Financing Costs and Health Effects of Air Pollution in the Tri-City Agglomeration.

This paper examines the relationship between the presence of air pollution and incidence of selected respiratory diseases in the urban population of the Tri-City agglomeration. The study takes into consideration the specific character of the region, relating to coastal, and port-based shipping. Three research hypotheses formulated the study. General regression models were used to identify the health effects of air pollution and developed health costs were calculated in relation to the treatment of diseases. The findings have shown that air pollution and climatic conditions in the Tri-City aggravate the symptoms of bronchial asthma, while also increasing the number of cases of exacerbated chronic obstructive pulmonary disease and pneumonia. The evidence demonstrates the negative impact of shipping on the health condition of the inhabitants. The calculations have shown the extent of financial losses incurred in connection with the treatment of diseases found to have been caused by air pollution. The estimated health costs turned out to be significant for each of the examined diseases. The financial inefficiency of the Polish health care system has also been demonstrated. All the models have been identified for monthly data for the first time.

Inhalation Exposure to PM-Bound Polycyclic Aromatic Hydrocarbons Released from Barbecue Grills Powered by Gas, Lump Charcoal, and Charcoal Briquettes.

The present study seeks to define the possible cancer risk arising from the inhalation exposure to particle (PM)-bound polycyclic aromatic hydrocarbons (PAHs) present in barbecue emission gases and to compare the risk depending on the type of fuel used for grill powering. Three types of fuel were compared: liquid propane gas, lump charcoal, and charcoal briquettes. PM2.5 and PM2.5-100 were collected during grilling. Subsequently, 16 PAHs congeners were extracted from the PM samples and measured quantitatively using gas chromatography. The content of PM-bound PAHs was used to calculate PAHs deposition in the respiratory tract using the multiple path particle dosimetry model. Finally, a probabilistic risk model was developed to assess the incremental lifetime cancer risk (ILCR) faced by people exposed to PAHs. We found a distinctly greater PAHs formation in case of grills powered by charcoal briquettes. The summary concentration of PAHs (Σ16PAH) ranged from <0.002 µg/m3 (gas grill) to 21.52 µg/m3 (grill powered by briquettes). Daily exposure of a grill operator, while grilling meat, to PM2.5-bound PAHs, adjusted to benzo[a]pyrene toxicity equivalent (BaPeq), was 326.9, 401.6, and 0.04 ng/d for lump charcoal, charcoal briquettes, and gas powered grill, respectively. Exposure to PAHs emitted from charcoal briquettes was four orders of magnitude greater than that for gas grill. The ILCR followed a log-normal distribution, with a geometric mean of 8.38 × 10-5 for exposure to PM2.5-bound PAHs emitted from gas grills unloaded with food and as high as 8.68 × 10-1 for the grills loaded with food over charcoal briquettes. The estimated cancer risk for people who would inhale barbecue particles for 5 h a day, 40 days a year exceeds the acceptable level set by the U.S. Environmental Protection Agency. We conclude that the type of heat source used for grilling influences the PM-bound PAHs formation. The greatest concentration of PAHs is generated when grilling over charcoal briquettes. Loading grills with food generates conspicuously more PAHs emissions. Traditional grilling poses cancer risk much above the acceptable limit, as opposed to much less risk involving gas powered grills.

Indoor Exposure to Volatile Organic Compounds in Children: Health Risk Assessment in the Context of Physiological Development.

Indoor air quality is strongly affected by the contamination of ambient air and that related to building and finishing materials and to human activity. Poor ventilation of closed spaces facilitates retention of greater quantity of pollutants. Infants and children are at particular risk of exposure to indoor air pollutants as they undergo rapid physiological and biochemical changes and demonstrate activity patterns unlike those in adults. Health risk assessment in children should be carried out with regard to children-specific factors, since these factors may constitute a source of errors. In this article we weigh up two different: Scenario 1 in which risk assessment was carried out in five age-groups (0-1, 2-3, 4-6, 7-11, and 12-16 years of age) and Scenario 2 encompassing only two age-groups (0-6 and 7-16 years of age). The findings indicate that data on carcinogenic and non-carcinogenic effects obtained by applying the second scenario were overestimated or averaged; either giving much reduced information that may lead to a false judgment on actual risk. This kind of fallacy is avoided when applying the age stratification into a greater number of groups for the health risk assessment in children.

Particulate Matter in the Air of the Underground Chamber Complex of the Wieliczka Salt Mine Health Resort.

This study evaluates the mass concentration and chemical composition of particulate matter (PM), collected in the chamber complex of the underground health resort located in the Wieliczka Salt Mine in southern Poland. Physical and chemical properties of PM were examined from the standpoint of their possible connection with therapeutic effects of the subterranean air in the mine. We found that in three underground spots we measured the average concentration of PM did not exceed 30 µg/m3. Chemical composition of PM was dominated by sodium chloride, making up 88 % of its mass, on average. It was shown that the underground ambient concentration of PM and its chemical composition depended mostly on the nature of the rock material present in the ventilation tunnel of the health resort, filtering the incoming air. The presence and effect of external sources of PM, including patients' activity, also had an impact on the underground PM concentration.

Ambient PM2.5 Exposure and Mortality Due to Lung Cancer and Cardiopulmonary Diseases in Polish Cities.

Air pollution, one of ten most important causes of premature mortality worldwide, remains a major issue also in the EU, with more than 400,000 premature deaths due to exposure to PM2.5 reported yearly. The issue is particularly significant in Poland, where there is the highest concentration of PM2.5 among the UE countries. This study focused on the proportion of mortality due to lung cancer and cardiopulmonary diseases attributable to PM2.5 in eleven biggest Polish cities in the years 2006-2011. The findings demonstrate that the mean annual concentration of PM2.5 varied from 14.3 to 52.5 µg/m3. The average population attributable fractions varied from 0.195 to 0.413 in case of lung cancer and from 0.130 to 0.291 for cardiopulmonary diseases. Such substantial values of this ratio translate into a considerable number of deaths, which ranged between 9.6 and 22.8 cases for lung cancer and 48.6 to 136.6 cases for cardiopulmonary diseases per 100,000 inhabitants. We conclude that the impact of PM2.5 concentration on the incidence of premature deaths is unduly high in Polish cities.

Socioeconomic Effects of Chronic Obstructive Pulmonary Disease from the Public Payer's Perspective in Poland.

Chronic obstructive pulmonary disease (COPD) is currently the third most common cause of death worldwide and the total number of people affected reaches over 200 million. It is estimated that approximately 50 % of persons having COPD are not aware of it. In the EU, it is estimated that the total annual costs of COPD exceed €140 billion, and the expected increase in the number of cases and deaths due to COPD would further enhance economic and social costs of the disease. In this article we present the results of cost analysis of health care benefits associated with the treatment of COPD and with the disease-related incapacity for work. The analysis is based on the data of the National Health Fund and the Social Insurance Institutions, public payers of health benefits in Poland. The annual 2012 expenditures incurred for COPD treatment was €40 million, and the benefits associated with incapacity for work reached more than €55 million. The extent of these expenditures indicates that it is necessary to optimize the functioning system, including the allocation of resources for prevention, social awareness, and detection of COPD at early stages when treatment costs are relatively low.

Assessment of Air Pollution Effects on the Respiratory System Based on Pulmonary Function Tests Performed During Spirometry Days.

The Polish Spirometry Day is an initiative aimed at increasing awareness of the causes, symptoms, course, and effects that accompany respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD). In 2013, the second edition of the Spirometry Day was held. It gathered 180 medical centers and other institution. The final analysis encompassed a total of 1187 persons from 26 different locations, including rural areas, and smaller and larger city agglomerations. Of this total, 755 persons (63.6 %) completed their spirometry tests for the first time in life. Each person fulfilled a questionnaire regarding the personal information, respiratory diseases, symptoms, lifestyle, and a place of residence. In the total group, 234 (19.7 %) cases of bronchial obstruction were diagnosed. A hundred and thirty four persons with obstruction, among those tested for the first time in life (17.8 %), were unaware of their disease. The lowest values of FEV1 and FEF(1)/FVC, corresponding to the highest percentage of persons with obstruction (27.9 %) were observed in small and medium cities (100,000-500,000 inhabitants). There were differences in the prevalence of obstruction depending on the distance of the place of residence from a busy traffic road. A significant decrease of both spirometric variables was observed among people living in cities above 100,000 inhabitants within a distance lower than 50 m from roads. In general, better spirometry results were observed among inhabitants living more than 150 m from main roads.

The influence of particulate matter on respiratory morbidity and mortality in children and infants.

Air pollution is the most important environmental health risk leading to premature mortality, respiratory and other health problems. The aim of this study was to quantify its impact on infants and children in Warsaw (Poland), following the principles of Health Impact Assessment method. Particulate matter (PM(2.5) and PM(10)) was considered as the indicator of air pollution. Exposure-response functions between air pollution and health impacts were employed based on the literature. According to the calculations, around 5,201 asthma symptoms and 234 hospital respiratory admissions were caused annually due to air pollution. Hospitalizations due to cardiovascular problems related to air pollution amounted to 13. The mortality among infants and children is relatively low and occurs mostly in the postneonatal period. Nonetheless, approx. 5 mortality cases were assessed to be air pollution-attributable. The study demonstrates a significant impact of air pollution on infants and children, which is manifested primarily as a range of respiratory problems.

Relative risk of lung obstruction in relation to PM10 concentration as assessed by pulmonary function tests.

Epidemiological studies show that long-term exposure to air pollution may increase the relative risk of obstructive lung diseases such as COPD or asthma. The risk of increased obstruction is higher among residents living in close proximity to high traffic routes where there are high concentrations of PM(10). The present study consists of two parts: the measurement of the concentration of air pollutants and of pulmonary function in selected groups of people. The study was conducted in Warsaw, Poland, in seven localizations with typical urban canyon characteristics and roads with high traffic. The control group consisted of people living in other regions of Poland with a significantly lower (p < 0.05) concentration of air pollutants. The study was performed in the years 2008-2012. The incidence of obstructive lung disease was determined according to the GOLD guidelines. The study subjects were all non-smokers. The relative risk of disease took into account different exposure times to air pollutants. The findings indicate that an increase in PM(10) concentration by each 10 µg/m(3) caused an increase in the relative risk of lung obstruction by a factor of 1.27, 1.24, and 1.19 for the residence period in the vicinity to heavy traffic city roads for 20, 30, and 40 years, respectively as compared with the residence of rural unpolluted areas. A decrease in the number of people with lung obstruction with the length of residence actually indicates that people exposed to high concentrations of PM(10) become affected by lung obstruction at a lower age. The study shows a positive relative risk of lung obstruction due to an exposure to high PM(10) emission.

Spirometry day: a means to enhance social knowledge on respiratory diseases.

The chapter presents the results of pulmonary function tests conducted as part of the Polish Spirometry Day of 2011, an initiative aimed at increasing the awareness of causes, symptoms, and delayed effects of common respiratory diseases, in particular of bronchial asthma and chronic obstructive pulmonary disease, and at demonstrating the role of regular examinations, especially in higher risk groups. The results show that there was a relatively substantial group of persons, 11.2 % of the population sample studied, not being aware of a respiratory disease they had. Furthermore, the results show that quite often, 12.4-16.0 % of the population studied, obstruction was diagnosed in persons who did not have any spirometry tests done before, despite some respiratory symptoms that should raise the attention of general practitioners to perform such tests.

Influence of traffic-related air pollutants on lung function.

We investigated the influence of traffic-related air pollutants on respiratory function, with a focus on the non-smoking residents of the capital city of Warsaw in Poland, who lived close to busy streets. The results demonstrate that people living in some parts of the city show symptoms of bronchial obstruction over four times more often than those from the control group consisting of the inhabitants of a remote region in eastern Poland, with considerably less air pollution. Using multiple regression models it was shown that, apart from the place of living, the floor the apartment is situated on, the length of residence, allergy, and physical activity are the factors that significantly influence the forced expiratory volume in 1 s (FEV1) and the pseudo-Tiffenau index (FEV1/FVC).

Exposure to traffic-related air pollutants as a risk of airway obstruction.

Dynamic increases in the number of vehicles, particularly in large urban areas, cause a visible decline in the average speed of cars. Street networks are not able to efficiently handle generated traffic, which could result in increasing levels of air pollutant emissions and consequently in a greater incidence of people suffering from respiratory diseases. This study presents the effects of investigations on the influence of traffic-related air pollutants on inhabitants of two Polish cities living in the proximity of busy roads. As a control group rural area residents were taken. In 2005-2006 and 2008-2009 respiratory function tests were conducted on a group of 3,506 people (including residents of non-urban areas). The investigation has shown that people living near busy urban roads had a significant increase in the risk of bronchi obstruction.