Abstract
Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM10, NO2, and SO2 up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM10, NO2, and SO2 at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m3 for PM10, 7.3 µg/m3 for NO2, and 3.6 µg/m3 for SO2. The overall cumulative risks for RD per IQR increase in PM10 and NO2 for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM10 and NO2 concentrations. Associations were strongest among children and warm season for RD.
Highlights
Over four million deaths are attributed to outdoor air pollution yearly, as reported by the World Health Organization (WHO); the majority of these deaths are largely cardiovascular and respiratory diseases [1]
Air pollution is the biggest threat to public health, of which the highest exposure is in low- and middle-income countries [2]
PM10 exceeded the daily WHO 2021 guideline values of 45 μg/m3 on 123 days, NO2 exceeded the value of 25 μg/m3 on 237 days, and SO2 exceeded the guideline of 40 μg/m3 on 9 days
Summary
Over four million deaths are attributed to outdoor air pollution yearly, as reported by the World Health Organization (WHO); the majority of these deaths are largely cardiovascular and respiratory diseases [1]. Air pollution is the biggest threat to public health, of which the highest exposure is in low- and middle-income countries [2]. In these countries, the air quality levels are not compliant with the new WHO guideline values nor the previous ones [1,3]. Air pollution is composed of a complex mixture of gases and particulate matter. The most common pollutants are nitrogen dioxide (NO2 ), sulfur dioxide (SO2 ), ground-level ozone (O3 ), carbon monoxide (CO), and particulate matter (PM). The mixtures and concentrations of these pollutants differ by countries
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