Dirk Wintermeyer

Das Konzept der umweltbedingten Krankheitslast

GOAL OF THE STUDY Environmental risk factors are of great importance for public health with a considerable but often unused potential for prevention. However, knowledge about the complex associations between the environment and health effects is limited for some risk factors. A concept, which is using the existing evidence on associations between the impact of environmental factors and health effects, is the environmental burden of disease (EBD) concept. The aim of this article is to present the quantification method of the EBD concept and to discuss the advantages and its points of criticism. METHODS The EBD concept combines morbidity and mortality data in a single measure (Disability-Adjusted Life Year, DALY) to enable a comparative description of the burden of disease. Life years are used as measurement unit. The environmental share of the total DALYs is quantified by using the attributable fraction. RESULTS Despite its increasing application especially in the international context, the method is still criticized, because by summarizing the complex construct of health in one single measurement unit, much important information about quality of life is lost. A further criticism refers to partly arbitrarily set social value choices. Additionally, missing or insufficient data can limit the quality and validity of EBD estimations. CONCLUSION A scientific discourse is needed to decide to what extent the EBD approach can and should be used in Germany.

Proceedings of the International Workshop ‘From Global Burden of Disease Studies to National Burden of Disease Surveillance'

Table of contentsI1 Introduction and aims of the workshop Christa Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich PlassS1 History, concept, and current results of GBD for GermanyTom Achoki, Katherine Leach-Kemon, Peter Speyer, William E. Heisel, Emmanuela Gakidou, Theo VosS2 Methodology of the GBD 2013 Study–Mortality, Morbidity, Risk-FactorsMohammad Hossein ForouzanfarS3 National burden of disease surveillance examples of good practice: the case of Public Health EnglandJürgen C. SchmidtS4 Critical aspects of the burden of disease methodology and country-specific challengesClaudia E. SteinS5 Non-communicable disease surveillance in Germany – public health and data challengesChrista Scheidt-Nave, Elena von der Lippe, Benjamin Barnes, Markus Busch, Nina Buttmann-Schweiger, Judith Fuchs, Christin Heidemann, Klaus Kraywinkel, Enno Nowossadeck, Thomas ZieseS6 Different approaches in estimating the burden of communicable diseases using the examples of the healthcare associated infections and influenzaUdo Buchholz, Matthias an der Heiden, Tim Eckmanns, Sebastian HallerS7 Behavioral and environmental attributable risk estimationMohammad Hossein ForouzanfarS8 Environmental Burden of Disease (EBD) in Germany – past achievements and future perspectivesDietrich Plass, Myriam Tobollik, Dagmar Kallweit, Dirk WintermeyerC1 Conclusions of the workshopChrista Scheidt-Nave, Thomas Ziese, Judith Fuchs, Dietrich Plass

OP IX – 4 Quantification of environmental burden of disease related to nitrogen dioxide exposure in germany

Background/aim Epidemiological studies have shown associations of nitrogen dioxide (NO2) with numerous health outcomes. EU-wide air quality limit values for NO2 are in place but regularly exceeded at measuring stations near roads in Germany. Therefore, a health risk assessment for the NO2-exposure of the German population was conducted. Methods For 2007 up to 2014, maps of the annual spatial 1*1 km2 distribution of a population-weighted NO2 concentration indicator were calculated based on assimilated modelling data of background NO2 within a 7*8 km2 grid and population density within a 250*250 m2 grid. For three model regions a small scale assessment of the NO2 exposure was achieved by considering concentrations in the higher resolved urban background as well as close to highly polluted street sections. A systematic literature search of epidemiological studies was performed to ascertain the current evidence on long-term health effects of NO2 and to identify exposure-response-functions transferrable to Germany. The Environmental Burden of Disease-concept was applied to quantify the NO2-associated health risks for relevant outcomes. Results The yearly mean of background NO2 slightly decreased from 13 μg/m3 (range: 4.3 to 37.3 μg/m3) in 2007 to 11.8 μg/m3 (3.4 to 32.7 μg/m3) in 2014. Using a counterfactual value of 10 µg/m3, 5966 (95%-confidence interval: 2031 to 9,893) premature deaths and 49,726 (16,929 to 82,456) Years of Live Lost (YLL) due to cardiovascular mortality attributable to NO2 long-term exposure were estimated for the year 2014. Between 2007 and 2014 an overall slightly decreasing trend was observed for attributable premature deaths. The higher resolution of NO2-concentration for the three model regions led to a substantial increase in the estimated number of premature deaths due to cardiovascular disease by 40% to 165%. Conclusion The present estimates are based on NO2 concentrations reflecting background exposure and thus underestimate the burden of disease. A better accuracy of the NO2 exposure estimation accounting for the higher concentrations in urban areas close to traffic improves the burden of disease quantification and may enhance the distinction of health effects related to fine and ultrafine particles.

Quantification of the health impact of environmental stressors in Germany for use in policy making: results of the VegAS project

Abstract Background The German VegAS project (long title: Distribution-based analysis of the health effect of environmental stressors) deals with the health impact of environmental stressors in Germany, aiming for a comparative risk assessment (CRA) using the environmental burden-of-disease (EBD) approach developed by WHO. Methods Extensive literature and data searches were conducted to determine the evidence-based environment–health relations of seven stressors (benzene, cadmium, noise [various types], ozone, particulate matter, perfluorinated compounds [PFC], and second-hand smoke) and their distribution of exposure in Germany. The EBD was expressed as lost disability-adjusted life-years (DALYs) attributable to these stressors. Uncertainties and limitations at different stages of the analysis were identified and discussed in detail. Moreover, an expert meeting was held to review the methods and data. The VegAS results were discussed regarding compatibility requirements of CRA. Findings DALYs attributable to the seven environmental stressors were determined for 11 health outcomes, some of them attributed to more than one stressor. Five stressors could be associated with years of life lost. The quality of EBD quantification was restricted by missing sources of exposure data, lack of exposure–response functions, or incomplete knowledge on the outcome weighting. DALY estimates were reported for all stressors except PFC. Interpretation A full DALY calculation failed for several outcomes because of insufficient or missing data. CRAs building on this approach should therefore be interpreted with caution. The VegAS results provide evidence-based, stressor-specific EBD estimates that can support informed decision making in environmental health. These estimates, however, should be used against the background of a detailed uncertainty analysis that should also help close data gaps, as applied in VegAS. Funding The VegAS project was funded by the Federal Ministry of Environment, Nature Conservation, and Nuclear Safety in context of the Environment Research Plan 2009. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.