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Air pollution, health and social deprivation in an urban setting

Abstract : In urban areas, atmospheric pollution represents a major threat to human health. The accurate characterization of this threat relies centrally on the quality of exposure assessment. It also requires assessment of other factors sharing the same sources and also possibly impacting health, such as noise. Fine-scale exposure assessment of air pollution levels may allow identifying spatial contrasts. Such spatial variations may lead to social differences in the distribution of the health impact of these pollutants.The general aims of the PhD were: 1. To study the possibility to model ultrafine particles distribution in urban areas and assess the correlation of ultrafine particles levels with road traffic noise; 2. To assess the risk incurred by air pollution exposure with a fine-scale modelling approach and investigate the potential socio-economic disparities in health burden induced by particulate matter; 3. To investigate the health benefits expected from hypothetical scenarios of reduction of air pollution levels at the urban scale.The first aim relies on Tri-tabs project, conducted in three European cities (Basel, Girona, Grenoble). Measurements during 20 minutes of outdoor noise and traffic, but not of UFP, were strongly reproducible over durations of a couple of days or months. In these areas, on the short-term, noise levels and UFP concentrations exhibited relatively moderate correlations, which may allow adjustment for mutual confounding in epidemiological studies, thus allowing to disentangle their possible short-term health effects.The second aim introduces health effects, and focuses on the longer term. Risk assessment studies often ignore within-city spatial variations of air pollutants. In Grenoble and Lyon areas (0.4 and 1.2 million inhabitants, respectively) in 2012, PM2.5 exposure was estimated on a 10×10 m grid by coupling a dispersion model to fine-scale data on population density. Outcomes were mortality, lung cancer and term low birth weight incidences. The numbers of cases attributable to air pollution were estimated overall and stratifying areas according to the European Deprivation Index, a measure of social deprivation. Estimations were repeated assuming spatial homogeneity of air pollutants within city. The proportion of cases attributable to air pollution was in the 3-8% range for mortality and 9–43% range for term low birth weight. In Grenoble, 6.8% (95% CI: 3.1–10.1%) of incident lung cancer cases were attributable to air pollution. The impact was underestimated by 8 to 20% when background monitoring stations were used to assess exposure, compared to fine-scale dispersion modeling. Health impact was highest in neighborhoods with intermediate to higher social deprivation.Several countries across Europe have implemented air pollution regulation policies, or low emission zones, France being an exception. We estimated the health impact of air pollution under different scenarios of reduction of fine particulate matter concentrations. Scenarios targeting a reduction in the PM2.5 annual averages by 5% led to a 10% decrease of the health burden, while actions aiming at only reducing the exposure of the population exposed above the 90th percentile did not yield a significant reduction of the health burden (around 1%).In conclusion, we have shown that short-term measurements cannot be used to model ultrafine particles levels in urban areas; we were among the first to rely on a fine-scale exposure model for estimating the health impact of air pollution, and quantify its impact on term low birth weight. Our estimations showed that background air quality monitoring stations used classically in France for health impact assessment studies tend to underestimate exposure, compared to a spatially-resolved dispersion model. We have provided an estimate of the air pollution decrease required to obtain a significant reduction of the health impact of air pollutants in urban areas.
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Xavier Morelli. Air pollution, health and social deprivation in an urban setting. Santé publique et épidémiologie. Université Grenoble Alpes, 2016. English. ⟨NNT : 2016GREAS015⟩. ⟨tel-01756162⟩

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