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Heinrich, J. ; Hoelscher, B. ; Frye, C. ; Meyer, I. ; Pitz, M. ; Cyrys, J.* ; Wjst, M. ; Neas, L.* ; Wichmann, H.-E.

Improved Air Quality in Reunified Germany and Decreases in Respiratory Symptoms.

Epidemiology 13, 394-401 (2002)

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Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.

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Background. Previous research on air pollution effects has found associations with chronic adverse health effects even at the relatively low levels of ambient particulates currently measured in most urban areas. Methods. We assessed the impact of declines of total suspended particulates and sulfur dioxide in eastern Germany after reunification on the prevalence of nonallergic respiratory disorders in children. In the 1990s, particle mass (total suspended particulates) and sulfur dioxide declined, whereas number concentrations of nucleation-mode particles (10–30 nm) increased. In three study areas, questionnaires for 7,632 children between 5 and 14 years of age were collected in three phases: 1992–1993, 1995–1996, and 1998–1999. Results. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for a 50-µg/m³ increment in total suspended particulates were 3.0 (CI = 1.7–5.3) for bronchitis, 2.6 (CI = 1.0–6.6) for sinusitis, and 1.9 (CI = 1.2–3.1) for frequent colds. The effect sizes for a 100-µg/m³ increment in sulfur dioxide were similar. The effect estimates for ambient total suspended particulates and sulfur dioxide were stronger among children not exposed to gas stove emissions, visible molds or dampness, cats, or environmental tobacco smoke. Conclusions. The decreasing prevalence of nonallergic respiratory symptoms, along with improvements in ambient particle mass and sulfur dioxide (but not in nucleation-mode particles), indicates the reversibility of adverse health effects in children. This adds further evidence of a causal association between combustion-related air pollutants and childhood respiratory symptoms. Cross-sectional studies of children in the United States and Europe consistently have shown higher rates of bronchitis and bronchitic symptoms in areas with higher exposure to total suspended particulates (TSP). 1–4 Recently published reviews of air pollution effects 5–7 reported associations with chronic adverse health effects even at the relatively low levels of ambient particulates currently measured in most urban areas. Since German reunification in 1990, the levels of ambient sulfur dioxide (SO₂) and TSP in eastern Germany have declined tremendously. 8 In Erfurt, eastern Germany, the concentrations of accumulation-mode particles (100–500 nm) have decreased, whereas those of nucleation-mode particles (10–30 nm in aerodynamic diameter) have increased. 9,10 In the three areas of this study (all in eastern Germany), we found similar trends in size-specific particle number concentrations between 1993 and 1999. 11 These trends may be related to declining emissions from stationary sources, to increasing emissions from mobile sources, and to clean air regulations that selectively removed larger particles. 9–11 If ambient TSP and SO₂ levels are associated with bronchitic symptoms in children, a decline in these air pollution concentrations should produce a corresponding decrease in symptom prevalence. We examined this relationship in surveys of children living in eastern Germany.

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