. 2017 Jan 11;49(1):1600419.

doi: 10.1183/13993003.00419-2016. Print 2017 Jan.

A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework

George D Thurston¹, Howard Kipen², Isabella Annesi-Maesano³, John Balmes^{4

5}, Robert D Brook⁶, Kevin Cromar⁷, Sara De Matteis⁸, Francesco Forastiere⁹, Bertil Forsberg¹⁰, Mark W Frampton¹¹, Jonathan Grigg¹², Dick Heederik¹³, Frank J Kelly¹⁴, Nino Kuenzli^{15

16}, Robert Laumbach², Annette Peters¹⁷, Sanjay T Rajagopalan¹⁸, David Rich¹⁹, Beate Ritz²⁰, Jonathan M Samet²¹, Thomas Sandstrom¹¹, Torben Sigsgaard²², Jordi Sunyer²³, Bert Brunekreef^{24

25}

Affiliations

¹ Depts of Environmental Medicine and Population Health, New York University School of Medicine, New York, NY, USA.
² Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA.
³ Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Sorbonne Universités, UPMC Université Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France.
⁴ Dept of Medicine, University of California, San Francisco, CA, USA.
⁵ School of Public Health, University of California, Berkeley, CA, USA.
⁶ Dept of Cardiology, University of Michigan, Ann Arbor, MI, USA.
⁷ Marron Institute of Urban Management, New York University, New York, NY, USA.
⁸ Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.
⁹ Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy.
¹⁰ Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden.
¹¹ Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
¹² Centre for Genomics and Child Health, Queen Mary University of London, London, UK.
¹³ Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.
¹⁴ National Institute for Health Research Health Protection Unit: Health Impact of Environmental Hazards, King's College London, London, UK.
¹⁵ Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
¹⁶ University of Basel, Basel, Switzerland.
¹⁷ Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt Institute of Epidemiology II, Neuherberg, Germany.
¹⁸ University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁹ Depts of Public Health Sciences and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
²⁰ Center for Occupational and Environmental Health, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
²¹ Dept of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
²² University of Aarhus, Institute of Public Health, Aarhus, Denmark.
²³ CREAL (Center for Research on Environmental Epidemiology, Barcelona), Pompeu Fabra University, Barcelona, Spain.
²⁴ Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands b.brunekreef@uu.nl.
²⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 28077473
PMCID: PMC5751718
DOI: 10.1183/13993003.00419-2016

A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework

George D Thurston et al. Eur Respir J. 2017.

. 2017 Jan 11;49(1):1600419.

doi: 10.1183/13993003.00419-2016. Print 2017 Jan.

Authors

Affiliations

¹ Depts of Environmental Medicine and Population Health, New York University School of Medicine, New York, NY, USA.
² Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA.
³ Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Sorbonne Universités, UPMC Université Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France.
⁴ Dept of Medicine, University of California, San Francisco, CA, USA.
⁵ School of Public Health, University of California, Berkeley, CA, USA.
⁶ Dept of Cardiology, University of Michigan, Ann Arbor, MI, USA.
⁷ Marron Institute of Urban Management, New York University, New York, NY, USA.
⁸ Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.
⁹ Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy.
¹⁰ Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden.
¹¹ Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
¹² Centre for Genomics and Child Health, Queen Mary University of London, London, UK.
¹³ Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.
¹⁴ National Institute for Health Research Health Protection Unit: Health Impact of Environmental Hazards, King's College London, London, UK.
¹⁵ Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
¹⁶ University of Basel, Basel, Switzerland.
¹⁷ Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt Institute of Epidemiology II, Neuherberg, Germany.
¹⁸ University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁹ Depts of Public Health Sciences and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
²⁰ Center for Occupational and Environmental Health, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
²¹ Dept of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
²² University of Aarhus, Institute of Public Health, Aarhus, Denmark.
²³ CREAL (Center for Research on Environmental Epidemiology, Barcelona), Pompeu Fabra University, Barcelona, Spain.
²⁴ Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands b.brunekreef@uu.nl.
²⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 28077473
PMCID: PMC5751718
DOI: 10.1183/13993003.00419-2016

Abstract

The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

Figures

**FIGURE 1**
Overview of diseases, conditions and biomarkers affected by outdoor air pollution. Updated based on [31]. Bold type indicates conditions currently included in the Global Burden of Disease categories.

See this image and copyright information in PMC

References

1. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260. - PMC - PubMed
1. Forouzanfar MH, Alexander L, Anderson HR, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:2287–2323. - PMC - PubMed
1. Van Donkelaar A, Martin RV, Brauer M, et al. Use of satellite observations for long-term exposure assessment of global concentrations of fine particulate matter. Environ Health Perspect. 2015;123:135–143. - PMC - PubMed
1. Künzli N, Joss MK, Gintowt E. Global standards for global health in a globalized economy. Int J Public Health. 2015;60:757–759. - PubMed
1. Samet J, Buist S, Bascom R, et al. What constitutes an adverse health effect of air pollution? Am J Respir Crit Care Med. 2000;161:665–673. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

Grants and funding

P30 ES000260/ES/NIEHS NIH HHS/United States

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework

Affiliations

A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous