Quantification of environmental burden of disease due to the nitrogen dioxide exposure in Germany



As part of the project, a comprehensive coverage of the background nitrogen dioxide (NO2) exposure of the population in Germany was carried out with subsequent quantification of the associated disease burden. In the first step, NO2 exposure maps depicting the pollution situation in the background level were evaluated for the period from 2007 to 2014 based on the NO2 model data of the Federal Environmental Agency and the NO2 measurement data of the federal and state governments. Subsequently, the distribution of the population to NO2 load classes for all Germany was determined. The calculated average population-weighted NO2 concentration in the respective exposure classes served as the basis for calculating disease burden for all NO2-specific health endpoints. Analyzes were carried out on the temporal evolution of the burden and the health effects as well as on the uncertainties of the results obtained.

The health endpoints relevant for the calculation were identified as part of a systematic literature search. These were natural and cause-specific mortality (short-term and long-term effects), cause-specific hospitalizations, type 2 diabetes, hypertension, heart failure, myocardial infarction, stroke, ischemic heart disease, lung cancer, asthma, chronic bronchitis, COPD (chronic obstructive pulmonary disease), premature birth and low birth weight. In order to evaluate the evidence of the relationship between NO2 pollution and the listed outcomes, a list of criteria was developed in the project. On this basis, there was strong evidence of long-term effects on cardiovascular mortality. In terms of short-term effects, the outcomes "all-cause mortality" and "respiratory mortality" showed strong evidence. The recently increasing endpoint diabetes mellitus has been evaluated with moderate evidence.

Using a lower quantitation limit of 10 μg / m³ NO2, 2014 cardiovascular mortality from NO2 long-term exposure (based on annual mean values) resulted in 5,966 (95% confidence interval: 2,031 to 9,893) attributable premature deaths and 49,726 (16,929 to 82,456) estimated lost years of life. Between the years 2007 and 2014. In total a slightly decreasing showed trend with respect to the attribute ablen premature deaths. It is important to point out that the assessment of the burden of disease presented here is based exclusively on the background concentrations for NO2 and thus could not take into account higher concentrations, which are found especially in urban areas with a high traffic density. 


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