Otto Hänninen: Tautitaakka ja terveyteen liittyvät ennusteet Suomessa – menetelmiä ja tuloksia 3.12.2021

1. Health Impacts of Air Pollution
PoDDy-HePo Final Seminar
”Tautitaakka ja terveyteen liittyvät ennusteet Suomessa – menetelmiä ja tuloksia”
Friday 3.12.2021 klo 13:00-15:30
Otto Hänninen
Finnish Institute for Health and Welfare (THL)

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Susanna Hertrich, 2008 : ”Reality Checking Device”
Why quantitative risk assessment is needed?
Actual
risk
Perceived
risk
Terrorist
attack
Airplane
crash
Mobile
phones
Gun crime
Bird flu
Daily class of
wine
Stock
crash
Heat wave
Credit card copying
Road traffic accident
Cancer
Cardiovascular disease

3. COVID19
• Highly specific tests for confirming infections
• Causality of symptoms & death?
• Currently ~1k infections/d; -> 0.4M/a
• No vaccination: risk of hospitalization in Finland (2021-11)
• 40’s: 4%
• 50’s: 7%
• 60’s: 11%
• 70’s: 21%
• Risk of serious side effects <1E6..1E8 (risk ratio >1E5..1E7!?)
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4. Non-communicable diseases burden:
1.4 million DALY in Finland, 2015
• Currently unattributed
causes of disease and
death include
developmental exposures
leading to disease in later
life
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1.4 MDALY
610 kDALY (44%)
790 kDALY (56%) Gakidou et al. 2017. 84 Risk factors in GBD 2016 Study
Unknown
causes!

5. GBD Compare
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GBD Compare
2021-12
https://vizhub.healthdata.org/gbd-compare/
Risk
DALY
Finland
2019
Dark: attributable to all included ”84” risk factors
Light: NOT attributable to any of the included ”84” risk factors
Non-communicable
diseases
Communicable
diseases
Accidents
etc.

6. Pollution and health
2020-11-03
Landrigan et al., 2017
Published online October 19, 2017
R. Fuller
P. Landrigan

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Ladrigan et al., 2017
Global estimates

8. Ladrigan et al., 2017
Deaths
(millions)
Years of life lost
(YLL, millions)
Measuring health impacts:
Cases
• Deaths
• Disease incidence
DALY
• YLL
• YLD
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Not included in Landrigan et al.
Not included in Landrigan et al.
MORTALITY
MORTALITY+MORBIDITY

9. Finland:
Air pollution in TOP12 env. health risks
• Air pollutants dominate: TOP3 is
• ambient particles
• indoor radon and particles
• Total burden of these 12 factors is 3100 deaths,
• 53 000 years of life lost and
• 13 000 equivalent years lived with disability
• vs 270 in car accidents
vs 1700 due to alcohol
vs 5000 due to smoking
ca. 320 due to COVID19
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Y&T 2020 nr 1
0 300 600 900 1 200 1 500 1 800
Ambient particles
Indoor radon
Indoor particles
Environmental noise
UV radiation
Second hand smoking
Nitrogen dioxide
Other ambient air pollutants
Dampness at homes
Ambient ozone
Methylmercury
Environmental lead
0 5 000 10 000 15 000 20 000 25 000 30 000
Mortality (deaths per year)
Burden of disease (DALY=YLL+YLD)
Hänninen O, Lehtomäki H, Korhonen A, 2020. Ilmansaasteet ja kuolleisuus kärjessä, tautitaakka yli kaksinkertainen: Ympäristöaltisteiden
kansanterveysvaikutukset. Ympäristö ja Terveys-lehti, 1/2020 ss. 6-13. http://urn.fi/URN:NBN:fi-fe202002246282 (2020-02-24)
In 2015 car accident mortality
was 270
GBD estimate for alcohol mortality
in 2015 was 1700
COVID-19: 320

10. PM2.5 (n=3)
PM10 (n=4)
PMcoarse
As
Cd
Ni
PAH
Nitrogen dioxide (n=3)
Ozone (n=2)
SO2 (n=6)
CO
Benzene
TRS
Pb (n=3)
-5 000.0 0.0 5 000.0 10 000.0 15 000.0 20 000.0 25 000.0
DALY/a
ISTE updated (All pollutants,All endpoints) by P), Finland, 2015 (2020-05-13)
Finland:
Uncertainties in air pollution estimates
• Relatively large uncertainties
• especially total reduced sulfur
(TRS), CO and SO2
• Possible overlaps (double
counting, in particular NO2
and particles)
• Significance of PM2.5 as
indicator pollutant is clear
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PM2.5 (n=3)
PM10 (n=4)
Nitrogen dioxide (n=2)
Ozone (n=3)
SO2 (n=5)
CO
TRS
-10 000.0 0.0 10 000.0 20 000.0 30 000.0 40 000.0 50 000.0
DALY/a
ISTE 2019 (All pollutants,All endpoints) by P), Finland, 2015 (2020-05-12)
ISTE Exposures for 2013 – uncertainties from CRF and Exposures
Combination of ISTE exposures (Korhonen et al. 2016) and BATMAN-updates on calculation methods (Lehtomäki et al. 2018)
“Ambient particles”
Separately reported ambient gases

11. Health effects of traffic
in Finland
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Traffic noise (YLD dominated)
Fine particles
Traffic accidents
Physical activity/Cycling
Physical activity/Walking
Health losses
Health benefits
Disease
burden
(DALY)
Fig. 8. Annual burden of disease attributable to traffic in disability adjusted lifeyears (DALY) in
Finland in 2015. Traffic noise effects on morbidity (YLD) and years of life lost (YLL), other factors
only years of life lost (YLL).
Tailpipe particles (incl. Machinery)
+Street dust
YLL
YLL
YLL
YLL
YLD+YLL

12. Air pollution and health
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How inhalation of particulate matter may affect our health?
Particulate matter
Brain
▪ Increased cerebrovascular ischemisa
Lungs
▪ Inflammation
▪ Oxidative stress
▪ Progression of COPD
▪ Respiratory symptoms
▪ Pulmonary reflexes (cough etc.)
▪ Reduced lung function
Systemic effects
▪ Inflammation
▪ Oxidative stress
▪ Increased CRP
▪ Proinflammatory mediators
▪ Leukocyte and platelet aktivaation
Heart
▪ Altered cardiac autonomic function
▪ Oxidative stress
▪ Increased dyrshytmhmic susceptibility
▪ Altered cardiac repolarization
▪ Increased myöcardial ischemia
Blood and vasculature
▪ Altered rheology
▪ Increased coagulability
▪ Translocated particles
▪ Peripheral thrombosis
▪ Reduced oxygen saturation
▪ Atherosclerosis
▪ Endothelial dysfunction
▪ Vasoconstriction and hypertension
Birth outcomes
▪ lowered birth weight
(LBW, SGA)
▪ Fetal development (eg.
HC, BL)
▪ Preterm birth
Perustuen Pope & Dockery, 2006
Neurological responses
▪ Depression
▪ Parkinson’s disease
▪ Alzheimer’s disease
▪ Schitsofrenia
”Silhuette” by abra123, FAVPNG, CC BY-
SA
Reproductive health
▪ genotoxic effects on germ
cells
Traditional endpoints
affecting adults and elderly:
• Mortality
• Respiratory diseases
• Cardiovascular diseases
• Lung cancer
More recent additions
• Birth outcomes
• Reproductive health
• Neurological diseases
APHEKOM-report, 2011

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Human
Vähäkangas 25.1.2018
3 weeks 4 weeks 5 weeks 6 weeks
fertilization
Ho et al., 2017, Reprod. Tox. (85-104)

14. Burden of Disease (DALY= YLD+YLL) Strengths
• Quantitative, additive, comparable:
• can be subdivided into/by e.g. population groups, diseases, risk
factors
• International
• Developed by World Bank & WHO in the 1990’s
• Accounts for both premature mortality and morbidity
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15. Burden of Disease (DALY= YLD+YLL) Challenges
• YLL dominance
• Does not particularly look at
• need for care and support (dressing etc.)
• productivity at work, school
• wellbeing and happyness
• International procedures, extrapolation, lack of national data
• Majority of burden still due to unknown causes (”Act of God”)
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16. otto.hanninen@thl.fi
Welcome to Kuopio
Thank you for your interest!
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<3
Photo:
Courtesy
of
City
of
Kuopio

17. Ohjelma
klo Otsikko ja esittäjä
13:00 Tilaisuuden avaus
- Hyvinvointivaikuttajat-osaston osastonjohtaja Tiina Laatikainen
13:10 Tautitaakka Suomessa
- Hanna Tolonen
13:20 Tautitaakan sosioekonomiset erot Suomessa
- Laura Paalanen
13:35 Ympäristöaltisteiden osuus tautitaakastamme
- Otto Hänninen
13:50-14:05 Tauko
14:05 Lihavuusennusteiden karttapalvelun esittely
- Päivi Mäki
14:15 Mihin suuntaan kroonisten tautien riskitekijöiden odotetaan kehittyvät vuoteen 2040
mennessä?
- Jaakko Reinikainen
14:30 Ikääntyvien toimintakyvyn ennusteet eri vaihtoehtojen valossa
- Jukka Kontto
14:45 Keskustelu aiheesta Tutkittua tietoa päätöksenteon tueksi
- 2-3 pyydettyä lyhyttä kommenttipuheenvuoroa
- Avointa keskustelua
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https://thl.fi/fi/ajankohtaista/tapahtumat/tapahtumakalenteri/-/event/8112240