LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67000 Strasbourg, France.
School of Public Health (EHESP), 35043 Rennes CEDEX, France.
Int J Environ Res Public Health. 2018 Dec 24;16(1):38. doi: 10.3390/ijerph16010038.
: To support environmental policies aiming to tackle air pollution, quantitative health impact assessments (HIAs) stand out as one of the best decision-making tools. However, no risk assessment studies have quantified or mapped the health and equity impact of air pollution reduction at a small spatial scale. : We developed a small-area analysis of the impact of air pollution on "premature" death among an adult population over 30 years of age to quantify and map the health and equity impact related to a reduction of air pollution. : All-cause mortality data of an adult population (>30 years) from January 2004 to December 2009 were geocoded at the residential census block level in Paris. Each census block was assigned socioeconomic deprivation levels and annual average ambient concentrations of NO₂, PM, and PM. HIAs were used to estimate, at a small-area level, the number of "premature" deaths associated with a hypothetical reduction of NO₂, PM, and PM exposure. In total, considering global dose response function for the three pollutants and socioeconomic deprivation specific dose response function, nine HIAs were performed for NO₂ and six and four HIAs for PM10 and PM2.5, respectively. Finally, a clustering approach was used to quantify how the number of "premature" deaths could vary according to deprivation level. : The number of deaths attributable to NO₂, PM, and PM exposure were equal to 4301, 3209, and 2662 deaths, respectively. The most deprived census blocks always appeared as one of the groups most impacted by air pollution. Our findings showed that "premature" deaths attributable to NO₂ were not randomly distributed over the study area, with a cluster of excess "premature" deaths located in the northeastern area of Paris. : This study showed the importance of stratifying an environmental burden of disease study on the socioeconomic level, in order to take into consideration the modifier effect of socioeconomic status on the air pollution-mortality relationship. In addition, we demonstrated the value of spatial analysis to guide decision-making. This shows the need for tools to support priority-setting and to guide policymakers in their choice of environmental initiatives that would maximize health gains and reduce social inequalities in health.
为了支持旨在应对空气污染的环境政策，定量健康影响评估（HIAs）是最佳决策工具之一。然而，目前尚无风险评估研究在小空间尺度上量化或绘制空气污染减少对健康和公平的影响。
我们开发了一种针对 30 岁以上成年人“过早”死亡的空气污染影响的小区域分析，以量化和绘制与空气污染减少相关的健康和公平影响。
2004 年 1 月至 2009 年 12 月，所有成人（>30 岁）的全因死亡率数据在巴黎的居住人口普查块级进行了地理编码。每个普查块被分配了社会经济剥夺水平以及年度平均环境浓度的 NO₂、PM 和 PM。使用 HIAs 在小区域层面估计与假设的 NO₂、PM 和 PM 暴露减少相关的“过早”死亡人数。总共，考虑到三种污染物的全球剂量反应函数和特定于社会经济剥夺的剂量反应函数，对 NO₂进行了九项 HIA，对 PM10 和 PM2.5 分别进行了六项和四项 HIA。最后，使用聚类方法来量化根据剥夺水平，“过早”死亡人数可能会如何变化。
归因于 NO₂、PM 和 PM 暴露的死亡人数分别为 4301、3209 和 2662 人。最贫困的普查块始终被视为受空气污染影响最大的群体之一。我们的研究结果表明，归因于 NO₂的“过早”死亡人数在研究区域内没有随机分布，巴黎东北部地区存在一个“过早”死亡人数过多的集群。
本研究表明，在环境疾病负担研究中按社会经济水平进行分层的重要性，以便考虑社会经济地位对空气污染-死亡率关系的修饰作用。此外，我们展示了空间分析的价值，以指导决策。这表明需要工具来支持确定优先事项，并指导决策者选择能够最大程度地提高健康收益并减少健康方面社会不平等的环境倡议。
