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Health impact assessment of brief exposures to urban air pollution in northwestern France Volume 1, issue 3, Juillet - Août 2002

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Cellule inter-régionale d'épidémiologie ouest, École nationale de la santé publique, avenue du Pr.-Léon-Bernard, CS 74312, 35043 Rennes Cedex.

Context: The French Clean Air Law recommends regional air quality plans that assess the health effects of atmospheric pollution to help determine air quality objectives. The aim of this work is to assess the public health impact of brief exposures to outdoor air pollution in the metropolitan areas of Caen, Nantes and Rennes. Materials and Methods: The standard methodology for a Health Impact Assessment was used to calculate the attributable deaths and hospital admissions. Population exposure was estimated from data collected by air quality measurement networks. The relative risks were modeled by the exposure-risk functions previously established in epidemiologic time-series studies in the general population. Findings: Pollution in the study area is currently associated with 77 (95% CI: 37-126) deaths and 108 (95% CI: 42-184) hospitalizations annually for a population of 650,000 inhabitants. A 25% reduction in pollution levels during the study period would have reduced the anticipated mortality attributable to pollution by 40%. Consideration of the O3 indicator shows that the levels higher than 120 mug/m3 are responsible for only 5 to 11% of the anticipated mortality. Its health effects are due primarily to chronic levels of pollution rather than to "peaks". Discussion: These results show that urban air pollution, even at these moderate levels, affects the health of the general population. Simulations of the pollution reduction carried out thus far point out the ineffectiveness of a risk-reduction strategy based only on controlling pollution peaks. Recent progress in the monitoring of pollutants and awareness of their effects should encourage the evaluation of the impact of long-term exposure to urban pollution.