Original Research

Air pollution and hospital admissions and deaths due to respiratory infections in megacity of Tehran: A time series analysis

Abstract

Introduction: Air pollution is one of the main causes for the significant increase of respiratory infections in Tehran. In the present study, we investigated the associations between short-term exposure to ambient air pollutants with the hospital admissions and deaths.

Materials and methods: Health data from 39915 hospital admissions and 2459 registered deaths associated with these hospital admissions for respiratory infections were obtained from the Ministry of Health and Medical Education during 2014-2017. We used the distributed lag non-linear model (DLNM) for the analyses.

Results: There was a statistically positive association between PM2.5 and AURI in the age group of 16 years and younger at lags 6 (RR 1.31; 1.05-1.64) and 7 (RR 1.50; 1.09-2.06). AURI admissions was associated with O3 in the age group of 16 and 65 years at lag 7 with RR 1.13 (1.00-1.27). ALRI admissions was associated with CO in the age group of 65 years and older at lag 0 with RR 1.12 (1.02-1.23). PM10 was associated with ALRI daily hospital admissions at lag 0 for males. ALRI admissions were associated with NO2 for females at lag 0. There was a positive association between ALRI deaths and SO2 in the age group of 65 years and older at lags 4 and 5 with RR 1.04 (1.00-1.09) and 1.03 (1.00-1.07), respectively.

Conclusion: Exposure to outdoor air pollutiants including PM10, PM2.5, SO2, NO2, O3, and CO was associated with hospital admissions for AURI and ALRI at different lags. Moreover, exposure to SO2 was associated with deaths for ALRI.

1. Soleimani Z, Darvishi Boloorani A, Khalifeh R, Teymouri P, Mesdaghinia A, Griffin DW. Air pollution and respiratory hospital admissions in Shiraz, Iran, 2009 to 2015. Atmospheric Environment. 2019;209:233-9.
2. Kelly FJ, Fussell JC. Air pollution and airway disease. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. 2011;41(8):1059-71.
3. Karimi B, shokrinezhad B, Samadi S. Mortality and hospitalizations due to cardiovascular and respiratory diseases associated with air pollution in Iran: A systematic review and meta-analysis. Atmospheric Environment. 2019;198:438-47.
4. Kaplan GG, Hubbard J, Korzenik J, Sands BE, Panaccione R, Ghosh S, et al. The inflammatory bowel diseases and ambient air pollution: a novel association. The American journal of gastroenterology. 2010;105(11):2412-9.
5. Lin S, Liu X, Le LH, Hwang S-A. Chronic exposure to ambient ozone and asthma hospital admissions among children. Environmental health perspectives. 2008;116(12):172530.
6. Schikowski T, Adam M, Marcon A, Cai Y, Vierkotter A, Carsin AE, et al. Association of ambient air pollution with the prevalence and incidence of COPD. The European respiratory journal. 2014;44(3):614-26.
7. Guan WJ, Zheng XY, Chung KF, Zhong NS. Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action. Lancet. 2016;388(10054):1939-51.
8. Zheng PW, Wang JB, Zhang ZY, Shen P, Chai PF, Li D, et al. Air pollution and hospital visits for acute upper and lower respiratory infections among children in Ningbo, China: A time-series analysis. Environmental science and pollution research international. 2017;24(23):18860-9.
9. Namvar Z, Yunesian M, Shamsipour M, Hassanvand MS, Naddafi K, Shahhosseini E. Cross-sectional associations between ambient air pollution and respiratory signs and symptoms among young children in Tehran. Atmospheric Environment. 2020;223:117268.
10. Khaniabadi YO, Daryanoosh SM, Hopke PK, Ferrante M, De Marco A, Sicard P, et al. Acute myocardial infarction and COPD attributed to ambient SO2 in Iran. Environmental research. 2017;156:683-7.
11. Liang Y, Fang L, Pan H, Zhang K, Kan H, Brook JR, et al. PM2.5 in Beijing–temporal pattern and its association with influenza. Environmental Health. 2014 Dec;13(1):1-8
12. Halonen JI, Lanki T, Tiittanen P, Niemi JV, Loh M, Pekkanen J. Ozone and cause-specific cardiorespiratory morbidity and mortality. Journal of epidemiology and community health. 2010;64(9):814-20.
13. Tao Y, Mi S, Zhou S, Wang S, Xie X. Air pollution and hospital admissions for respiratory diseases in Lanzhou, China. Environmental pollution. 2014;185:196-201.
14. MacIntyre EA, Gehring U, Mölter A, Fuertes E, Klümper C, Krämer U, et al. Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE Project. Environmental health perspectives. 2014;122(1):107-13.
15. Do AHL, van Doorn HR, Nghiem MN, Bryant JE, Hoang THT, Do QH, et al. Viral etiologies of acute respiratory infections among hospitalized Vietnamese children in Ho Chi Minh City, 2004–2008. PloS one. 2011;6(3):e18176.
16. Bellos A, Mulholland K, O'Brien KL, Qazi SA, Gayer M, Checchi F. The burden of acute respiratory infections in crisis-affected populations: a systematic review. Conflict and health. 2010;4(1):1-12.
17. Tam WW, Wong TW, Ng L, Wong SY, Kung KK, Wong AH. Association between air pollution and general outpatient clinic consultations for upper respiratory tract infections in Hong Kong. PLoS One. 2014 Jan 23;9(1):e86913.
18. Chang Q, Zhang H, Zhao Y. Ambient air pollution and daily hospital admissions for respiratory system–related diseases in a heavy polluted city in Northeast China. Environmental Science and Pollution Research. 2020:1-10.
19. Kirwa K, Eckert CM, Vedal S, Hajat A, Kaufman JD. Ambient air pollution and risk of respiratory infection among adults: evidence from the multiethnic study of atherosclerosis (MESA). BMJ open respiratory research. 2021;8(1):e000866.
20. Symonds MR, Moussalli A. A brief guide to model selection, multimodel inference and model averaging in behavioural ecology using Akaike’s information criterion. Behavioral Ecology and Sociobiology. 2011;65(1):13-21.
21. Aho K, Derryberry D, Peterson T. Model selection for ecologists: the worldviews of AIC and BIC. Ecology. 2014;95(3):631-6.
22. Phung D, Hien TT, Linh HN, Luong LM, Morawska L, Chu C, et al. Air pollution and risk of respiratory and cardiovascular hospitalizations in the most populous city in Vietnam. The Science of the total environment. 2016;557-558:322-30.
23. Tang S, Yan Q, Shi W, Wang X, Sun X, Yu P, et al. Measuring the impact of air pollution on respiratory infection risk in China. Environmental Pollution. 2018;232:477-86.
24. Nhung NTT, Schindler C, Dien TM, Probst-Hensch N, Perez L, Künzli N. Acute effects of ambient air pollution on lower respiratory infections in Hanoi children: an eight-year time series study. Environment international. 2018;110:139-48.
25. Chen Y, Yang Q, Krewski D, Burnett RT, Shi Y, McGrail KM. The effect of coarse ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly. Inhalation toxicology. 2005;17(12):649-55.
26. Zheng P-w, Wang J-b, Zhang Z-y, Shen P, Chai P-f, Li D, et al. Air pollution and hospital visits for acute upper and lower respiratory infections among children in Ningbo, China: a time-series analysis. Environmental Science and Pollution Research. 2017;24(23):18860-9.
27. Croft DP, Zhang W, Lin S, Thurston SW, Hopke PK, Masiol M, et al. The association between respiratory infection and air pollution in the setting of air quality policy and economic change. Annals of the American Thoracic Society. 2019;16(3):321-30.
28. Mehta S, Shin H, Burnett R, North T, Cohen AJ. Ambient particulate air pollution and acute lower respiratory infections: a systematic review and implications for estimating the global burden of disease. Air Quality, Atmosphere & Health. 2013;6(1):69-83.
29. Chen T-M, Kuschner WG, Gokhale J, Shofer S. Outdoor Air Pollution: Nitrogen Dioxide, Sulfur Dioxide, and Carbon Monoxide Health Effects. The American Journal of the Medical Sciences. 2007;333(4):249-56.
30. Arbex MA, Santos UdP, Martins LC, Saldiva PHN, Pereira LAA, Braga ALF. Air pollution and the respiratory system. Jornal brasileiro de pneumologia. 2012;38:643-55.
31. Tajudin MABA, Khan MF, Mahiyuddin WRW, Hod R, Latif MT, Hamid AH, et al. Risk of concentrations of major air pollutants on the prevalence of cardiovascular and respiratory diseases in urbanized area of Kuala Lumpur, Malaysia. Ecotoxicology and environmental safety. 2019;171:290-300.
32. Phosri A, Ueda K, Phung VLH, Tawatsupa B, Honda A, Takano H. Effects of ambient air pollution on daily hospital admissions for respiratory and cardiovascular diseases in Bangkok, Thailand. Science of the Total Environment. 2019;651:1144-53.
33. Chen R, Huang W, Wong C-M, Wang Z, Thach TQ, Chen B, et al. Short-term exposure to sulfur dioxide and daily mortality in 17 Chinese cities: the China air pollution and health effects study (CAPES). Environmental research. 2012;118:101-6.
34. Reno AL, Brooks EG, Ameredes BT. Mechanisms of heightened airway sensitivity and responses to inhaled SO2 in asthmatics. Environmental health insights. 2015;9:EHI. S15671.
35. Chen R, Kan H, Chen B, Huang W, Bai Z, Song G, et al. Association of particulate air pollution with daily mortality: the China Air Pollution and Health Effects Study. American journal of epidemiology. 2012;175(11):1173-81.
Files
IssueVol 6 No 1 (2021): Winter 2021 QRcode
SectionOriginal Research
DOI https://doi.org/10.18502/japh.v6i1.7601
Keywords
Outdoor air pollutant; Respiratory diseases; Hospital admissions; Deaths

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Namvar Z, Hadei M, Hashemi SS, Shahhosseini E, K. Hopke P, Rahmatinia M, Bazzazpour S, Kermani M, Mohseni Bandpey A, Shahsavani A. Air pollution and hospital admissions and deaths due to respiratory infections in megacity of Tehran: A time series analysis. japh. 2021;6(1):1-13.