Mortality and Morbidity Due to Exposure to Ambient NO2, SO2, and O3 in Isfahan in 2013-2014

Background

The presence of air pollutants such as CO, NO₂, SO₂, O₃, and PM in the ambient air mainly emitted from fossil fuels combustion has become a major health concern. The aims of this study were to estimate the attribution of NO₂, SO₂, and O₃ in the premature deaths and prevalence of cardiovascular and respiratory diseases in Isfahan in 2013-2014.

Methods

In this study, short-term health effects (total mortality, cardiovascular and respiratory mortality, chronic obstructive pulmonary disease, and acute myocardial infarction) of exposure NO₂, SO₂, and O₃ on the population of Isfahan were assessed using AirQ 2.2.3 software suggested by the World Health Organization (WHO).

Results

The result showed that from nonaccident total mortality in 2013-2014 in Isfahan, the attributable proportion related to NO₂, SO₂, and O₃ were 1.03% (109 cases), 3.46% (365 cases), and 1.29% (136 cases), respectively. The percentage of days that people were exposed to the highest concentration of NO₂ (40-49 μg/m³), SO₂ (60-69 μg/m³), and O₃ (40-49 μg/m³) was 34.46%, 16.85%, and 42.74% of a year, respectively. Total mortality attributed to NO₂, SO₂, and O₃ exposure was 0.36%, 0.79%, and 0.83%, respectively.

Conclusions

The concentrations of NO₂ and SO₂ were upper than the WHO guidelines. The Air-Q software in spite of its limitations can provide useful information regarding the health outcome of the air pollutants. The results estimated in this study were considerable. This information can help the health authorities and policy makers to draw suitable strategies and fulfill effective emission control programs.

Asthma disease as cause of admission to hospitals due to exposure to ambient oxidants in Mashhad, Iran

Nowadays, asthma is one of the most common chronic respiratory diseases, worldwide. Many reports have emphasized the correlation between the short-term exposure to the ambient air pollutants and acute respiratory diseases, especially among children with asthmatic symptoms. The aim of this study was to evaluate the relationship between the exposure to three atmospheric antioxidants (NO₂, SO₂, and O₃) and hospital admission due to asthmatic disease (HAAD) in the city of Mashhad, Iran. The concentrations of atmospheric antioxidants were obtained from the real-time monitoring stations located in the city. The collected data were employed for developing predictive models in the AirQ software. In order to investigate the association between short-term exposure to air pollutants and HAAD, the study participants were categorized into two age groups: less than 15 and from 15 to 64 years old. The results indicated that in people less than 15 years increase in NO₂ (attributable proportion (AP) = 3.775%, 95% CI 0.897-6.883%), SO₂ (AP = 3.649%, 95% CI 1.295-5.937%), and O₃ (AP = 0.554%,95% CI 0.00-3.321) results in increase in HAAD. While for those aged between 15 and 64 years, the AP was 4.192% (95% CI 0.450-7.662%) for NO₂; 0.0% (95% CI 0.00-1.687%) for SO₂; and 0.236% (95% CI 0.00-1.216%) for O₃. The number of asthmatic cases who were less than 15 years admitted to the hospitals during the study period was higher than that of those within the age groups between 15 and 64 years as a consequence of exposure to NO₂ (101 vs. 75), SO₂ (98 vs. 0), and O₃ (15 vs. 3), respectively. To the best of our knowledge, the AirQ model has not been applied before to estimate the effect of atmospheric antioxidant exposure on hospital admission because of asthma disease. Eventually, this model is proposed to be applicable for other cities around the world.

Health benefits of PM10 reduction in Iran

Air pollution contains a complex mixture of poisonous compounds including particulate matter (PM) which has wide spectrum of adverse health effects. The main purpose of this study was to estimate the potential health impacts or benefits due to any changes in annual PM₁₀ level in four major megacities of Iran. The required data of PM₁₀ for AirQ software was collected from air quality monitoring stations in four megacities of Iran. The preprocessing was carried out using macro coding in excel environment. The relationship between different presumptive scenarios and health impacts was determined. We also assessed the health benefits of reducing PM₁₀ to WHO Air Quality Guidelines (WHO-AQGs) and National Ambient Air Quality Standards (NAAQSs) levels with regard to the rate of mortality and morbidity in studied cities. We found that the 10 μg/m³ increase in annual PM₁₀ concentration is responsible for seven (95% CI 6-8) cases increase in total number of deaths per 2 × 10⁵ person. We also found that 10.7, 7.2, 5.7, and 5.3% of total death is attributable to short-term exposure to air pollution for Ahvaz, Isfahan, Shiraz, and Tehran, respectively. We found that by attaining the WHO's proposed value for PM₁₀, the potential health benefits of 89, 84, 79, and 78% were obtained in Ahvaz, Isfahan, Shiraz, and Tehran, respectively. The results also indicated that 27, 10, 3, and 1% of health impacts were attributed to dust storm days for Ahvaz, Isfahan, Shiraz, and Tehran, respectively.

Acute myocardial infarction and COPD attributed to ambient SO2 in Iran

Acute myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) are important diseases worldwide. Inhalation is the major route of short-term exposure to air sulfur dioxide (SO₂) that negatively affect human health. The objective of this study was to estimate the health effects of short-term exposure to SO₂ in Khorramabad, Iran using the AirQ software developed by the World Health Organization (WHO). Daily mean SO₂ concentrations were used as the estimates of human short-term exposure and allow calculation of the attributable excess relative risk of an acute MI and hospital admissions due to COPD (HACOPD). The annual mean SO₂ concentration in Khorramabad was 51.33µg/m³. Based on the relative risk (RR) and baseline incidence (BI) approach of WHO, an increased risk of 2.7% (95% CI: 1.1-4.2%) of acute MI and 2.0% (95% CI: 0-4.6%) of HACOPD, respectively, were attributed to a 10µg/m³ SO₂ increase. Since the geographic, demographic, and climatic characteristics are different from the areas in which the risk relationships were developed and not evaluated here, further investigations will be needed to fully quantify other health impacts of SO₂. A decreased risk for MIs and COPD attributable to SO₂ could be achieved if mitigation strategies and measures are implemented to reduce the exposure.

Health risk assessment of exposure to the Middle-Eastern Dust storms in the Iranian megacity of Kermanshah

OBJECTIVE

This study assessed the effects of particulate matter (PM), equal or less than 10 μm in aerodynamic diameter (PM₁₀), from the Middle-Eastern Dust events on public health in the megacity of Kermanshah (Iran).

STUDY DESIGN

This study used epidemiological modeling and monitored ambient air quality data to estimate the potential PM₁₀ impacts on public health.

METHODS

The AirQ2.2.3 model was used to calculate mortality and morbidity attributed to PM₁₀ as representative of dust events. Using Visual Basic for Applications, the programming language of Excel software, hourly PM₁₀ concentrations obtained from the local agency were processed to prepare input files for the AirQ2.2.3 model.

RESULTS

Using baseline incidence, defined by the World Health Organization, the number of estimated excess cases for respiratory mortality, hospital admissions for chronic obstructive pulmonary disease, for respiratory diseases, and for cardiovascular diseases were 37, 39, 476, and 184 persons, respectively, from 21st March, 2014 to 20th March, 2015. Furthermore, 92% of mortality and morbidity cases occurred in days with PM₁₀ concentrations lower than 150 μg/m³. The highest percentage of person-days occurred for daily concentrations range of 100-109 μg/m³, causing the maximum health end-points among the citizens of Kermanshah.

CONCLUSIONS

Calculating the number of cumulative excess cases for mortality or morbidity attributed to PM₁₀ provides a good tool for decision and policy-makers in the field of health care to compensate their shortcomings particularly at hospital and healthcare centers for combating dust storms. To diminish these effects, several immediate actions should be managed in the governmental scale to control dust such as spreading mulch and planting new species that are compatible to arid area.

Cardiovascular, respiratory, and total mortality ascribed to PM10 and PM2.5 exposure in Isfahan, Iran

BACKGROUND

Air pollution is an important environmental issue due to its proven serious impacts on human health. The aim of this study was to estimate the attribution of particulate matter with an aerodynamic diameters of ≤ 2.5 and 10 (PM_2.5 and PM₁₀) in the prevalence of cardiovascular and respiratory diseases and premature deaths in Isfahan in 2013-2014.

MATERIALS AND METHODS

This descriptive, ecological study was conducted to assess health impacts of PM_2.5 and PM₁₀ on the population using Air Q_2.2.3 software, suggested by the World Health Organization (WHO).

RESULTS

The results showed that the annual mean, winter mean, summer mean, and the 98 percentile of PM₁₀ concentration in Isfahan were 108, 100, 116, and 264 μg/m³, respectively. The number of deaths per year related to PM_2.5 was 670 and that for PM₁₀ was 713 cases. The number of annual deaths due to cardiovascular and respiratory diseases attributed to PM₁₀ was 316 and 68 cases, respectively.

CONCLUSION

The results of this study revealed that about 44.3% of total annual death due to cardiovascular diseases and 9.55% of that due to respiratory diseases were attributed to PM₁₀ exposure. In the other word, residents were exposed to PM_2.5 and PM₁₀ concentrations higher than the WHO guidelines which caused a notable increase in the rate of mortality.

Evaluation of Chronic Obstructive Pulmonary Disease (COPD) attributed to atmospheric O3, NO2, and SO2 using Air Q Model (2011-2012 year)

Chronic obstructive pulmonary disease (COPD) is an important disease worldwide characterized by chronically poor airflow. The economic burden of COPD on any society can be enormous if not managed. We applied the approach proposed by the World Health Organization (WHO) using the AirQ2.2.3 software developed by the WHO European Center for Environment and Health on air pollutants in Tabriz (Iran) (2011-2012 year). A 1h average of concentrations of ozone (O3), daily average concentrations of nitrogen dioxide (NO2) and sulfur dioxide (SO2) were used to assess human exposure and health effect in terms of attributable proportion of the health outcome and annual number of excess cases of Hospital Admissions for COPD (HA COPD). The results of this study showed that 2% (95% CI: 0.8-3.1%) of HA COPD were attributed to O3 concentrations over 10 μg/m(3). In addition, 0.7 % (95% CI: 0.1-1.8%) and 0.5% (95% CI: 0-1%) of HA COPD were attributed to NO2 and SO2 concentrations over 10 μg/m(3) respectively. In this study, we have shown that O3, NO2 and SO2 have a significant impact on COPD hospitalization. Given these results the policy decisions are needed in order to reduce the chronic pulmonary diseases caused by air pollution and furthermore better quantification studies are recommended.