Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Stroke | Research

Mortality burden of cardiovascular disease attributable to ambient PM2.5 exposure in Portugal, 2011 to 2021

Authors: Mariana O. Corda, Periklis Charalampous, Juanita A. Haagsma, Ricardo Assunção, Carla Martins

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Exposure to high levels of environmental air pollution causes several health outcomes and has been associated with increased mortality, premature mortality, and morbidity. Ambient exposure to PM2.5 is currently considered the leading environmental risk factor globally. A causal relationship between exposure to PM2.5 and the contribution of this exposure to cardiovascular morbidity and mortality was already demonstrated by the American Heart Association.

Methods

To estimate the burden of mortality attributable to environmental risk factors, a comparative risk assessment was performed, considering a “top-down” approach. This approach uses an existing estimate of mortality of the disease endpoint by all causes as a starting point. A population attributable fraction was calculated for the exposure to PM2.5the overall burden of IHD and stroke was multiplied by the PAF to determine the burden attributable to this risk factor. The avoidable burden was calculated using the potential impact fraction (PIF) and considering the WHO-AQG 2021 as an alternative scenario.

Results

Between 2011 and 2021, the ambient exposure to PM2.5 resulted in a total of 288,862.7 IHD YLL and a total of 420,432.3 stroke YLL in Portugal. This study found a decreasing trend in the mortality burden attributable to PM2.5 exposure, for both males and females and different age-groups. For different regions of Portugal, the same trend was observed in the last years. The mortality burden attributable to long-term exposure to PM2.5 was mainly concentrated in Lisbon Metropolitan Area, North and Centre. Changes in the exposure limits to the WHO recommended value of exposure (WHO-AQG 2021) have a reduction in the mortality burden due to IHD and stroke attributable to PM2.5 exposure, in Portugal.

Conclusion

Between 2011 and 2021, approximately 22% and 23% of IHD and stroke deaths were attributable to PM2.5 exposure. Nevertheless, the mortality burden attributable to cardiovascular diseases has been decreasing in last years in Portugal. Our findings provide evidence of the impact of air pollution on human health, which are crucial for decision-making, at the national and regional level.
Appendix
Available only for authorised users
Literature
1.
Cohen AJ, Brauer M, Burnett R, Anderson HR, Frostad J, Estep K, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of diseases Study 2015. Lancet. 2017;389(10082):1907–18.PubMedPubMedCentralCrossRef
2.
3.
GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease Study 2019. Lancet. 2020;396(1):1223–49.
4.
Brauer M, Casadei B, Harrington RA, Kovacs R, Sliwa K. Taking a stand against air pollution: the impact on cardiovascular disease. Glob Heart. 2021;16(1):1–6.CrossRef
5.
Burnett R, Chen H, Szyszkowicz M, Fann N, Hubbell B, Pope CA, et al. Global estimates of mortality associated with longterm exposure to outdoor fine particulate matter. Proc Natl Acad Sci USA. 2018;115(38):9592–7.PubMedPubMedCentralCrossRef
6.
7.
WHO. Burden of disease from the joint effects of household and ambient air pollution for 2016: summary of results. Geneva: World Health Organization; 2018.
8.
9.
Danesh Yazdi M, Wang Y, Di Q, Zanobetti A, Schwartz J. Long-term exposure to PM2.5 and ozone and hospital admissions of Medicare participants in the Southeast USA. Environ Int. 2019;130(1):104879.PubMedCrossRef
10.
Basith S, Manavalan B, Shin TH, Park CB, Lee WS, Kim J, et al. The impact of fine particulate matter 2.5 on the cardiovascular system: a review of the invisible killer. Nanomaterials. 2022;12(1):2656.PubMedPubMedCentralCrossRef
11.
Kaufman JD, Adar SD, Barr RG, Budoff M, Burke GL, Curl CL, et al. Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the multi-ethnic study of atherosclerosis and Air Pollution): a longitudinal cohort study. Lancet. 2016;388:696–704.PubMedPubMedCentralCrossRef
12.
Hänninen O, Knol AB, Jantunen M, Lim TA, Conrad A, Rappolder M, et al. Environmental burden of disease in Europe: assessing nine risk factors in six countries. Environ Health Perspect. 2014;122(5):439–46.PubMedPubMedCentralCrossRef
13.
Li L, Yang J, Song YF, Chen PY, Ou CQ. The burden of COPD mortality due to ambient air pollution in Guangzhou, China. Sci Rep. 2016;6(2):1–7.
14.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2224–60.PubMedPubMedCentralCrossRef
15.
Brook RD, Rajagopalan S, Pope CA, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Am Hear Assoc. 2010;121(21):2331–78.
16.
17.
Torres P, Ferreira J, Monteiro A, Costa S, Pereira MC, Madureira J, et al. Air pollution: a public health approach for Portugal. Sci Total Environ. 2018;643(135):1041–53.PubMedCrossRef
18.
Brito J, Bernardo A, Zagalo C, Gonçalves LL. Quantitative analysis of air pollution and mortality in Portugal: current trends and links following proposed biological pathways. Sci Total Environ. 2021;755(1):142473.PubMedCrossRef
19.
Lima LF. Outdoor air monitoring of atmospheric levels of PM2.5 in Portugal over the years (2003–2021): first step for effectiveness evaluation of air quality policies in Portugal [Master Dissertation]. Lisbon: NOVA National School of Public Health; 2023.
20.
WHO. Health risks of air pollution in Europe: HRAPIE project: recommendations for concentration–response functions for cost–benefit analysis of particulate matter, ozone and nitrogen dioxide. Copenhagen: Regional Office for Europe. World Health Organization; 2013.
21.
INE. Resident population (No.) by place of residence (NUTS − 2013), sex and age group (annual estimates of resident population) [Internet]. Lisboa: Instituto Nacional de Estatistica; 2022. Available from: http://​tiny.​cc/​1ffjvz.
22.
INE. Deaths (No.) by place of residence (NUTS − 2013), sex, age group and death cause (European short-list) (Mortality by causes of death). Lisboa: Instituto Nacional de Estatística; 2021. Available from: http://​tiny.​cc/​iffjvz. Cited 2022 Dec 17.
23.
Pruss-Ustun A, Mathers C, Corvalan C, Woodward A. Introduction and methods: assessing the environmental burden of disease at national and local levels. Geneva: World Health Organisation; 2003.
24.
Plass D, Hilderink H, Lehtomäki H, Øverland S, Eikemo TA, Lai T, et al. Estimating risk factor attributable burden: challenges and potential solutions when using the comparative risk assessment methodology. Arch Public Heal. 2022;80(1):1–12.
25.
Murray CJL, Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S. Comparative quantification of health risks: conceptual framework and methodological issues. Popul Health Metr. 2003;1:1–20.PubMedPubMedCentralCrossRef
26.
27.
WHO. Global air quality guidelines: particulate matter (‎PM2.5 and PM10)‎, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organisation; 2021.
28.
Murray CJL, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C, et al. GBD 2010: design, definitions, and metrics. Lancet. 2012;380(1):2063–6.PubMedCrossRef
29.
Global Burden of Disease Collaborative Network. Global burden of Disease Study 2019 (GBD 2019): reference life table. Seattle, WA: Institute for Health Metrics and Evaluation (IHME); 2020.
30.
31.
Alexeeff SE, Liao NS, Liu X, Van Den Eeden SK, Sidney S. Long-term PM2.5 exposure and risks of ischemic heart disease and stroke events:review and meta-analysis. J Am Heart Assoc. 2021;10(1):1–22.CrossRef
32.
Barendregt JJ, Veerman JL. Categorical versus continuous risk factors and the calculation of potential impact fractions. J Epidemiol Community Health. 2010;64(3):209–12.PubMedCrossRef
33.
Zhang J, Wang X, Yan M, Shan A, Wang C, Yang X, et al. Sex differences in cardiovascular risk associated with long-term PM2.5 exposure: a systematic review and meta-analysis of cohort studies. Front Public Heal. 2022;10(1):1–9.
34.
Liao M, Braunstein Z, Rao X. Sex differences in particulate air pollution-related cardiovascular diseases: a review of human and animal evidence. Sci Total Environ. 2023;884(1):163803.PubMedCrossRef
35.
Shumake KL, Sacks JD, Lee JS, Johns DO. Susceptibility of older adults to health effects induced by ambient air pollutants regulated by the European Union and the United States. Aging Clin Exp Res. 2013;25(1):3–8.PubMedCrossRef
36.
Li X, Li C, Zhang W, Wang Y, Qian P, Huang H. Inflammation and aging: signaling pathways and intervention therapies. Signal Transduct Target Ther. 2023;8(1):1–29.
37.
38.
39.
40.
EEA. Air quality in Europe 2014 report: report no 5/2014. Luxembourg: European Environment Agency; 2014.
41.
EEA. Air quality in Europe 2015 report: report no 5/2015. Luxembourg: European Environment Agency; 2015.
42.
EEA. Air quality in Europe 2016 report: report no 28/2016. Luxembourg: European Environment Agency; 2016.
43.
EEA. Air quality in Europe 2017 report: report no 13/2017. Luxembourg: European Environment Agency; 2017.
44.
EEA. Air quality in Europe 2018 report: report 12/2018. Luxembourg: European Environment Agency; 2018.
45.
EEA. Air quality in Europe 2019 report: report no 4/2012. Luxembourg: European Environment Agency; 2019.
46.
EEA. Air quality in Europe 2020 report: report no 9/2020. Luxembourg: European Environment Agency; 2020.
47.
EEA. Air quality in Europe 2021 report: report no 15/2021. Luxembourg: European Environment Agency; 2021.
48.
Khomenko S, Cirach M, Pereira-Barboza E, Mueller N, Barrera-Gómez J, Rojas-Rueda D, et al. Premature mortality due to air pollution in European cities: a health impact assessment. Lancet Planet Heal. 2021;5(3):e121-134.CrossRef
49.
EEA. Europe’s air quality status 2023: briefing no 05/2023. Luxembourg: European Environment Agency; 2023.
50.
WHO. New WHO global air quality guidelines aim to save millions of lives from air pollution. Geneva: World Health Organisation. 2021. http://​tiny.​cc/​tagjvz. Cited 2023 Jan 10.
51.
Dechezleprêtre A, Rivers N, Stadler B. The economic cost of air pollution: evidence from Europe. Paris: OECD Publishing; 2020.
52.
EEA. Unequal exposure and unequal impacts: social vulnerability to air pollution, noise and extreme temperatures in Europe: report no 22/2018. Luxembourg: European Environment Agency; 2018.
53.
WHO. Environmental health inequalities in Europe: second assessment report. Copenhagen: WHO Regional Office for Europe; 2019.
Metadata
Title
Mortality burden of cardiovascular disease attributable to ambient PM2.5 exposure in Portugal, 2011 to 2021
Authors
Mariana O. Corda
Periklis Charalampous
Juanita A. Haagsma
Ricardo Assunção
Carla Martins
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Stroke
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18572-0

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue

Research

Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions

Research

Associations of parental age at pregnancy with adolescent cognitive development and emotional and behavioural problems: a birth cohort in rural Western China

Research

Impact of the ´Alforja Educativa’ on Ecuadorian schoolchildren’s knowledge of bacteria, antibiotics, and antibiotic resistance, a pretest-posttest study

Research

Burden of colorectal cancer and its risk factors in the North Africa and Middle East (NAME) region, 1990–2019: a systematic analysis of the global burden of disease study

Research

Normalisation and equity of referral to the NHS Low Calorie Diet programme pilot; a qualitative evaluation of the experiences of health care staff

Research

Age at death during the Covid-19 lockdown in French metropolitan regions: a non parametric quantile regression approach