Luftschadstoffe zählen bei Betrachtung der Bevölkerungsgesundheit in Deutschland sowie weltweit zu den bedeutendsten Risikofaktoren. Studien verschiedener Disziplinen haben deutlich gezeigt, dass insbesondere Volkskrankheiten, wie beispielsweise Herz-Kreislauferkrankungen, chronisch obstruktive Lungenerkrankungen (COPD) oder auch der Diabetes mellitus Typ 2 in einem kausalen oder potentiell kausalen Zusammenhang mit der Belastung gegenüber Luftschadstoffen stehen. Die stärkste Evidenz für einen kausalen Zusammenhang besteht aktuell insbesondere für den Feinstaub und hier für die Partikel mit einer Größe von kleiner als 2,5 Mikrometer.

Abstract Background Worldwide, according to the global burden of disease (GBD) study, around 118 million disability-adjusted life years (DALYs) were attributable to ambient particulate matter (PM2.5) in 2019. Further, 97% of Europe’s urban population are exposed to annual average levels of PM2.5 above the World Health Organization’s guideline value of 5 µg/m³. In Germany, considerable efforts have been made to reduce PM2.5-emissions, which resulted in a continuous decrease of exposure. We estimated the burden of disease attributable to PM2.5-exposure in Germany for a time series from 2010 to 2021. Methods We used the environmental burden of disease (EBD) methodology developed by the WHO. For the exposure assessment we combined annual average measured and modelled PM2.5-concentrations with information on population density at a 2-by-2 km² grid. Using the exposure-response functions from GBD 2019, we estimated the EBD for chronic obstructive pulmonary diseases, type 2 diabetes mellitus, lung cancer, stroke and ischemic heart diseases (IHD). National surveys and register data were used to estimate the baseline burden of disease. Results In total, we estimated 232,863 (95%-CI: 153,716-314,882) DALYs attributable to PM2.5 in 2021. We observed a reduction of about 50% compared to 2010. The highest attributable burden was estimated for IHD with 70,197 (95%-CI: 42,609-101,785) DALYs, which is about 8% of the overall IHD-burden. The mortality-to-morbidity ratio revealed that years lost due to death (YLLs) had a higher share (69.9%) of overall DALYs with 162,561 (95%-CI: 106,918-222,567) YLLs. Discussion Despite a decreasing trend of the EBD for PM2.5 in Germany since 2010, our results show that there is still a long way to a pollutant free environment as envisaged by the EU’s zero pollution ambition. Using EBD as a standardized methodology and the DALYs as the core measure allows to have a comprehensive and comparable overview of the impact of PM2.5 on population health. Key messages • Ambient particulate matter pollution is an important environmental risk factor in Germany. • The decreasing trends is encouraging but there is still a long way to go to meet the objectives of the EU’s zero pollution ambition.

Abstract Introduction In addition to the population health effects of outdoor ambient particulate matter pollution (PM2.5), estimates of the costs related to these health impacts are increasingly requested to inform policy decision-making processes. Within the UKAGEP-project the burden of disease due to PM2.5 in Germany was monetized. Methods First, the disease burden attributable to PM2.5 in Germany for the year 2018 was estimated using the Environmental Burden of Disease approach. To estimate the monetary impact of PM2.5, two approaches were followed. We applied the Value of Statistical Life (VSL) approach, using a monetary value of about 6.3 (2.4-7.2) million € attached to each death case. Further, we used the Value Of a statistical Life Year (VOLY) approach, attaching a monetary value of 58,623 (36.646-146.582) € to the loss of a life year. Statistical uncertainties in both the disease burden results and the VSL and VOLY values were considered, presenting a lower and upper estimate of the overall disease costs. Results In 2018, the overall burden of disease attributable to PM2.5 was 209,702 (194,265-391,112) Disability-Adjusted Life Years. Using the VOLY-approach, this corresponds to disease costs of about 17 (7-57) billion €. In contrast, when using the VSL-approach, the estimated 15,652 (10,390-21,466) deaths attributable to PM2.5 in this year result in disease costs of about 98 (25-124) billion €. Conclusions In comparison with other cost assessments, connecting EBD estimates with the VSL- and VOLY-approach allows to include indirect and intangible costs and not to simply focus on the disease treatment costs. The VSL-approach leads to remarkably higher costs because it does not take into account the age at the time of death and thus attaches the same monetary value to each death case. We recommend to use the VOLY-approach because it considers the remaining life expectancy. Key messages • Air pollution causes considerable disease costs in Germany. • We recommend to use the VOLY-approach because it considers the remaining life expectancy.

Abstract Introduction Children and adolescents are more vulnerable to the impacts of environmental risk factors. They are in a sensitive stage of life, where the organ systems are still developing. Already minor interferences can have an effect on their future health. The UKAGEP-project aimed to estimate the Environmental Burden of Disease (EBD) for children and adolescents in Germany. Methods We tested the feasibility of applying the EBD-concept, developed by the World Health Organization, for 18 environmental risk factors. Where possible, data from the German Environmental Survey (GerES V) was used as the basis for the analyses. In addition, we performed systematic literature searches to identify adequate exposure-response-relationships. Results EBD quantifications were performed for 5 out of 18 environmental risk factors (PM2.5, bisphenol A, environmental noise, second-hand smoke and benzene). For the remaining risk factors, only particular steps of the EBD approach were realized. Taking two exemplary risk factors, about 28 % (170,000) of all obesity cases in the 7-17-year-olds were due to the exposure to bisphenol A and nearly 5 % (1,300) of the disability-adjusted life years for lower respiratory tract infections in 3-17-year-olds were attributable to PM2.5 in 2016. Conclusions Even though quantifications were performed for several risk factors, we had to conclude that for the remainder, availability and quality, especially of the exposure-response relationships and health data, were not sufficient to estimate burden of disease. Further, the exposure to some of these risk factors assessed in the GerES-V-study was too low to allow estimating the EBD. This does not mean that the identified concentrations were generally uncritical or that lifelong exposure could not lead to health impairments in the further life course. It only means that potential health outcomes have not occurred yet or the concentrations may lead to subclinical alterations in human body systems. Key messages • Environmental risk factors cause considerable burden in children and adolescents. • Estimating the environmental burden of disease for children and adolescents remains challenging.

Abstract Introduction To evaluate the health relevance of fine particulate matter (PM2.5), it is necessary to assess the PM2.5 exposure of the populations. For this purpose, time series (2010-2021) for two PM2.5 indicators for Germany were developed: (1) the mean population-weighted PM2.5 exposure per year and (2) the proportion of the population exceeding the recent WHO air quality guideline value for PM2.5 of 5 µg/m3 (annual mean). Methods To calculate the two indicators for the period 2010-2021, nationwide modelled annual means of PM2.5 background concentrations were used. They were joined with spatial information on population density from the 2011 census. The population data were additionally scaled for each year according to the official population update. On this basis, the population could be assigned to different PM2.5 exposure classes per year. Results Over the years considered, the mean population-weighted PM2.5 exposure in Germany decreased by approximately 41 %: in 2021, the indicator value of 9.3 µg/m3 was significantly lower than in 2010 with 15.9 µg/m3. However, throughout the time series, almost 100 % of the German population was exposed to PM2.5 annual mean concentrations above the current WHO air quality guideline value. Conclusions Generally, the decreasing PM2.5 exposure of the German population is very positive. Measures taken in recent years to reduce emissions from stationary sources and the transport sector have contributed significantly to this development. On the other hand, the large proportion of the population above the WHO guideline value shows that the current annual average PM2.5 reduction is still far from being sufficient to protect human health. In fact, far-reaching measures are required to significantly reduce particulate matter concentrations in Germany. Key messages • The mean population-weighted particulate matter exposure in Germany has decreased significantly in recent years. • The exposure reduction in Germany is still not sufficient. To protect human health, further and far-reaching measures are required to significantly reduce particulate matter concentrations in Germany.

Abstract Background The Environmental Burden of Disease (EBD)-concept was introduced by the World Health Organization to quantify the impacts of environmental risk factors on population health in a comprehensive and comparable way. Since the first Global Burden of Disease (GBD)-study the EBD-methodology was used in numerous global, regional and national assessments. Methods In the EBD-concept data from different sources are joined using a standardized framework. To calculate the EBD several steps need to be taken into account. First, the exposure of the selected population towards an environmental risk factor is estimated. In a second step, exposure data and information from an exposure-response-function are combined by using the population attributable fraction formula. In a last step, the attributable fraction (percentage) is multiplied by the disease burden resulting from a selected health outcome to estimate the share of disease burden attributable to the environmental risk factor. Results Since the first GBD-study several stakeholders have used the EBD-concept to estimate the disease burden attributable to environmental risk factors. This lead to an increased number of available data sets, which - due to the varying assumptions used in the models - are not ad hoc comparable among each other. Generally, the results of EBD-assessments are presented using disability-adjusted life years (DALY) as the core measure of burden of disease assessments. However, e. g. due to lack of data, assessments also focus on the number of attributable deaths, illnesses or single components of the DALY such as the years of life lost due to premature mortality (YLL). Conclusions The EBD-concept allows to compare the impact of environmental risk factors on population health. Though the general concept is widely standardized, assumptions on model parameters can lead to varying results. Therefore, when communicating EBD-results it is necessary to be very transparent about data and model inputs.

Abstract Background Numerous studies identified adverse effects of air pollution on health. According to the recent Global Burden of Disease Study about 2.9 million people died prematurely due to the effects of ambient particulate matter (PM) pollution in 2016, which resulted in about 70 million years of life lost (YLL). In addition to PM, a growing body of evidence shows convincing associations between nitrogen dioxide (NO2) with several health outcomes. The case study provides a health risk assessment for NO2 in Germany. Methods A systematic review was performed to select health outcomes with strong evidence for an association with NO2 and to derive an updated exposure-response function (ERF). The exposure assessment was performed on a 1x1 km2 grid by combining measured and modelled data (annual means of NO2 background concentration) with population density. Exposure data and the ERF were combined by the population attributable fraction formula. The main analysis was performed using a counterfactual of 10 µg/m3. Results Only for cardiovascular mortality the evidence for the association with long-term NO2-exposure was rated as “strong”. Thus, the main analysis merely included this outcome. For the year 2014, 5,966 (95% CI: 2,031-9,893) attributable deaths and 49,726 (95% CI: 16,929-82,456) YLL were estimated. Looking at time trends a decrease of disease burden was observed compared to the year 2007 where 7,832 (95% CI: 2,669-12,973) attributable deaths and 69.244 (95% CI: 23.601-114.690) YLL due to NO2 were calculated. Conclusions Our results show a considerable burden due to NO2 in Germany. Compared to previous estimates for PM (ca. 41,100 attributable deaths in 2014) the burden due to NO2 is much lower. However, due to methodological constraints we could not incorporate higher concentrations from traffic hotspots. This, and the fact that we only considered one health outcome in our main analysis, suggests that our results might be an underestimation.

Comment on: Warum ist die „Anzahl vorzeitiger Todesfälle durch Umweltexpositionen“ nicht angemessen quantifizierbar?Gesundheitswesen eFirstDOI: 10.1055/a-0832-2038

Ergebnisse aus Untersuchungen zur umweltbedingen Krankheitslast (Environmental Burden of Disease; EBD) werden zunehmend eingesetzt, um die Politik und die Allgemeinbevölkerung über die negativen gesundheitlichen Auswirkungen von Feinstaub (PM2,5) zu informieren. Institutionen wie die WHO, EUA und IHME präsentieren Ergebnisse zu vorzeitigen Sterbefällen und verlorenen gesunden Lebensjahren, die nicht im Einklang sind. Das Ziel der Untersuchung war es in einer systematischen Analyse die Unterschiede in den methodischen Vorgehensweisen der unterschiedlichen Studien mit Bezug auf Deutschland zu identifizieren.

Background Globally, ambient air pollution is an important risk factor for human health. Particularly in South Asia, this risk factor causes a considerable disease burden. For developing effective mitigation programs small-scale health risk assessments are needed to quantify the effects of ambient air pollution on health. The objective of the study is to test the feasibility of the environmental burden of disease (EBD) concept at state level in India and to quantify …

Einleitung/Hintergrund: Ca. 24% der globalen Krankheitslast und 23% aller Todesfälle gehen nach Schätzungen der WHO auf den Einfluss von Umwelt-Stressoren zurück (Prüss-Üstün & Corvalán 2006). Der Environmental Burden of Disease-Ansatz erlaubt eine vergleichende Beschreibung des Ausmaßes der gesundheitlichen Auswirkungen von umweltbedingten Risikofaktoren. Das VegAS-Vorhaben (Verteilungsbasierte Analyse gesundheitlicher Auswirkungen von Umwelt-Stressoren) vergleicht umweltbedingte Krankheitslasten für relevante Umwelt-Stressoren in Deutschland, um gesundheits- und umweltpolitische Entscheidungsprozesse zu unterstützen mit dem Ziel umweltbedingte Krankheitslasten zu reduzieren. Daten und Methoden: Nach systematischer Literaturrecherche zum Expositions-Wirkungs-Verhältnis von Umwelt-Stressoren und Gesundheitsendpunkten wird deren Übertragbarkeit auf die deutsche Allgemeinbevölkerung geprüft. Nationale Daten zur umweltbedingten Exposition und zum Morbiditäts- und Mortalitätsgeschehen stammen aus repräsentativen Erhebungen und epidemiologischen Registern. Fehlende epidemiologische Krankheitsparameter (Inzidenz, Krankheitsdauer) werden mit dem Modellierungsprogramm DisMod geschätzt. Durch die Attribuierung und Kombination der verteilungsbasiert stratifizierten Daten werden die verlorenen Lebensjahre durch erkrankungsbedingt eingeschränkte Lebensjahre und/oder vorzeitigen Tod (Disability-adjusted life years, DALYs) geschätzt. Ziel ist, potentielle Gesundheitsgewinne verschiedener Interventionsszenarien zu quantifizieren und zu vergleichen. Unsicherheits- und Sensitivitätsanalysen werden zur Ergebnisinterpretation herangezogen. Gewichtungsfaktoren werden von etablierten Burden of Disease-Studien verwendet. Ergebnisse: Die umweltbedingte Krankheitslast der Umwelt-Stressoren Benzol, Cadmium, Feinstaub, Lärm, Ozon, Passivrauch und perfluorierte Tenside wird für die deutsche Allgemeinbevölkerung ermittelt. Einschlusskriterien für assoziierte Gesundheitsendpunkte sind das Evidenzlevel sowie die Verfügbarkeit von Expositions-Wirkungs-Funktionen und Gewichtungsfaktoren. Die Anzahl assoziierter Gesundheitsendpunkte sowie Evidenzlevel variieren für die Umwelt-Stressoren. Während für Lärmexpositionen kein Gesundheitsendpunkt mit starker Evidenz, allerdings mehrere mit moderater Evidenz ermittelt werden konnten (z.B. Myokardinfarkt), konnte einigen gesundheitlichen Auswirkungen durch Passivrauch die Evidenz „stark„ zugeordnet werden (z.B. Asthma, Lungenkrebs). Diskussion/Schlussfolgerungen: Durch die Quantifizierung der Krankheitslast ausgewählter Umwelt-Stressoren wird das VegAS-Vorhaben dazu beitragen, in Deutschland gezielte Präventionsmaßnahmen zur Reduktion der Krankheitslast zu entwickeln. Zur Berechnung der attributablen DALYs werden im Sommer 2011 erste Schätzungen erwartet. Dieses Projekt wird gefördert vom Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit.

Hintergrund: Die Bestimmung der umweltbedingten Krankheitslast (engl. Environmental Burden of Disease, EBD) erfährt als Entscheidungsgrundlage in Politik und Gesundheitsforschung international wachsende Aufmerksamkeit. EBD-Studien erlauben eine vergleichende Beschreibung des Ausmaßes der gesundheitlichen Auswirkungen, die einem oder mehreren umweltbedingten Risikofaktoren zuzuschreiben sind. Sie können prognostisch eingesetzt werden, um durch Prävention erreichbare Verbesserungen der gesundheitlichen Lage abzuschätzen. Das Projekt VegAS untersucht die EBD für ausgewählte Umweltrisikofaktoren mit hoher gesundheitlicher Bedeutung. Im Fokus steht die Nutzbarkeit der für Deutschland verfügbaren Daten und die Abbildung der Variation der EBD innerhalb der Bevölkerung. Material und Methoden: Die Auswirkungen von umweltbezogenen Risikofaktoren werden auf Grundlage ausgewählter Expositions-Wirkungs-Funktionen (EWFs) geschätzt und als Disability Adjusted Life Years (DALY=Summenmaß aus verlorenen Lebensjahren durch erkrankungsbedingt eingeschränkte Lebensqualität oder vorzeitigen Tod) quantifiziert. Die Berechnung der DALYs basiert auf nationalen Daten zur umweltbedingten Exposition sowie zum Morbiditäts- bzw. zum Mortalitätsgeschehen. Unsicherheiten in den Expositionsszenarien, den Modellen und Parametern werden beschrieben. Ergebnisse: Als relevante Umweltrisikofaktoren wurden Feinstaub, Ozon und Benzol in der Atemluft, Lärm, Passivrauch sowie Cadmium identifiziert. Nach Durchsicht von über 750 aktuellen Literaturquellen inklusive Reviews können für über 35 Gesundheitsendpunkte EWFs beschrieben werden. Survey-Daten zur Expositionsschätzung sowie Sekundärdaten zur Morbidität und Mortalität werden einbezogen. Hierbei wurden Datenlücken, beispielsweise hinsichtlich gruppenspezifischer Expositionsverteilungen oder Prävalenz/Inzidenz, identifiziert. Schlussfolgerungen: Erste Analysen des VegAS-Projekts demonstrieren, dass in Deutschland umfangreiche, für EBD-Berechnungen prinzipiell geeignete Daten zur Verfügung stehen. Neben weiteren umweltepidemiologischen Untersuchungen könnten insbesondere Sekundärdaten, z.B. von Krankenversicherungen, die Qualität deutscher EBD-Schätzungen weiter erhöhen. In weiteren Analysen werden die Unsicherheiten zu dem erreichten Wissensstand hinsichtlich der prognostizierten Auswirkungen von Umweltrisiken beschrieben. Dieses Projekt wird gefördert vom Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit.

P-641 Introduction: For the successful application of (probabilistic) exposure modelling, both sufficient data of good quality and guidance on their use are necessary. A German report on exposure factors dating from 1995 was partially made obsolete by recent studies and by requirements of probabilistic exposure modelling. The Xprob project aimed to evaluate recent data and methods of probabilistic exposure assessment, to derive distributions for exposure factors, and to provide guidelines on good practice of probabilistic exposure modelling. Methods: Comprehensive data and literature searches with focus on German sources were carried out, taking the 1995 report as a basis. These sources were analysed in a standardised way. A methodology for deriving distributions needed for probabilistic modelling was developed, based on a US EPA approach. This methodology was then applied to analyse the data sources. In addition, literature reviews were carried out to assess the quality of data sources and to fill data gaps. A database was developed and implemented for structured documentation and retrieval of the information gathered. Results: Based on more than 50 data and literature sources, recommendations concerning derived distributions of human exposure factors were made. They can also be used for point estimates. In the database RefXP developed by the project, the distributions and characteristics of the individual exposure factors are provided, structured by thematic areas. Information is given on data source, exposure factor, empirical and derived distribution, each stratified by age and gender. For some exposure factors (e.g. inhalation, soil ingestion), only data from literature were available. Various data gaps were identified. Discussion and Conclusions: The provision of distributions as well as point estimates for exposure factors in a uniformly structured database offers clear advantages. The distributions fit the empirical data. For filling remaining data gaps, the developed methodology should be used to evaluate recent studies hitherto inaccessible, as well as future studies. Derived principles of good practice will facilitate the application of probabilistic exposure modelling. Distribution based exposure reference values can contribute to a harmonisation of the assessment of environmental health risk assessment. Implementation into administrative policy, however, calls for additional support and practice-oriented developments. This project was funded by the German Federal Environmental Agency (UBA) under No. FKZ 20261218/02.