A. Lefranc

Short-term associations between fine and coarse particles and hospital admissions for cardiorespiratory diseases in six French cities

Objectives: Little is known about the potential health effects of the coarse fraction of ambient particles. The aim of this study is to estimate the links between fine (PM2.5) and coarse particle (PM2.5−10) levels and cardiorespiratory hospitalisations in six French cities during 2000–2003. Methods: Data on the daily numbers of hospitalisations for respiratory, cardiovascular, cardiac and ischaemic heart diseases were collected. Associations between exposure indicators and hospitalisations were estimated in each city using a Poisson regression model, controlling for confounding factors (seasons, days of the week, holidays, influenza epidemics, pollen counts, temperature) and temporal trends. City-specific findings were combined to obtain excess relative risks (ERRs) associated with a 10 μg/m3 increase in PM2.5 and PM2.5−10 levels. Results: We found positive associations between indicators of particulate pollution and hospitalisations for respiratory infection, with an ERR of 4.4% (95% CI 0.9 to 8.0) for PM2.5−10 and 2.5% (95% CI 0.1 to 4.8) for PM2.5. Concerning respiratory diseases, no association was observed with PM2.5, whereas positive trends were found with PM2.5−10, with a significant association for the 0–14-year-old age group (ERR 6.2%, 95% CI 0.4 to 12.3). Concerning cardiovascular diseases, positive associations were observed between PM2.5 levels and each indicator, although some did not reach significance; trends with PM2.5−10 were weaker and non-significant except for ischaemic heart disease in the elderly (ERR 6.4%, 95% CI 1.6 to 11.4). Conclusions: In accordance with other studies, our results indicate that the coarse fraction may have a stronger effect than the fine fraction on some morbidity endpoints, especially respiratory diseases.

Les « Années de vie ajustées sur l'incapacité » : un outil d'aide à la définition des priorités de santé publique ?

Position du probleme L’objectif est l’etude d’un indicateur de sante permettant d’estimer l’etat de sante d’une population, comme celle de Paris, en combinant les donnees de mortalite et de morbidite. A partir de ces donnees, cet indicateur contribuera a determiner les actions curatives et preventives a entreprendre en priorite. De plus, la comparaison entre les resultats obtenus avec cet indicateur et les donnees disponibles dans la bibliographie concernant la situation parisienne permettront d’eclairer certains des questionnements entourant la pertinence des indicateurs synthetiques de sante. Methodes La methode utilisee est celle du Fardeau Global de la Maladie (FGM). Elle permet une hierarchisation des pathologies grâce a un indicateur nomme « Les annees de vie ajustees sur l’incapacite » (AVAI). Cet indicateur integre les notions de mortalite et de morbidite. Il permet d’estimer le nombre d’annees de vie en bonne sante, perdues a cause d’une incapacite ou d’un deces premature. Les calculs ont ete realises pour Paris a partir des donnees locales de mortalite de 1999 et des tables regionales d’incapacites publiees par l’Organisation mondiale de la sante (OMS). Resultats Sur un total de 242 064 annees de vie ajustees sur l’incapacite pour Paris en 1999, les six premieres causes d’AVAI sont : les psychoses et dependances alcooliques (6,5 % du total), les cancers des voies respiratoires (5,7 %), les cardiopathies ischemiques (4,8 %), la depression (4,4 %), les demences (4,2 %) et l’arthrose (3,9 %). Il existe une predominance masculine pour les trois premieres d’entre elles. Les cancers et les cardiopathies ischemiques ont une mortalite superieure a la morbidite avec un nombre d’annees potentielles de vie perdues (APVP) predominant. La morbidite est la plus importante pour les quatre autres principales causes qui presentent une majorite d’annees de vie avec incapacite (AVI). Conclusion Les classements obtenus pour Paris montrent comment les AVAI pourraient aider au classement des priorites de sante publique. De tels resultats pourraient servir a informer la population sur son etat de sante et fournir aux decideurs un indicateur global de sante. La prochaine etape devra permettre d’estimer plus precisement les annees de vie ajustees sur l’incapacite grâce a l’evaluation locale de la morbidite, ceci afin de ne plus dependre des incidences regionales peu sensibles de l’OMS. Des mesures repetees de cet indicateur pourraient en faire un barometre de sante publique, il pourrait contribuer a la surveillance sanitaire et a l’evaluation des actions entreprises. Cependant, certains des resultats obtenus avec cet indicateur illustrent les limites de ce type d’analyse.

Retentissement de la pollution atmosphérique sur la santé: Le Programme de Surveillance Air et Santé 9 villes

OBJECTIVESnTo quantify the short term effects of air pollution on mortality and hospitalisation for cardiovascular or respiratory disorders in the nine French cities (Bordeaux, Le Havre, Lille, Lyon, Marseille, Paris, Rouen, Strasbourg and Toulouse) of the Surveillance Air et Santé program.nnnMETHODSnData were available on mortality and hospitalisation were available, respectively, from 1990 to 1997 and 1995 to 1999. Exposure data were the concentrations of sulphur dioxide, particles with a diameter of less than or equal to 10 mm, black smoke, nitrogen dioxide, ozone, and carbon monoxide. The analysis assessed the relationships, in each of the cities, between the daily numbers of deaths and hospitalisations and the daily levels of polluting agents, taking into account confounding factors. A combined relative risk was calculated for all the cities. The number of deaths and hospitalisations attributable to air pollution was then estimated for each of the cities, based on the relative risk.nnnRESULTSnSignificant relationships were found for mortality, from whatever cause, and for hospitalisations for respiratory disorders in children aged under 15. If the levels of air pollution were reduced to 10 microg/m3 in the nine cities, 2800 premature deaths and 750 hospitalisations for respiratory disorders in children would be avoided, every year.nnnCONCLUSIONnToday, it is possible to assess the benefits of reducing air pollution in terms of health in the short term. These analyses would provide a sanitary dimension to the strategies for the reduction of urban pollution on local and European level.Resume Objectif Quantifier les effets a court terme de la pollution atmospherique sur la mortalite et les admissions hospitalieres d’origine cardio-vasculaire ou respiratoire, dans les 9 villes (Bordeaux, Le Havre, Lille, Lyon, Marseille, Paris, Rouen, Strasbourg et Toulouse) du Programme de Surveillance Air et Sante. Methodes Les donnees de mortalite et d’hospitalisation etaient disponibles, respectivement, de 1990 a 1997 et de 1995 a 1999. Les donnees d’exposition concernaient les concentrations du dioxyde de soufre, des particules de diametre inferieur ou egal a 10 mm, des fumees noires, du dioxyde d’azote, de l’ozone, du monoxyde de carbone. L’analyse a mis en relation, dans chacune des villes, les nombres journaliers de deces et d’hospitalisations avec les niveaux journaliers des polluants, en tenant compte d’un ensemble de facteurs de confusion. Un risque relatif combine a ete calcule pour l’ensemble des villes. Les nombres de deces et d’hospitalisations attribuables a la pollution atmospherique dans chacune des villes ont ete estimes a partir de ce risque relatif. Resultats Des associations significatives ont ete observees pour la mortalite, quelle que soit la cause, et pour les hospitalisations pour motifs respiratoires chez les moins de 15 ans. Si les niveaux de pollution atmospherique etaient ramenes a 10 μg/m 3 sur les 9 villes, 2800 deces anticipes au total et 750 hospitalisations respiratoires chez les enfants seraient evitables chaque annee. Conclusion Il est possible d’estimer l’impact de la reduction de la pollution sur la sante pour le court terme. Ces analyses permettent de donner une dimension sanitaire aux politiques de reduction de la pollution urbaine au niveau local et europeen.

Revue généraleÉtude de la santé déclarée par les personnes riveraines de sources locales de pollution environnementale : une revue de la littérature. Première partie : les indicateurs de santé déclaréeStudy of self-reported health of people living near point sources of environmental pollution: A review. First part: Health indicators

BACKGROUNDnEpidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators.nnnMETHODSnThe literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators.nnnRESULTSnThe literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress.nnnCONCLUSIONnThe choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used.

Étude de la santé déclarée par les personnes riveraines de sources locales de pollution environnementale : une revue de la littérature. Première partie : les indicateurs de santé déclarée

BACKGROUNDnEpidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators.nnnMETHODSnThe literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators.nnnRESULTSnThe literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress.nnnCONCLUSIONnThe choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used.

La mesure de la mortalité prématurée : comparaison des décès avant 65 ans et des années espérées de vie perdues

BACKGROUNDnFor many years in France, premature mortality (i.e., deaths before 65 years old) and avoidable deaths have generally been used to monitor health of the population and help to elaborate policies in this area. This paper aims to examine the utility of another indicator of premature mortality, which makes it possible to take into account the impact of deaths, the expected years of life lost (EYLL).nnnMETHODSnMortality data for France in the years 2000 to 2002 were obtained from the Centre for Epidemiology of the Medical Causes of Death. Premature mortality was defined as death before 65 years of age. For the calculation of EYLL, the mortality norm chosen was French-life expectancy for the years 2001 to 2003. In order to study the spatial distribution of the indicators above defined, standardized ratios were calculated for each administrative area, taking France as the reference population.nnnRESULTSnIrrespective of the gender and indicator considered, ranking of the causes emphasized three major groups of pathological conditions, which are strongly distinguished from the others: cardiovascular diseases, malignant neoplasm and injuries. The ranking of causes varied considerably according to the indicator used. The spatial representation of standardized ratios of expected years of life lost and deaths before 65 showed a strong North-South trend.nnnCONCLUSIONnThe concept of premature mortality is difficult to define and discussions persist on the age limit to use for its quantification. The choice of an indicator strongly depends on the use which one wishes to make. The simple analysis of deaths before 65 years currently used to describe premature mortality in France makes it possible to describe its frequency. The use of a summary measure as EYLL allows to quantify the impact of premature mortality by giving different weights to deaths depending on the age of occurrence. EYLL, thus, seems to be an indicator, which is particularly adapted to decision-making in public health, depending on choices and values one wishes to give preference to.