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

Impacts of policies on sources (fraction of the source controllable by a particular policy).
Integrate IAQ into the EPBD procedure for buildings Develop and apply European harmonised protocols for IAQ Provide systematic documentation and operating, inspection and maintenance manuals for all buildings. Assign for each building a sufficiently qualified and trained person. Mandate radon safe construction for all new buildings Apply tight building envelopes, balanced ventilation and air cleaning for all new/renovated buildings when ambient air quality is below WHO AQG Ban all unflued combustion heaters, equip gas stoves with exhaust hoods and fans, mandate CO detectors, regular maintenance/inspection for all combustion devices. 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) 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
Ambient outdoor air quality 0.5 0.2 0.3 0.3 0.1
Building materials 0.3 0.8 0.5
Fixed heating and combustion equipment/appliances 0.8 0.5 0.3 0.5 0.3
Ventilation and air conditioning systems 0.8 0.5 0.8 0.7 0.1
Water systems, dampness and mould 0.1 0.3 0.1 0.4 0.8 0.3 0.2
Furnishings, decoration materials and electrical appliances 0.3 0.8 0.3
Cleaning and other household products 0.5 0.3 0.2
Radon implications for building envelope, ventilation and air cleaning 0.1 0.1 0.6 0.3 0.1


Indoor air parameters.
Parameter Austria Belgium Bosnia-Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy
Population (millions) 8.11 10.3 4.13 7.96 4.44 0.8 10.25 5.35 1.34 5.2 59.85 82.41 10.97 9.92 0.29 3.91 57.48
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
Asthma (symptoms) - W113 129 152 121 93 171 126 170 182 175 183 184 149 86 72 134 312 114
Lung (trachea & bronchus) cancer - WO67 331 535 418 398 559 181 505 484 409 269 407 429 443 766 332 307 415
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
Chronic obstructive pulmonary disease - W112 79 182 78 242 134 390 162 98 374 203 130 111 135 87 109 259 99
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
Acute CO toxication - W151 (5 30 20 30 30 30 30 30 70 30 20 8 30 30 30 30 30 30
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 0.4 0.35 0.35 0.9 0.82 0.69 0.9 0.52 0.79 0.74 0.88 0.87 0.71 0.8 0.9
Fraction of total asthma/bronchitis sick days attributable to indoor exposure to airborne biological particles originating from outdoor air (d 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3
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
Fraction of total asthma sick days attributable to combustion particles 0.02 0.02 0.07 0.03 0.03 0.03 0.03 0.02 0.03 0.01 0.03 0.02 0.03 0.03 0.02 0.03 0.05
Fraction of indoor air combustion particles particles originating from outdoor air 0.9 0.9 0.32 0.71 0.79 0.9 0.9 0.9 0.69 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9
Fraction of indoor air combustion particles originating from fix heating and combustion equipment (c 0.1 0.1 0.68 0.29 0.21 0.1 0.1 0.1 0.31 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
Fraction of total asthma sick days attributable to indoor air exposure to volatile organic compounds (VOCs) 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.01 0.03 0.02 0.03 0.01 0.03 0.03 0.03 0.03 0.04
Fraction of indoor air VOCs originating from outdoor air 0.22 0.31 0.27
Fraction of indoor air VOCs originating from building materials 0.09 0.18 0.13
Fraction of indoor air VOCs originating from fix heating and combustion equipment 0.1 0.1 0.68 0.29 0.21 0.1 0.1 0.1 0.31 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
Fraction of indoor air VOCs originating from furnishings, decorating materials and electrical appliances 0.36 0.23 0.27
Fraction of indoor air VOCVs originating from cleaning and other household products 0.23 0.18 0.23
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 0.4
National average residential indoor air total VOC (TVOC) level (µg/m3) - if known from a national survey 290 400
If the above is not available, then 1997 1997 1997
Average residential indoor air TVOC level from a broad (city or regional) survey 450 290 690
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
National average residential indoor/outdoor air total VOC ratio (TVOC I/O) - if known from a national survey
If the above is not available, then
Average residential TVOC I/O from a broad (city or regional) survey
If the above is not available, then
Typical residential TVOC I/O from one or more studies (not studies based on complaints)
National average residential indoor air PM2.5 level (µg/m3) (overstrike the unnecessary) - if known from a national survey 11 29
If the above is not available, then
Average residential indoor air PM2.5 level from a broad (city or regional) survey 23
If the above is not available, then 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
National average residential indoor/outdoor air PM2.5 ratio (PM I/O) - if known from a national survey
If the above is not available, then
Average residential PM I/O from a broad (city or regional) survey
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
Nationally representative outdoor air PM2.5 (1 14 15 58 24 12 8 13 14 15 28
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
National lung cancer from Rn RR-model, DALY/year 3651 5324 1331 2363 14 10142 1922 919 2350 30316 24765 3739 11390 1495 23353
Proportion of population living in damp homes (%) (3 8 14 30 16 11 23 5 14 13 19 19 11 15 21
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
Population (2002)


Indoor air parameters (cont'd).
Parameter Latvia Lithuania Luxembourg Nether lands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden Switzerland UK EU population-weighted average
Population (millions) 2.33 3.47 0.45 16.07 4.51 38.62 10.05 22.39 5.4 1.99 40.98 8.87 7.17 59.07 438120
National burden of disease in DALY/100 000 - GBD code 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 68 182 196 183 146 177 61 111 166 125 141 139 269 158
Lung (trachea & bronchus) cancer - WO67 435 366 350 454 331 556 285 410 357 461 377 255 342 389 426
Cardiovascular disease - W134 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 228 160 111 182 157 133 286 482 212 145 103 123 117 397 180
Upper and lower respiratory disease symptoms - W038 103 294 395 607 510 140 422 258 133 399 405 323 316 621 385
Acute CO toxication - W151 (5 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 0.9 0.9 0.81 0.84 0.63 0.9 0.88 0.9 0.58 0.84 0.85 0.57 0.35 0.79 0.79
Fraction of total asthma/bronchitis sick days attributable to indoor exposure to airborne biological particles originating from outdoor air (d 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3
Fraction of asthma sick days attributable to asthma originating from childhood esposure to a damp home (b 0.62 0.61 0.45 0.5 0.29 0.73 0.53 0.65 0.23 0.49 0.5 0.23 0.45 0.49
Fraction of total asthma sick days attributable to combustion particles 0.03 0.03 0.03 0.03 0.02 0.05 0.02 0.03 0.03 0.03 0.03 0.02 0.03 0.02 0.03
Fraction of indoor air combustion particles particles originating from outdoor air 0.82 0.9 0.9 0.9 0.9 1 0.9 0.63 1 1 0.9 0.9 0.9 0.9 0.9
Fraction of indoor air combustion particles originating from fix heating and combustion equipment (c 0.18 0.1 0.1 0.1 0.1 0.1 0.37 0.1 0.1 0.1 0.1 0.12
Fraction of total asthma sick days attributable to indoor air exposure to volatile organic compounds (VOCs) 0.03 0.03 0.04 0.01 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.02 0.02
Fraction of indoor air VOCs originating from outdoor air 0.15 0.26
Fraction of indoor air VOCs originating from building materials 0.24 0.15
Fraction of indoor air VOCs originating from fix heating and combustion equipment 0.18 0.1 0.1 0.1 0.1 0.1 0.1 0.37 0.1 0.1 0.1 0.1 0.1 0.1 0.12
Fraction of indoor air VOCs originating from furnishings, decorating materials and electrical appliances 0.24 0.27
Fraction of indoor air VOCVs originating from cleaning and other household products 0.27 0.23
Fraction of total respiratory symptom days attributable to dampness (a (b 0.47 0.45 0.31 0.35 0.18 0.59 5 0.51 0.14 0.34 0.35 0.14 0.31 0.44
National average residential indoor air total VOC (TVOC) level (µg/m3) - if known from a national survey 203 393
If the above is not available, then 1997
Average residential indoor air TVOC level from a broad (city or regional) survey 370 512
If the above is not available, then
Typical residential indoor air TVOC level from one or more studies (not studies based on complaints) 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 27
If the above is not available, then
Average residential indoor air PM2.5 level from a broad (city or regional) survey 23
If the above is not available, then 1997 1997
Typical residential indoor air PM2.5 level from one or more studies (not studies based on complaints) 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 1.4 1.6 1.6 1.7 1.6 2
Nationally representative outdoor air PM2.5 (1 13 34 16 20 13 13 19
Nationally representative residential average indoor air Radon (Bq/m3) (2 55 115 30 89 49 86 45 87 87 90 108 77 20 65
National lung cancer from Rn RR-model, DALY/year 976 252 3065 1863 14722 3452 5783 2346 1115 19480 3418 2642 6434
Proportion of population living in damp homes (%) (3 26 25 15 18 8 37 20 29 6 17 18 6 15 18
Proportion of children in homes using solid fuels (%) (4 10 5 5 5 5 5 5 23 5 5 5 5 5 5 7
Population (2002)


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

Formula

Result

See also

References

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