HEALTH-EFFECTS OF HIGH-LEVEL EXPOSURE TO TRADITIONAL POLLUTANTS IN EAST-GERMANY - REVIEW AND ONGOING RESEARCH

In East Germany ambient air pollution is characterized by high concentrations of sulfur dioxide (SO2) and suspended particulates (SP). Since acidity and sulfate are surprisingly low, oxidation of SO2 seems to be incomplete and neutralization seems to play an important role. Few studies on health effects of air pollution in the former German Democratic Republic have been performed. They showed an increased prevalence in polluted areas of respiratory symptoms, lung function decrement, mild anemia, nonspecific stimulation of the immune system and, retardation of skeletal maturation of children. Since the German unification in 1990, several large-scale studies have been started. Short-term effects of air pollution on daily mortality have been investigated in Erfurt retrospectively for 1980 to 1989. Logarithmic exposure-effect curves have been found for both SO2 and SP. The number of deaths increased by about 10% with SO2 and by more than 20% with SP if the 95th percentile of the pollutant is compared to the 5th percentile. The logarithmic shape shows that the increase of ambient concentrations at the beginning of the heating season in fall is more important than further increases in concentrations later in winter. A second study on short-term effects was conducted using daily peak flow measurements and respiratory symptoms in 270 patients with asthma and other obstructive airway diseases in East Germany and the Czech Republic between 1990 and 1992. From regression analysis it follows that an increase by 500 mu g/m3 of SO2 leads to a mean decrease of the average patient's peak flow below 2%. Three cross-sectional studies are in progress to compare the existing respiratory health status in East and West Germany. They consider about 9000 adults (20-44 years of age), 9000 school children (9-11 years of age) and 10,000 preschool children (age 6). Analysis is ongoing. Preliminary analyses show that respiratory symptoms like bronchitis, tonsillitis, recurrent colds, and chronic cough are reported more often in East than in West Germany. In contrast, prevalence of asthma, wheezing, hayfever, bronchial hyperresponsiveness and positive skin tests for common allergies is higher in West Germany. Total IgE (but not specific IgE) is clearly elevated in East Germany. To summarize the results, respiratory symptoms, lung function decrement and daily mortality, are compatible with a possible influence of the ''classical pollutants'' SO2 and SP. For asthma prevalence and atopic reactions other risk factors seem to be more relevant. Total IgE in East Germany seems to be related to crowded homes and may reflect specific chains of reinfection. It should be of interest to follow the rapidly changing composition of ambient air (less SO2 and particulates and more NO2 and other automobile emissions) as well as improved insulation of homes to observe ?heir effects on the health status of the East German population in the future.