Abstract
BACKGROUND AND AIM: Indonesia faces significant air quality issues due to peatland fires associated with agricultural land management and rapid urbanization. Limited prior research has estimated the episodic shock of intense fires on morbidity and mortality in Indonesia but has largely ignored the impact of poor air quality on biomarkers of chronic disease risk. We conducted a cross-sectional study of the association between particulate matter less than 2.5 microns in diameter (PM₂.₅) and blood pressure. METHODS: Blood pressure was obtained from the fifth wave of the Indonesian Family Life Survey (IFLS5), fielded in late 2014 and early 2015. The IFLS is an ongoing population-based socioeconomic and health survey. We used a global chemical transport model, GEOS-Chem version 12.8.2, to simulate daily PM₂.₅ concentrations at 0.5° x 0.625° resolution across the IFLS domain. GEOS-Chem, a three-dimensional atmospheric composition model, was used to assign PM₂.₅ exposure based on each participant’s kabupaten, or district, of residence. We assessed the association between PM₂.₅ and blood pressure, using mixed effects models with random intercepts for kabupaten and household and adjusted for age, sex, smoking status, BMI, hypertension medication, education, subjective socioeconomic status, and seasonality. RESULTS:For each 10 µg/m³ increase in PM₂.₅ in the month before the clinical exam, we find a 0.14% (95% CI: -0.01, 0.28) increase in diastolic blood pressure in adults, with a greater association seen in participants age 65 and over (0.6%, 95% CI: 0.03, 1.17). For the same exposure metric, there was a 0.8% (95% CI: 0.18, 1.41) increase in systolic blood pressure in participants 65 and older. CONCLUSIONS:To our knowledge, this is the first study to provide evidence for an association between PM₂.₅ and blood pressure in Indonesia. If this association is causal, the health burden of air quality within Indonesia may be severely underestimated. KEYWORDS: air pollution, particulate matter, wildfires, cardiovascular diseases
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