellants, explosives, pyrotechnics, ISSN 0721-3115, E-ISSN 1521-4087, Vol. 43, no 3, p. 228-233Article in journal (Refereed)
    Abstract [en]

    Small firearm shooting emits residues of energetic materials as well as heavy metals of different particle sizes into the air, posing a risk to human health. The current study assessed concentrations of Pb, Cu, Ni and Zn in 14 different size fractions of particulate matter at indoor military shooting ranges. Air samples were collected using ELPI+ over two hour period and filters analysed with ICP-MS and ICP-OES.

  • 47.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Teinemaa, Erik
    Lai, Taavi
    Tamm, Tanel
    Kaasik, Marko
    Kimmel, Veljo
    Kangur, Kati
    Merisalu, Eda
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health impact assessment of particulate pollution in Tallinn using fine spatial resolution and modeling techniques2009In: Environmental Health, E-ISSN 1476-069X, Vol. 8, p. 7-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health impact assessments (HIA) use information on exposure, baseline mortality/morbidity and exposure-response functions from epidemiological studies in order to quantify the health impacts of existing situations and/or alternative scenarios. The aim of this study was to improve HIA methods for air pollution studies in situations where exposures can be estimated using GIS with high spatial resolution and dispersion modeling approaches.

    METHODS: Tallinn was divided into 84 sections according to neighborhoods, with a total population of approx. 390,000 persons. Actual baseline rates for total mortality and hospitalization with cardiovascular and respiratory diagnosis were identified. The exposure to fine particles (PM2.5) from local emissions was defined as the modeled annual levels. The model validation and morbidity assessment were based on 2006 PM10 or PM2.5 levels at 3 monitoring stations. The exposure-response coefficients used were for total mortality 6.2% (95% CI 1.6-11%) per 10 microg/m3 increase of annual mean PM2.5 concentration and for the assessment of respiratory and cardiovascular hospitalizations 1.14% (95% CI 0.62-1.67%) and 0.73% (95% CI 0.47-0.93%) per 10 microg/m3 increase of PM10. The direct costs related to morbidity were calculated according to hospital treatment expenses in 2005 and the cost of premature deaths using the concept of Value of Life Year (VOLY).

    RESULTS: The annual population-weighted-modeled exposure to locally emitted PM2.5 in Tallinn was 11.6 microg/m3. Our analysis showed that it corresponds to 296 (95% CI 76528) premature deaths resulting in 3859 (95% CI 10236636) Years of Life Lost (YLL) per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.64 (95% CI 0.17-1.10) years. While in the polluted city centre this may reach 1.17 years, in the least polluted neighborhoods it remains between 0.1 and 0.3 years. When dividing the YLL by the number of premature deaths, the decrease in life expectancy among the actual cases is around 13 years. As for the morbidity, the short-term effects of air pollution were estimated to result in an additional 71 (95% CI 43-104) respiratory and 204 (95% CI 131-260) cardiovascular hospitalizations per year. The biggest external costs are related to the long-term effects on mortality: this is on average euro 150 (95% CI 40-260) million annually. In comparison, the costs of short-term air-pollution driven hospitalizations are small euro 0.3 (95% CI 0.2-0.4) million.

    CONCLUSION: Sectioning the city for analysis and using GIS systems can help to improve the accuracy of air pollution health impact estimations, especially in study areas with poor air pollution monitoring data but available dispersion models.

  • 48.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Viitak, Anu
    Herodes, Koit
    Veber, Triin
    Lukk, Marten
    Human Biomonitoring in the Oil Shale Industry Area in Estonia: Overview of Earlier Programmes and Future Perspectives2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 582114Article in journal (Refereed)
    Abstract [en]

    Ida-Viru County, in Eastern Estonia, features industrially contaminated sites–where oil shale has been mined and used for electricity generation, and shale oil extraction. Higher prevalence of respiratory and cardiovascular disease has been found in the region due to high quantities of air pollution. Within the framework of “Studies of the health impact of the oil shale sector—SOHOS,” this analysis aimed to map earlier human biomonitoring (HBM) studies and identify the suitable biomarkers for upcoming HBM in Estonia. Altogether, three studies have been conducted among residents: first, among adults in the 1980's; second, among children in the 1990's; and third, among employees, with a focus on workers and miners in the oil shale chemistry industry in the late 1990's and 2000's. In some of those studies, increased levels of biomarkers in blood and urine (heavy metals, 1-OHP) have appeared; nevertheless, in last 20 years, there has been no population-wide HBM in Estonia. According to air pollution monitoring and emission analysis, the pollutants of concern are benzene, PM10, PM2.5, and PAHs. In general, there is a decreasing trend in air pollutant levels, with the exception of a slight increase in 2018. One of the aims of HBM is to be analyzed if this trend can be identified in HBM, using similar biomarkers as applied earlier. The future perspective HBM could be divided into two Tiers. Tier 1 should focus on exposure biomarkers as heavy metals, PAH, and BTEX metabolites and Tier 2, in later stage, on effect biomarkers as Ox LDL, TBARS, etc.

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  • 49.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    Tamm, Tanel
    Ebi, Kristie L.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ozone and heat-related mortality in Europe in 2050 significantly affected by changes in climate, population and greenhouse gas emission2019In: Environmental Research Letters, E-ISSN 1748-9326, Vol. 14, no 7, article id 074013Article in journal (Refereed)
    Abstract [en]

    Climate change is expected to increase to extreme temperatures and lead to more intense formation of near-surface ozone. Higher temperatures can cause heat stress and ozone is a highly oxidative pollutant; both increase cardiorespiratory mortality. Using greenhouse gas and ozone precursor emission scenarios, global and regional climate and chemistry-transport models, epidemiological data, and population projections, we projected ozone- and heat-related health risks under a changing climate. European near-surface temperature was modelled with the regional climate model (RCA4), forced by the greenhouse gas emission scenario RCP4.5 and the global climate model EC-EARTH, and near-surface ozone was modelled with the Multi-scale Atmospheric Transport and Chemistry (MATCH) model. Two periods were compared: recent climate in 1991-2000 and future climate in 2046-2055, projecting around a 2 degrees increase in global temperatures by that time. Projections of premature mortality considered future climate, future population, and future emissions separately and jointly to understand the relative importance of their contributions. Ozone currently causes 55 000 premature deaths annually in Europe due to long-term exposure, including a proportion of the estimated 26 000 deaths per year due to short-term exposures. When only taking into account the impact of a changing climate, up to an 11% increase in ozone-associated mortality is expected in some countries in Central and Southern Europe in 2050. However, projected decreases in ozone precursor emissions are expected to result in a decrease in ozone-related mortality (-30% as EUaverage). Due to aging and increasingly susceptible populations, the decrease in 2050 would be smaller, up to -24%. During summer months, ozone risks could combine with increasing temperatures, especially during the hottest periods and in densely populated urban areas. While the heat burden is currently of the same order of magnitude as ozone, due to increasing temperatures and decreasing ozone precursor emissions, heat-related mortality could be twice as large as ozone-related mortality in 2050.

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  • 50.
    Orru, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Åström, Daniel Oudin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Centre for Primary Health Care Research, Department of Clinical Science, Lund University, Lund, Sweden.
    Increases in external cause mortality due to high and low temperatures: evidence from northeastern Europe2017In: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254, Vol. 61, no 5, p. 963-966Article in journal (Refereed)
    Abstract [en]

    The relationship between temperature and mortality is well established but has seldom been investigated in terms of external causes. In some Eastern European countries, external cause mortality is substantial. Deaths owing to external causes are the third largest cause of mortality in Estonia, after cardiovascular disease and cancer. Death rates owing to external causes may reflect behavioural changes among a population. The aim for the current study was to investigate if there is any association between temperature and external cause mortality, in Estonia. We collected daily information on deaths from external causes (ICD-10 diagnosis codes V00-Y99) and maximum temperatures over the period 1997-2013. The relationship between daily maximum temperature and mortality was investigated using Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 10 days. We found significantly higher mortality owing to external causes on hot (the same and previous day) and cold days (with a lag of 1-3 days). The cumulative relative risks for heat (an increase in temperature from the 75th to 99th percentile) were 1.24 (95% confidence interval, 1.14-1.34) and for cold (a decrease from the 25th to 1st percentile) 1.19 (1.03-1.38). Deaths due to external causes might reflect changes in behaviour among a population during periods of extreme hot and cold temperatures and should therefore be investigated further, because such deaths have a severe impact on public health, especially in Eastern Europe where external mortality rates are high.

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