Costa Solange, Ferreira Joana, Silveira Carlos, Costa Carla, Lopes Diogo, Relvas Hélder, Borrego Carlos, Roebeling Peter, Miranda Ana Isabel, Teixeira João Paulo
a National Institute of Public Health , Environmental Health Department , Porto , Portugal.
J Toxicol Environ Health B Crit Rev. 2014;17(6):307-40. doi: 10.1080/10937404.2014.946164.
Quantifying the impact of air pollution on the public's health has become an increasingly critical component in policy discussion. Recent data indicate that more than 70% of the world population lives in cities. Several studies reported that current levels of air pollutants in urban areas are associated with adverse health risks, namely, cardiovascular diseases and lung cancer. IARC recently classified outdoor air pollution and related particulate matter (PM) as carcinogenic to humans. Despite the air quality improvements observed over the last few years, there is still continued widespread exceedance within Europe, particularly regarding PM and nitrogen oxides (NOx). The European Air Quality Directive 2008/50/EC requires Member States to design appropriate air quality plans for zones where air quality does not comply with established limit values. However, in most cases, air quality is only quantified using a combination of monitored and modeled data and no health impact assessment is carried out. An integrated approach combining the effects of several emission abatement measures on air quality, impacts on human health, and associated implementation costs enables an effective cost-benefit analysis and an added value to the decision-making process. Hence, this review describes the basic steps and tools for integrating health into air quality assessment (health indicators, exposure-response functions). In addition, consideration is given to two major outdoor pollutants: PM and NO2. A summary of the health metrics used to assess the health impact of PM and NO2 and recent epidemiologic data are also described.
量化空气污染对公众健康的影响已成为政策讨论中日益关键的组成部分。最近的数据表明，世界上70%以上的人口居住在城市。多项研究报告称，城市地区目前的空气污染物水平与不良健康风险相关，即心血管疾病和肺癌。国际癌症研究机构（IARC）最近将室外空气污染及相关颗粒物（PM）归类为对人类致癌物质。尽管在过去几年中空气质量有所改善，但在欧洲仍有广泛的超标现象持续存在，特别是在PM和氮氧化物（NOx）方面。《欧洲空气质量指令》2008/50/EC要求成员国为空气质量不符合既定限值的区域制定适当的空气质量计划。然而，在大多数情况下，空气质量仅通过监测数据和模型数据的组合进行量化，并未进行健康影响评估。一种综合方法，将多种减排措施对空气质量的影响、对人类健康的影响以及相关实施成本结合起来，能够进行有效的成本效益分析，并为决策过程增加价值。因此，本综述描述了将健康纳入空气质量评估的基本步骤和工具（健康指标、暴露-反应函数）。此外，还考虑了两种主要的室外污染物：PM和NO2。还介绍了用于评估PM和NO2对健康影响的健康指标总结以及近期的流行病学数据。
