Experience in Organizing and Conducting Epidemiological Studies to Detect and Prove the Causal Relationship between Ambient Air Quality and Health Disorders in the Population of Industrially Contaminated Sites

Introduction: Within the framework of the Federal Clean Air Project, it is envisaged to implement comprehensive action plans aimed at reducing air pollution and increasing the level of public satisfaction with the environmental situation in a number of industrial centers of the Russian Federation with high and extremely high levels of ambient air pollution. Decree No. 1792 of the Russian Government of December 24, 2019 approved the requirements for compensatory measures aimed at improving ambient air quality, preventing and eliminating adverse health effects of environmental factors. To increase the validity and adequacy of the measures taken, it is necessary to elaborate method approaches for Rospotrebnadzor bodies to designing and conducting studies on establishing the association between air pollution and adverse health outcomes in the population living in industrially contaminated areas. The purpose of our work was to substantiate an algorithm of actions and to demonstrate its efficiency within epidemiological studies focused on establishing and proving the causal relationship between airborne chemicals and observed health consequences in the population. Materials and methods included a set of modern hygienic and epidemiological research methods, assessment of risk and its health damage, in-depth research, and modeling of cause and effect relationships. Results: We proposed approaches and conducted studies to establish the link between industrial air pollution and the diseases diagnosed in the exposed population. Conclusions: The suggested algorithm of actions tested in the city of Bratsk proved to be effective and helped identify risk-attributed health disorders; specify the pollutants requiring development or adjustment of measures to reduce their ambient emissions; clarify and expand the list of target organs and systems for prediction and monitoring; substantiate and fulfil managerial decisions and adequate targeted preventive measures based on health damage criteria.

1. Popova AYu. Strategic priorities of the Russian Federation in the field of ecology from the position of preservation of health of the nation. Zdorov'e Naseleniya i Sreda Obitaniya. 2014; (2(251)):4-7. (In Russian).

2. Onischenko GG. Health risk assessment and management as an effective tool to solve issues to ensure the health and epidemiological well-being of the Russian Federation population. Health Risk Analysis. 2013; (1):4-14. (In Russian). DOI: https://doi.org/10.21668/health.risk/2013.1.01

3. Zaitseva NV, Onishchenko GG, Popova AYu, et al. Social and economic determinants and potential for growth in life expectancy of the population in the Russian Federation taking into account regional differentiation. Health Risk Analysis. 2019; (4):14-29. (In Russian). DOI: https://doi.org/10.21668/health.risk/2019.4.02.eng

4. Stepanova LP, Mishkin AI, Korenkova EA. The complex ecological valuation for the identification of failure in the environment. Vestnik Rossiyskogo Universiteta Druzhby Narodov. Seriya: Ekologiya i Bezopasnost' Zhiznedeyatel'nosti. 2011; (1):42-48.

5. Verevina ML, Rusakov NV, Zhukova TV, et al. Estimation of morbidity rates in relation to living conditions. Gigiena i Sanitariya. 2010; (3):21-25. (In Russian).

6. Gauderman WJ, Urman R, Avol E, et al. Association of improved air quality with lung development in children. N Engl J Med. 2015; 372(10):905-913. DOI: https://doi.org/10.1056/NEJMoa1414123

7. Popova AYu, Zaitseva NV, May IV. Population health as a target function and criterion for assessing efficiency of activities performed within “Pure Air” Federal Project. Health Risk Analysis. 2019; (4):4-13. (In Russian). DOI: https://doi.org/10.21668/health.risk/2019.4.01

8. Kleyn SV, Vekovshinina SA, Balashov SYu, et al. Analysis of cause-effect relations of the levels of biological markers of exposure to heavy metals with their personalized loading dose in the areas of wastes' influence induced by the operation of the metallurgical plant in the past. Gigiena i Sanitariya. 2017; 96(1):29-35. (In Russian). DOI: https://doi.org/10.18821/0016-9900-2017-96-1-29-35

9. Gurvich VB, Kuzmin SV, Dikonskaya OV, et al. Health risk management to provide health and epidemiological well-being to the population in municipalities (the experience of the Sverdlovsk region). Health Risk Analysis. 2013; (3):64-74. (In Russian). DOI: https://doi.org/10.21668/health.risk/2013.3.08

10. Rakitskii VN, Avaliani SL, Novikov SM, et al. Health risk analysis related to exposure to ambient air contamination as a component in the strategy aimed at reducing global non-infectious epidemics. Health Risk Analysis. 2019; (4):30-36. (In Russian). DOI: https://doi.org/10.21668/health.risk/2019.4.03

11. May IV, Zaitseva NV, Klein SV, et al. Establishment and proof of health damage due to the negative impact of environmental factors. Zdorov'e Naseleniya i Sreda Obitaniya. 2013; (11(248)):4-6. (In Russian).

12. Onishchenko GG, Zaitseva NV, Zemlianova MA. [Hygienic indication of health effects during external exposure to chemical elements.] Perm: Knizhnyi format Publ., 2011. 532 p. (In Russian).

13. Zemlyanova MA, Dolgikh OV. Biomarkers as health effect indicators and criteria of the exposure to man-made chemical environmental and occupational factors. Zdorov'e Naseleniya i Sreda Obitaniya. 2010; (11(212)):31-33. (In Russian).

14. May IV, Kleyn SV, Sedusova EV. Experience proof of health damage to the impact of environmental factors. Zdorov'e i Okruzhayushchaya Sreda. 2015; 1(25):59-63. (In Russian).

15. Zaytseva NV, Klein SV, Sedusova EV. To the practice of proofing the harm to the population health at population and individual levels at influence of harmful factors of habitat. Izvestiya Samarskogo Nauchnogo Tsentra Rossiyskoi Akademii Nauk. 2015; 1(7):457-463. (In Russian).

16. Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Ann Rev Public Health. 1995; 16:61-81. DOI: https://doi.org/10.1146/annurev.pu.16.050195.000425