Respiratory Treatment and Prevention (Advances in Experimental Medicine and Biology)

Keywords

Air pollution • Cardiopulmonary disease • City • Lung cancer • Particulate

matter • Pollutant concentration • Population attributable fraction •

Premature death

1 Introduction

The European Environment Agency (EEA)
estimates that 9–30 % of the urban population
of the EU was exposed to the concentrations of
particulate matter with an aerodynamic diameter
of less than 10μm (PM 10 ) and less than 2.5μm
(PM2.5) exceeding the upper limit values
according to the 2008/50/EC Directive of the
European Parliament and of the Council on
ambient air quality and cleaner air for Europe
(CAFE Directive) in the period of 2011–2013.
That proportion has been since declining. None-
theless, in view of the World Health Organiza-
tion (WHO 2006 ), proportion of the urban
population of the EU exposed to particulate mat-
ter exceeding the health-safe level still remains at
a disquieting 61–93 % (EEA 2015 ).
Exposure to high levels of air pollution is
associated with a wide range of acute and chronic
diseases, especially of respiratory, cardiovascu-
lar, and central nervous systems (Kalkbrenner
et al. 2015 ; WHO 2014a; Volk et al. 2013 ;
Balmes 2009 ), or rheumatoid arthritis (Essouma
and Noubiap 2015 ). Urban populations are par-
ticularly affected by adverse effects resulting
from breathing highly polluted air. That creates
severe social and economic problems, given that
approximately 75 % of the European population
live in cities (Crosette 2010 ). It is estimated that
particulate pollutants are responsible for about
8 % of lung cancer deaths, 5 % of cardiovascular
diseases, and 3 % of respiratory infections
(WHO 2009 ). 3.7 MM premature deaths have
been attributed to atmospheric pollution world-
wide in both urban and non-urban populations in
2012 (WHO2014b). Lelieveld et al. ( 2015 ) have
demonstrated that air pollution, namely PM2.5,is
responsible globally for 3.3 MM deaths, with the
largest impact on premature mortality in China

and India, where air pollutants are emitted, in a

substantial part, from the residential sources. In

the EU, the number of premature deaths attribut-

able to exposure to PM2.5exceeded 400,000 in

2015; a figure that was some 30,000 lower than

that a year before (EEA 2015 ). Although the

number of deaths attributable to exposure to

PM2.5 decreases in Europe as a whole, an

increase in this number has been noted in

countries where the problem of air pollution is

particularly large, such as Poland or Bulgaria.

Moreover, 16,000 premature deaths have been

attributed to exposure to tropospheric ozone in

the EU, the figure remaining unchanged com-

pared with years past, and more than 70,

deaths have been attributed to exposure to nitro-

gen dioxide.

The International Agency for Research on

Cancer (IARC), after careful analysis of the

available literature on both epidemiologic and

mechanistic studies, stated in November 2013

that there is sufficient evidence on the relation-

ship between exposure to air pollution and the

incidence of lung and bladder cancers. In this

context, particulate matter, a major component

of air pollutants, has been classified as Group

1 carcinogen (carcinogenic to humans) (IARC

2013 ). Therefore, the aim of this study was to

estimate the proportion of mortality from lung

cancer and cardiopulmonary diseases that can be

attributed to exposure to PM2.5in ambient air in

selected Polish cities.

2 Methods

The Institutional Review Board approved this

study. The consent requirement was waived

because of the retrospective nature of the analy-

sis of medical records of deceased persons. Data

10 A.J. Badyda et al.