cause specific endpoints long term cardiopulmonary and lung mortality compared

Cause specific endpoints long term cardiopulmonary

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cause-specific endpoints (long-term cardiopulmonary and lung mortality) compared to the all-cause natural mortality RR that we used [ 14 ]. Further, we assume no counterfactual for the current situation, but there is a recommended cutoff (7.5 μ g/m 3 for PM 2.5 ) in the mentioned review. These factors would suggest a smaller difference between the World Bank estimates and ours than expected on the basis of population and measured pollution concentrations alone. Another study [ 32 ] provides an estimate in 2013 of 3360 deaths attributable to PM 2.5 (annual mean 30.4 μ g/m 3 ) for the whole country. Adjusting for the difference in share of the population 30+ in Skopje and nationally (62.4% and 59% respectively), as well as for the differences in exposure (urban in Skopje vs. a mix of urban and rural nationally), their adjusted premature mortality estimate is within 15% of our result. Our study has a number of limitations. We have assumed a log-linear function between exposure and response to ambient pollution, so health effects would be the same for incremental ranges of pollution at different levels. For the relatively high exposures experienced in Skopje, this is likely to result in an over-estimation of the burden, as well as of the health co-benefits associated with reduced pollution. On the other hand, however, our results should be interpreted as conservative. For instance, some relevant pollutants were excluded from the analysis (e.g., ozone and NO 2 ), although their relative contribution to health morbidity and mortality is likely to be relatively small compared with PM [ 14 ]. Furthermore, some important nonfatal health endpoints such as aggravation of asthma and other chronic respiratory diseases, which may in turn impact a person’s ability to work or engage in routine daily activities, were excluded, but could represent significant additional health and economic burdens on the population and social services. In past European studies, morbidity costs accounted for 10 to 15% of the total health cost when mortality was valued using VSL [ 12 ]. The data availability for our study was not optimal, with a very low coverage of measurements for most stations in 2011, and to a lesser extent in 2013. These periods of non-functionality of the measuring stations were officially noted at the yearly reports of the Macedonian Ministry of the Environment, hinting at the urgent need for the air quality monitoring system in Skopje to be strengthened, particularly the geographical and time series coverage of measurements, as well as the availability of adequate human and physical resources for monitoring.
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Int. J. Environ. Res. Public Health 2018 , 15 , 626 9 of 11 Notwithstanding these limitations, both our results and previous ones highlight the urgency of reducing the exposure to particulate matter in urban settings in MKD. The World Bank [ 30 ] provided policy advice for such reduction tailored to the emissions profile of the country, targeting pollution abatement in the industrial sector, a quick transition from the current lignite-based energy generation to
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  • Fall '18
  • Noor Shah

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