Burden of disease caused by local transport in Warsaw, Poland.

Transport is a major source of air pollution, noise, injuries and physical activity in the urban environment. The quantification of the health risks and benefits arising from these factors would provide useful information for the planning of cost-effective mitigation actions. In this study we quantified the burden of disease caused by local transport in the city of Warsaw, Poland. The disability-adjusted life-years (DALYs) were estimated for transport related air pollution (particulate matter (PM), nitrogen oxides (NO x ), sulfur dioxide (SO2), benzo[a]pyrene (BaP), cadmium, lead and nickel), noise, injuries and physical activity. Exposure to these factors was based on local and international data, and the exposure-response functions (ERFs) were based on published reviews and recommendations. The uncertainties were quantified and propagated with the Monte Carlo method. Local transport generated air pollution, noise and injuries were estimated to cause approximately 58,000 DALYs in the study area. From this burden 44% was due to air pollution and 46% due to noise. Transport related physical activity was estimated to cause a health benefit of 17,000 DALYs. Main quantified uncertainties were related to disability weight for the annoyance (due to noise) and to the ERFs for fine particulate matter (PM2.5) air pollution and walking. The results indicate that the health burden of transport could be mitigated by reducing motorized transport, which causes air pollution and noise, and by encouraging walking and cycling in the study area.The project has been funded by the Ministry of Science and Higher Education, Poland, through the Iuventus Plus project number IP2011 055871. The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.jth.2015.06.00

Methods and uncertainties in the assessment of the health effects of fine particulate matter (PM2.5) air pollution

Verkkoversiossa ei alkuperäisartikkeleit

Severity of injuries in different modes of transport, expressed with disability-adjusted life years (DALYS)

Background: Health impact assessment (HIA) studies are increasingly predicting the health effects of mode shifts in traffic. The challenge for such studies is to combine the health effects, caused by injuries, with the disease driven health effects, and to express the change in the health with a common health indicator. Disability-adjusted life year (DALY) combines years lived disabled or injured (YLD) and years of life lost (YLL) providing practical indicator to combine injuries with diseases. In this study, we estimate the average YLDs for one person injured in a transport crash to allow easy to use methods to predict health effects of transport injuries. Methods: We calculated YLDs and YLLs for transport fatalities and injuries based on the data from the Swedish Traffic Accident Data Acquisition (STRADA). In STRADA, all the fatalities and most of the injuries in Sweden for 2007–2011 were recorded. The type of injury was recorded with the Abbreviated Injury Scale (AIS) codes. In this study these AIS codes were aggregated to injury types, and YLDs were calculated for each victim by multiplying the type of injury with the disability weight and the average duration of that injury. YLLs were calculated by multiplying the age of the victim with life expectancy of that age and gender. YLDs and YLLs were estimated separately for different gender, mode of transport and location of the crash. Results: The average YLDs for injured person was 14.7 for lifelong injuries and 0.012 for temporal injuries. The average YLDs per injured person for lifelong injuries for pedestrians, cyclists and car occupants were 9.4, 12.8 and 18.4, YLDs, respectively. Lifelong injuries sustained in rural areas were on average 31% more serious than injuries in urban areas. Conclusions: The results show that shifting modes of transport will not only change the likelihood of injuries but also the severity of injuries sustained, if injured. The results of this study can be used to predict DALY changes in HIA studies that take into account mode shifts between different transport modes, and in other studies predicting the health effects of traffic injuries

Burden of Mortality and Disease Attributable to Multiple Air Pollutants in Warsaw, Poland.

Air pollution is a significant public health issue all over the world, especially in urban areas where a large number of inhabitants are affected. In this study, we quantify the health burden due to local air pollution for Warsaw, Poland. The health impact of the main air pollutants, PM, NOX, SO₂, CO, C₆H₆, BaP and heavy metals is considered. The annual mean concentrations are predicted with the CALPUFF air quality modeling system using the year 2012 emission and meteorological data. The emission field comprises point, mobile and area sources. The exposure to these pollutants was estimated using population data with a spatial resolution of 0.5 × 0.5 km². Changes in mortality and in disability-adjusted life-years (DALYs) were estimated with relative risk functions obtained from literature. It has been predicted that local emissions cause approximately 1600 attributable deaths and 29,000 DALYs per year. About 80% of the health burden was due to exposure to fine particulate matter (PM2.5). Mobile and area sources contributed 46% and 52% of total DALYs, respectively. When the inflow from outside was included, the burden nearly doubled to 51,000 DALYs. These results indicate that local decisions can potentially reduce associated negative health effects, but a national-level policy is required for reducing the strong environmental impact of PM emissions

Estimating traffic contribution to particulate matter concentration in urban areas using a multilevel Bayesian meta-regression approach.

Quantifying traffic contribution to air pollution in urban settings is required to inform traffic management strategies and environmental policies that aim at improving air quality. Assessments and comparative analyses across multiple urban areas are challenged by the lack of datasets and methods available for global applications. In this study, we quantify the traffic contribution to particulate matter concentration in multiple cities worldwide by synthesising 155 previous studies reported in the World Health Organization (WHO)'s air pollution source apportionment data for PM10 and PM2.5. We employed a Bayesian multilevel meta-regression that accounts for uncertainties and captures both within- and between-study variations (in estimation methods, study protocols, etc.) through study-specific and location-specific explanatory variables. The final sample analysed in this paper covers 169 cities worldwide. Based on our analysis, traffic contribution to air pollution (particulate matter) varies from 5% to 61% in cities worldwide, with an average of 27%. We found that variability in the traffic contribution estimates reported worldwide can be explained by the region of study, publication year, PM size fraction, and population. Specifically, traffic contribution to air pollution in cities located in Europe, North America, or Oceania is on average 36% lower relative to the rest of the world. Traffic contribution is 28% lower among studies published after 2005 than those published on or before 2005. Traffic contribution is on average 24% lower among cities with less than 500,000 inhabitants and 19% higher when estimated based on PM10 relative to PM2.5. This quantitative summary overcomes challenges in the data and provides useful information for health impact modellers and decision-makers to assess impacts of traffic reduction policies.This study was supported by the project “Towards an Integrated Global Transport and Health Assessment Tool (TIGTHAT)”, funded by Medical Research Council (MRC) Global Challenges Research Fund, UK (number: RG87632-SJ). The work of the first author was partly funded by the Natural Sciences and Engineering Research Council of Canada

Health effects of the London bicycle sharing system: health impact modelling study.

OBJECTIVE: To model the impacts of the bicycle sharing system in London on the health of its users. DESIGN: Health impact modelling and evaluation, using a stochastic simulation model. SETTING: Central and inner London, England. DATA SOURCES: Total population operational registration and usage data for the London cycle hire scheme (collected April 2011-March 2012), surveys of cycle hire users (collected 2011), and London data on travel, physical activity, road traffic collisions, and particulate air pollution (PM2.5, (collected 2005-12). PARTICIPANTS: 578,607 users of the London cycle hire scheme, aged 14 years and over, with an estimated 78% of travel time accounted for by users younger than 45 years. MAIN OUTCOME MEASURES: Change in lifelong disability adjusted life years (DALYs) based on one year impacts on incidence of disease and injury, modelled through medium term changes in physical activity, road traffic injuries, and exposure to air pollution. RESULTS: Over the year examined the users made 7.4 million cycle hire trips (estimated 71% of cycling time by men). These trips would mostly otherwise have been made on foot (31%) or by public transport (47%). To date there has been a trend towards fewer fatalities and injuries than expected on cycle hire bicycles. Using these observed injury rates, the population benefits from the cycle hire scheme substantially outweighed harms (net change -72 DALYs (95% credible interval -110 to -43) among men using cycle hire per accounting year; -15 (-42 to -6) among women; note that negative DALYs represent a health benefit). When we modelled cycle hire injury rates as being equal to background rates for all cycling in central London, these benefits were smaller and there was no evidence of a benefit among women (change -49 DALYs (-88 to -17) among men; -1 DALY (-27 to 12) among women). This sex difference largely reflected higher road collision fatality rates for female cyclists. At older ages the modelled benefits of cycling were much larger than the harms. Using background injury rates in the youngest age group (15 to 29 years), the medium term benefits and harms were both comparatively small and potentially negative. CONCLUSION: London's bicycle sharing system has positive health impacts overall, but these benefits are clearer for men than for women and for older users than for younger users. The potential benefits of cycling may not currently apply to all groups in all settings

Cycling in Warsaw, Poland - Perceived enablers and barriers according to cyclists and non-cyclists.

Cycling in urban environments provides many benefits to people. However, planning of cycling infrastructures in large cities faces numerous challenges and requires better understanding of both the factors enabling cycling as well as barriers to it, determined by particular local context. While there is a growing body of research that tackle the bike transport related questions in Western Europe and the USA, there is relatively little research on that in Central Eastern Europe (CEE), in post-communist countries. In this study we used qualitative and quantitative methods to explore urban cyclists and non-cyclists opinions about the cycling, the perceived problems and obstacles, and perception of the on-going changes in bicycle transportation system in Warsaw, Poland. Although many people see potential advantages of cycling, it is mostly perceived as a leisure time activity. Those who do utilitarian cycling are more acutely aware of the benefits, such as rapidity and flexibility of this mean of transport. The main perceived barriers are linked to lack of good cycling infrastructure in the city, the feeling of insecurity linked to the behaviour of drivers, and to maintenance during winter. In conclusion, our research highlights both the opportunities and challenges linked to the development of improved cycle transportation system, suggesting the need for a range of policies, from the infrastructure improvements and comprehensive planning of the whole transportation system, to improving the driving culture that would support feeling of security of the cyclists

The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

Objective To estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment

Severity of injuries in different modes of transport, expressed with disability-adjusted life years (DALYs).

BACKGROUND: Health impact assessment (HIA) studies are increasingly predicting the health effects of mode shifts in traffic. The challenge for such studies is to combine the health effects, caused by injuries, with the disease driven health effects, and to express the change in the health with a common health indicator. Disability-adjusted life year (DALY) combines years lived disabled or injured (YLD) and years of life lost (YLL) providing practical indicator to combine injuries with diseases. In this study, we estimate the average YLDs for one person injured in a transport crash to allow easy to use methods to predict health effects of transport injuries. METHODS: We calculated YLDs and YLLs for transport fatalities and injuries based on the data from the Swedish Traffic Accident Data Acquisition (STRADA). In STRADA, all the fatalities and most of the injuries in Sweden for 2007-2011 were recorded. The type of injury was recorded with the Abbreviated Injury Scale (AIS) codes. In this study these AIS codes were aggregated to injury types, and YLDs were calculated for each victim by multiplying the type of injury with the disability weight and the average duration of that injury. YLLs were calculated by multiplying the age of the victim with life expectancy of that age and gender. YLDs and YLLs were estimated separately for different gender, mode of transport and location of the crash. RESULTS: The average YLDs for injured person was 14.7 for lifelong injuries and 0.012 for temporal injuries. The average YLDs per injured person for lifelong injuries for pedestrians, cyclists and car occupants were 9.4, 12.8 and 18.4, YLDs, respectively. Lifelong injuries sustained in rural areas were on average 31% more serious than injuries in urban areas. CONCLUSIONS: The results show that shifting modes of transport will not only change the likelihood of injuries but also the severity of injuries sustained, if injured. The results of this study can be used to predict DALY changes in HIA studies that take into account mode shifts between different transport modes, and in other studies predicting the health effects of traffic injuries.We would like to thank Jan Ifver from the Swedish Transport agency for providing us the STRADA data and Tomasz Szreniawski from the Systems Research Institute, Poland, for helping with the data organizing. The work is part of the European-wide project Transportation Air pollution and Physical ActivitieS: an integrated health risk assessment progamme of climate change and urban policies (TAPAS)(http://www.tapas-program.org/), which has partners in Barcelona, Basel, Copenhagen, Paris, Prague and Warsaw. TAPAS is a four year project (partly) funded by the Coca-Cola Foundation, AGAUR, and CREAL. The funders have no role in the planning of study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All authors are independent from the funders. The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust. MT’s work has also been funded by the Ministry of Science and Higher Education through the Iuventus Plus project number IP2011 055871.This is the final published version, which is also available from BMC Public Health at http://www.biomedcentral.com/1471-2458/14/765