Health effects of indoor air in Europe
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Scope
What are the health impacts of exposure to indoor air pollutants?
Definition
Indices:
Diseases:
- SBS (sick building syndrome), sensory irritation
- Asthma (& allergy)
- Lung (trachea & Bronchus) cancer
- CV-diseases
- COPD
- U&L respiratory symptoms
- Acute CO toxication
Pollutants:
- bioaerosols from outdoors
- combuston products
- VOCs
- dampness
- CO
Sources:
- Ambient outdoor air quality
- Building materials
- Fixed heating and combustion equipment/appliances
- Ventilation and air conditioning systems
- Water systems, dampness and mould
- Furnishings, decoration materials and electrical appliances
- Cleaning and other household products
Policies:
- General policies
- Integrate IAQ into the EPBD procedure for buildings
- Develop and apply European harmonised protocols for IAQ testing, reporting and labelling for building materials, equipment and products (common IAQ monitoring procedures…)(REACH, GPSD)
- Provide systematic documentation and operating, inspection and maintenance manuals for buildings and all installations which may damage the building, deteriorate IAQ or cause health risks. Assign for each building a sufficiently qualified and trained person with control of all building documentation and responsibility for all building related tasks.
- Mandate radon safe construction for all new buildings
- Outdoor environment
- Apply tight building envelopes, balanced ventilation and air cleaning for all new/renovated buildings when ambient air quality is below WHO AQG
- Fixed heating/combustion installations
- Ban all unflued combustion heaters, equip gas stoves with exhaust hoods and fans, mandate CO detectors regular maintenance/inspection for all combustion devices (integrate with EPBD procedures)
- Ventilation & AC
- Develop health based ventilation guidelines to control exposure to pollutants from indoor and outdoor sources, indoor moisture and ensure comfortable indoor temperature.
- Mandate regular inspection and maintenance for all ventilation and air conditioning systems. (integrate to EPBD)
- Water systems, moisture management
- Develop moisture control guidelines for building design and maintenance, to prevent persistent dampness and hidden and visible mould growth.
- Provide kitchens, bath- and laundry rooms with controlled extract ventilation, bath- and laundry rooms also with waterproofed surfaces
- Avoid spaces, structures and materials which would not dry by convective airflows
Data
Parameter | Austria | Belgium | Bosnia-Herzegovina | Bulgaria | Croatia | Cyprus | Czech Republic | Denmark | Estonia | Finland | France | Germany | Greece | Hungary | Iceland | Ireland | Italy | Latvia | Lithuania | Luxembourg | Nether lands | Norway | Poland | Portugal | Romania | Slovakia | Slovenia | Spain | Sweden | Switzerland | UK | EU population-weighted average |
Population (millions) | 8.11 | 10.30 | 4.13 | 7.96 | 4.44 | 0.80 | 10.25 | 5.35 | 1.34 | 5.20 | 59.85 | 82.41 | 10.97 | 9.92 | 0.29 | 3.91 | 57.48 | 2.33 | 3.47 | 0.45 | 16.07 | 4.51 | 38.62 | 10.05 | 22.39 | 5.40 | 1.99 | 40.98 | 8.87 | 7.17 | 59.07 | 438120 |
National burden of disease in DALY/100 000 - GBD code | 11 955 | 13 189 | 15 739 | 18 385 | 15 983 | 13 633 | 14 389 | 14 019 | 19 742 | 12 847 | 12 375 | 12 637 | 12 700 | 17 927 | 9 863 | 12 469 | 11 811 | 20 704 | 18 044 | 12 314 | 11 630 | 11 530 | 15 101 | 14 086 | 18 341 | 15 455 | 14 218 | 12 084 | 11 023 | 11 136 | 12 790 | 13387 |
Asthma (symptoms) - W113 | 129 | 152 | 121 | 93 | 171 | 126 | 170 | 182 | 175 | 183 | 184 | 149 | 86 | 72 | 134 | 312 | 114 | 129 | 68 | 182 | 196 | 183 | 146 | 177 | 61 | 111 | 166 | 125 | 141 | 139 | 269 | 158 |
Lung (trachea & bronchus) cancer - WO67 | 331 | 535 | 418 | 398 | 559 | 181 | 505 | 484 | 409 | 269 | 407 | 429 | 443 | 766 | 332 | 307 | 415 | 435 | 366 | 350 | 454 | 331 | 556 | 285 | 410 | 357 | 461 | 377 | 255 | 342 | 389 | 426 |
Cardiovascular disease - W134 | 2 326 | 2 032 | 4 626 | 6 607 | 4 353 | 2 619 | 3 436 | 2 129 | 4 844 | 2 349 | 1 432 | 2 512 | 3 107 | 4 127 | 1 353 | 1 964 | 2 126 | 5 565 | 3 994 | 1 907 | 1 910 | 1 937 | 3 174 | 2 618 | 4 886 | 3 236 | 2 548 | 1 636 | 2 113 | 1 611 | 2 196 | 2539 |
Chronic obstructive pulmonary disease - W112 | 79 | 182 | 78 | 242 | 134 | 390 | 162 | 98 | 374 | 203 | 130 | 111 | 135 | 87 | 109 | 259 | 99 | 228 | 160 | 111 | 182 | 157 | 133 | 286 | 482 | 212 | 145 | 103 | 123 | 117 | 397 | 180 |
Upper and lower respiratory disease symptoms - W038 | 378 | 642 | 124 | 158 | 347 | 27 | 359 | 1 074 | 133 | 269 | 343 | 405 | 203 | 492 | 367 | 478 | 295 | 103 | 294 | 395 | 607 | 510 | 140 | 422 | 258 | 133 | 399 | 405 | 323 | 316 | 621 | 385 |
Acute CO toxication - W151 (5 | 30 | 20 | 30 | 30 | 30 | 30 | 30 | 70 | 30 | 20 | 8 | 30 | 30 | 30 | 30 | 30 | 30 | 30 | 30 | 30 | 75 | 30 | 30 | 12 | 30 | 30 | 30 | 30 | 13 | 30 | 17 | 27 |
Percent of total asthma sick days attributable to indoor air exposures, incl. indoor air exposures to contaminants originating from outdoor air | 0.63 | 0.78 | 0.40 | 0.35 | 0.35 | 0.90 | 0.82 | 0.69 | 0.90 | 0.52 | 0.79 | 0.74 | 0.88 | 0.87 | 0.71 | 0.80 | 0.90 | 0.90 | 0.90 | 0.81 | 0.84 | 0.63 | 0.90 | 0.88 | 0.90 | 0.58 | 0.84 | 0.85 | 0.57 | 0.35 | 0.79 | 0.793 |
Fraction of total asthma/bronchitis sick days attributable to indoor exposure to airborne biological particles originating from outdoor air (d | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.302 |
Fraction of asthma sick days attributable to asthma originating from childhood esposure to a damp home (b | 0.29 | 0.43 | 0.66 | 0.47 | 0.36 | 0.58 | 0.19 | 0.43 | 0.41 | 0.52 | 0.52 | 0.36 | 0.45 | 0.55 | 0.62 | 0.61 | 0.45 | 0.50 | 0.29 | 0.73 | 0.53 | 0.65 | 0.23 | 0.49 | 0.50 | 0.23 | 0.45 | 0.486 | ||||
Fraction of total asthma sick days attributable to combustion particles | 0.021 | 0.023 | 0.074 | 0.025 | 0.025 | 0.025 | 0.028 | 0.019 | 0.025 | 0.010 | 0.034 | 0.021 | 0.030 | 0.025 | 0.023 | 0.025 | 0.047 | 0.025 | 0.025 | 0.025 | 0.027 | 0.020 | 0.045 | 0.023 | 0.025 | 0.029 | 0.025 | 0.025 | 0.020 | 0.025 | 0.019 | 0.029 |
Fraction of indoor air combustion particles particles originating from outdoor air | 0.90 | 0.90 | 0.32 | 0.71 | 0.79 | 0.90 | 0.90 | 0.90 | 0.69 | 0.90 | 0.90 | 0.90 | 0.90 | 0.90 | 0.90 | 0.90 | 0.90 | 0.82 | 0.90 | 0.90 | 0.90 | 0.90 | 1.00 | 0.90 | 0.63 | 1.00 | 1.00 | 0.90 | 0.90 | 0.90 | 0.90 | 0.897 |
Fraction of indoor air combustion particles originating from fix heating and combustion equipment (c | 0.10 | 0.10 | 0.68 | 0.29 | 0.21 | 0.10 | 0.10 | 0.10 | 0.31 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.18 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.37 | 0.10 | 0.10 | 0.10 | 0.10 | 0.120 | |||
Fraction of total asthma sick days attributable to indoor air exposure to volatile organic compounds (VOCs) | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.029 | 0.009 | 0.030 | 0.018 | 0.026 | 0.010 | 0.032 | 0.025 | 0.025 | 0.025 | 0.044 | 0.025 | 0.025 | 0.040 | 0.011 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.024 | 0.024 |
Fraction of indoor air VOCs originating from outdoor air | 0.22 | 0.31 | 0.27 | 0.15 | 0.258 | |||||||||||||||||||||||||||
Fraction of indoor air VOCs originating from building materials | 0.09 | 0.18 | 0.13 | 0.24 | 0.147 | |||||||||||||||||||||||||||
Fraction of indoor air VOCs originating from fix heating and combustion equipment | 0.10 | 0.10 | 0.68 | 0.29 | 0.21 | 0.10 | 0.10 | 0.10 | 0.31 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.18 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.37 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.118 |
Fraction of indoor air VOCs originating from furnishings, decorating materials and electrical appliances | 0.36 | 0.23 | 0.27 | 0.24 | 0.267 | |||||||||||||||||||||||||||
Fraction of indoor air VOCVs originating from cleaning and other household products | 0.23 | 0.18 | 0.23 | 0.27 | 0.228 | |||||||||||||||||||||||||||
Fraction of total respiratory symptom days attributable to dampness (a (b | 0.18 | 0.29 | 0.52 | 0.32 | 0.24 | 0.43 | 0.12 | 0.29 | 0.27 | 0.37 | 0.37 | 0.24 | 0.31 | 0.40 | 0.47 | 0.45 | 0.31 | 0.35 | 0.18 | 0.59 | 5.00 | 0.51 | 0.14 | 0.34 | 0.35 | 0.14 | 0.31 | 0.443 | ||||
National average residential indoor air total VOC (TVOC) level (µg/m3) - if known from a national survey | 290 | 400 | 203 | 393 | ||||||||||||||||||||||||||||
If the above is not available, then | 1997 | 1997 | 1997 | 1997 | ||||||||||||||||||||||||||||
Average residential indoor air TVOC level from a broad (city or regional) survey | 450 | 290 | 690 | 370 | 512 | |||||||||||||||||||||||||||
If the above is not available, then | 1994 | 1994 | ||||||||||||||||||||||||||||||
Typical residential indoor air TVOC level from one or more studies (not studies based on complaints) | 520 | 135 | 120 | 410 | 150 | 500 | 180 | 530 | 250 | 440 | 314 | |||||||||||||||||||||
National average residential indoor/outdoor air total VOC ratio (TVOC I/O) - if known from a national survey | #DIV/0! | |||||||||||||||||||||||||||||||
If the above is not available, then | ||||||||||||||||||||||||||||||||
Average residential TVOC I/O from a broad (city or regional) survey | #DIV/0! | |||||||||||||||||||||||||||||||
If the above is not available, then | ||||||||||||||||||||||||||||||||
Typical residential TVOC I/O from one or more studies (not studies based on complaints) | #DIV/0! | |||||||||||||||||||||||||||||||
National average residential indoor air PM2.5 level (µg/m3) (overstrike the unnecessary) - if known from a national survey | 11 | 29 | 27 | |||||||||||||||||||||||||||||
If the above is not available, then | ||||||||||||||||||||||||||||||||
Average residential indoor air PM2.5 level from a broad (city or regional) survey | 23 | 23 | ||||||||||||||||||||||||||||||
If the above is not available, then | 1997 | 1997 | 1997 | 1997 | 1997 | 1997 | ||||||||||||||||||||||||||
Typical residential indoor air PM2.5 level from one or more studies (not studies based on complaints) | 23 | 25 | 80 | 30 | 21 | 11 | 37 | 54 | 32 | 25 | 51 | 29 | 22 | 49 | 25 | 31 | 22 | 27 | 21 | 39 | ||||||||||||
National average residential indoor/outdoor air PM2.5 ratio (PM I/O) - if known from a national survey | #DIV/0! | |||||||||||||||||||||||||||||||
If the above is not available, then | ||||||||||||||||||||||||||||||||
Average residential PM I/O from a broad (city or regional) survey | #DIV/0! | |||||||||||||||||||||||||||||||
If the above is not available, then | ||||||||||||||||||||||||||||||||
Typical residential PM I/O from one or more studies (not studies based on complaints) | 1.7 | 1.6 | 1.4 | 1.3 | 1.7 | 1.4 | 2.3 | 1.7 | 1.6 | 1.5 | 1.7 | 1.4 | 1.6 | 1.6 | 1.7 | 1.6 | 2 | |||||||||||||||
Nationally representative outdoor air PM2.5 (1 | 14 | 15 | 58 | 24 | 12 | 8 | 13 | 14 | 15 | 28 | 13 | 34 | 16 | 20 | 13 | 13 | 19 | |||||||||||||||
Nationally representative residential average indoor air Radon (Bq/m3) (2 | 97 | 69 | 30 | 68 | 7 | 140 | 53 | 120 | 120 | 89 | 50 | 55 | 107 | 89 | 70 | 55 | 115 | 30 | 89 | 49 | 86 | 45 | 87 | 87 | 90 | 108 | 77 | 20 | 65 | |||
National lung cancer from Rn RR-model, DALY/year | 3651 | 5324 | 1331 | 2363 | 14 | 10142 | 1922 | 919 | 2350 | 30316 | 24765 | 3739 | 11390 | 1495 | 23353 | 976 | 252 | 3065 | 1863 | 14722 | 3452 | 5783 | 2346 | 1115 | 19480 | 3418 | 2642 | 6434 | ||||
Proportion of population living in damp homes (%) (3 | 8 | 14 | 30 | 16 | 11 | 23 | 5 | 14 | 13 | 19 | 19 | 11 | 15 | 21 | 26 | 25 | 15 | 18 | 8 | 37 | 20 | 29 | 6 | 17 | 18 | 6 | 15 | 18 | ||||
Proportion of children in homes using solid fuels (%) (4 | 5 | 5 | 51 | 17 | 12 | 5 | 5 | 5 | 18 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 10 | 5 | 5 | 5 | 5 | 5 | 5 | 23 | 5 | 5 | 5 | 5 | 5 | 5 | 7 |
Population (2002) ('000) | 8 111 | 10 296 | 4 126 | 7 965 | 4 439 | 796 | 10 246 | 5 351 | 1 338 | 5 197 | 59 850 | 82 414 | 10 970 | 9 923 | 287 | 3 911 | 57 482 | 2 329 | 3 465 | 447 | 16 067 | 4 514 | 38 622 | 10 049 | 22 387 | 5 398 | 1 986 | 40 977 | 8 867 | 7 171 | 59 068 |
- 1) PM2.5 out values: Air Pollution in Europe 1990-2004, EEA Report, No 2/2007, p. 38
- 2) EU Radonmapping …
- 3) WHO/ENHIS Fact Sheet 3.5 2009 (RPG3_Hous_Ex2
- 4) WHO/ENHIS Fact Sheet 3.6 V1.0 Proportion of children living in homes using solid fuels (for cooking and heating)
- 5) Value of 30 DALY/100000 given in the absence of national data.Given national data (bolded) are of highly variable quality and strictly non-comparable betrween the countries. All data, except maybe for the Netherlands are underestimations by factor of 0.1 ... 0.9.
- a) In Finland 5% of homes are affected by dampness (ref 3). According to Rintala et al. (200X) respiratory symptoms were reduced by 40% in a school where the dampness problem had been verifiably corrected. This would indicate that of all current respiratory symptoms in Finland in the order of 2% could be eliminated by removing building dampness. The amount of all respiratory symptoms caused by buildind dampness must be bigger, 3..4%.
- b) according to Pekkanen et al. (2007) children's new asthma risk is increased by a factor of 2…2.5 in the presence of moisture damage. Assuming again 5% of damp residences in Finland, this increase indicates that some 5…7.5% of asthma would be due to moisture damaged buildings, assuming that the time windoe of a child's asthma onset would be quitre narrow, i.e. to include the occupancy of one home only. If the time window would cover, in average, the occupancy of 2..3 homes, the asthma risk would, respectively increase 2...3 fold, i.e. to 10 - 23%. We further assume that the total asthma sick days increase in proportion to the increase of asthma onset.
- c) According to Levesque (2001) and Zuk (2007) typical average indoor PM level in a building where solid fuel is used foor cooking and heating (vs. not used) is 1.6 … 4 fold. We use 2.0 fold
- d) based on onbserved seasomnality in asthma and acute bronchitis admissions to hospitals Khot etal. BMJ 1984 (there may be some overlap with dampness)
Dependencies
- Total DALYs due to the disease in the population of a particular country
- Fraction of the disease caused by a particular indoor pollutant exposure
- Fraction of the total indoor pollutant exposure from a particular source
- Fraction of the source controllable by a particular policy
↠ These lead to estimates of
- DALYs of the disease caused by a particular pollutant
- DALYs of the disease caused by a particular source
- DALYs of the disease avoided if a particular policy is implemented
Unit
DALY