Aug 2, 2014 - Health impact assessment of air pollution in Valladolid, Spain. AUTHORS. Cárdaba Arranz, Mario; Muñoz Moreno, MarÃa Fe; Armentia, Alicia;.
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. This paper was submitted to the JECH but declined for publication following peer review. The authors addressed the reviewers’ comments and submitted the revised paper to BMJ Open. The paper was subsequently accepted for publication at BMJ Open.
ARTICLE DETAILS TITLE (PROVISIONAL)
Health impact assessment of air pollution in Valladolid, Spain
AUTHORS
Cárdaba Arranz, Mario; Muñoz Moreno, María Fe; Armentia, Alicia; Alonso Capitán, Margarita; Carreras Vaquer, Fernando; Almaraz Gómez, Ana VERSION 1 - REVIEW
REVIEWER REVIEW RETURNED
Neal Fann U.S. Environmental Protection Agency 02-Aug-2014
GENERAL COMMENTS
This manuscript suffers from two critical weaknesses: 1. The methods are incompletely described. In particular, the authors do not provide a sufficient amount of information regarding the source of the ambient air quality monitoring data, how these data were used to estimate population exposure, and whether the authors interpolated the monitoring data (and if so, how). The authors describe the source of the baseline mortality rates, but provide not details regarding the year(s) of these data used, whether these data were stratified by age/race/sex, and whether these data were reported by cause of mortality. 2. The results section does not adequitely characterize the size, distribution, or cause of the mortality risk. For example, the authors report several estimates of PM-related death by cause, but do not attempt to synthesize these results for the reader.
REVIEWER
REVIEW RETURNED
Rojas-Rueda David Center for Research in Environmental Epidemiology, Barcelona, Spain. 05-Aug-2014
GENERAL COMMENTS
Title: The title need to be more specific with the topic of the manuscript. Till now is very broad. I suggest to include the type of study, the topic and area of study in the title: e.g. "Health impact assessment of air pollution in Valladolid, Spain" or "Air pollution burden of disease in Valladolid, Spain". Abstract:
Design: it is a Health impact assessment or at least risk assessment or burden of disease assessment more than a ecological study. Results: the section is raw, i suggest to improve the presentations of the results. Introduction: I suggest to include the complete reference of the REVIHAAP and HARPIE instead of use a webpage. I suggest in general use the reference of the document (report) more than the web pages. Please check the BMJopen guideline for references. Methods: Was mentioned PM sources. Can the authors specify about the % of the sources contribution to the PM and O3 concentration or emissions? And please add a reference here. Exposure assessment: The authors also mention data source for demographic and mortality data (99-08). But the concentration (Table 3) need to be mentioned here and including the table 3 here. It's important to know if the analysis were performed by year (exposure + population + mortality) or were used only one exposure year or average to all the time period (99-08). Page 4, line 46: include only 2 decimals to all the numbers. Calculation of burden of disease: Is a repetitive section. May be you can merge the steps (page 5, line 1) with section of the page 6. Present a table with the scenarios or create a section only for explain the scenarios. And specify the sensitivity analysis as that, and not like another scenarios. The main weakness of the paper are not the assumptions included (because all risk assessment are based on assumptions), if not the concentration response functions. CRF used by the authors from Ostro B 2004 and Anderson 2004, are old and in these past 10 years many new references on this topic have been published. Is understandable that the authors followed the WHO approach for environmental burden of disease. But is not understandable why that the authors also used these old CRF. I suggest to update all this CRF to a recent references. Part of the HIA is develop a critical review of the literature, to use the most robust and recent evidence (CRF) in this case of air pollution and mortality (specific and general). I provide a few references to improve the CRF. But this need to be improved and updated by the authors. Need to be justified why only was included mortality instead of morbidity and DALYs. Results: Table 2. the results presented is the accumulative of the 10 years? Or the deaths avoided per year?? Table 2: Background scenarios need to be better explained or need
a scenarios section or change the name of the subtitle in the table. Discussion: Comparison with others studies. Page 11 line 7-8. To which guideline are referring the authors? EBD of WHO? Page 11, Line 51. Need to be mentioned in abstract or results section too. Table 3. Please move to methods. Recommendations for future research and applicability of this results: These sections are missing. --References: Beelen R, Raaschou-Nielsen O, Stafoggia M, Andersen ZJ, Weinmayr G, Hoffmann B et al. Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 2014;383(9919):785-95. Hoek G, Krishnan RM, Beelen R, Peters A, Ostro B, Brunekreef B et al. Long-term air pollution exposure and cardio- respiratory mortality: a review. Environ.Health 2013;12(1):43. VERSION 1 – AUTHOR RESPONSE Reviewer Name Neal Fann Institution and Country U.S. Environmental Protection Agency Please state any competing interests or state ‘None declared’: None declared
Thank you for reviewing our manuscript. Your comments were meaningful and helped us to correct and revise our manuscript accordingly.
This manuscript suffers from two critical weaknesses: 1. The methods are incompletely described. In particular, the authors do not provide a sufficient amount of information regarding the source of the ambient air quality monitoring data, how these data were used to estimate population exposure, and whether the authors interpolated the monitoring data (and if so, how). The authors describe the source of the baseline mortality rates, but provide not details regarding the year(s) of these data used, whether these data were stratified by age/race/sex, and whether these data were reported by cause of mortality. RESPONSE We have revised the methods section and included further details to clearly set forth the source of pollutant concentrations (operating stations with valid data from the municipal fixed-site monitoring stations network), population and mortality data. We have re-written this section in order to clarify and address all of the steps in depth. We have clarified how annual average of pollutant, population and mortality indicators for the period 1999-2008 were obtained. We have also explained the additional risk estimates and PM2.5/PM10 ratio that we have added to the assessment and the sensitivity
analysis from the HRAPIE report and clarified the counterfactual exposure scenarios and the alternative conditions for sensitivity analysis.
2. The results section does not adequitely characterize the size, distribution, or cause of the mortality risk. For example, the authors report several estimates of PM-related death by cause, but do not attempt to synthesize these results for the reader. RESPONSE We have given further thought to the results section in order to better explain and summarize our estimates. We have re-written this section in order to include new results from applying certain risk coefficient estimates and an alternative PM2.5/PM10 ratio summarized by the HRAPIE report. We have changed the wording of the tables in order to clarify the message and also added a specific table with the sensitivity analysis estimates separately. We have also added further details to discussion in order to clarify and link more closely with the results section.
Reviewer Name Rojas-Rueda David Institution and Country Center for Research in Environmental Epidemiology, Barcelona, Spain. Please state any competing interests or state ‘None declared’: None declared
Thank you for reviewing our manuscript. Your comments were meaningful and helped us to correct and revise our manuscript accordingly. Title: The title need to be more specific with the topic of the manuscript. Till now is very broad. I suggest to include the type of study, the topic and area of study in the title: e.g. "Health impact assessment of air pollution in Valladolid, Spain" or "Air pollution burden of disease in Valladolid, Spain". RESPONSE We have changed the title accordingly. Abstract:
Design: it is a Health impact assessment or at least risk assessment or burden of disease assessment more than a ecological study. RESPONSE We have changed this point accordingly. At the objective we have replaced the reference to a local setting by a reference to the WHO methodology. We have also included further details on setting (number of residents) and outcome measures (acronyms for attributable and targeted avoidable deaths; reference to the period of analysis).
Results: the section is raw, i suggest to improve the presentations of the results. RESPONSE Taking into account word limit constraint, we have elaborated this section to make it easier to follow.
We have decided to include only the results relative to the WHO AQG target value scenario. We have now decided to include the estimates for all-cause mortality associated to PM10 (
