The Effects of Air Quality on Hospital Admissions for Chronic Respiratory Diseases in Petaling Jaya, Malaysia, 2013–2015

Karyn Morrissey,Ivy Chung,Maw Tan,Simon Frostick,Andrew Morse,Margaret Roebuck,Pooi-Fong Wong,Amanda Wood,Suhanya Parthasarath

doi:10.3390/atmos12081060

Abstract

This study assesses the impact of a decrease in air quality and the risk of hospital admissions to a public hospital for chronic respiratory diseases for residents of Petaling Jaya, a city in the Greater Kuala Lumpur area in Malaysia. Data on hospital admissions for asthma, bronchitis, emphysema and other chronic obstructive pulmonary disease, weather conditions and the Malaysian Air Pollution Index, a composite indicator of air quality, were collated. An unconstrained distributed lag model to obtain risk of hospitalization for a 10 μg/m3 increase in the API. The lag cumulative effect for a 10 μg/m3 increase in the API was calculated to test for harvesting in the short term. Findings indicate that after an initial decrease in admissions (days 3 and 4), admissions increased again at day 7 and 8 and this relationship was significant. We therefore conclude that a 10 μg/m3 increase has a greater effect on admissions for respiratory health in the short term than a harvesting effect alone would suggest. These results suggest that while air quality is improving in the Greater Kuala Lumpur area, no level of air pollution can be deemed safe.

Highlights

Acute short-term exposure to different pollutants, including both gaseous pollutants (i.e., nitrogen dioxide (NO2 ), sulfur dioxide (SO2 ) and ozone (O3 )) and particulate matter (PM10 and PM2.5 ), have been found to exacerbate existing respiratory health conditions, leading to premature death and increased hospitalizations in low- and middle-income countries [1,2]
The results indicate that a 10 μg/m3 increase in the Air pollution Index (API) is significantly associated with adult hospital admissions for chronic respiratory diseases in Petaling Jaya (PJ), with an initial increase in admissions in Day 1, followed by a decrease in admissions between day 3 and 5 peaking at an incident rate ratio of 0.97 (95%, CI 0.95–0.99)
Rapid economic development in Malaysia has resulted in localized air pollution, much of which is in the Greater Kuala Lumpur region [5,27]

Summary

Introduction

Acute short-term exposure to different pollutants, including both gaseous pollutants (i.e., nitrogen dioxide (NO2 ), sulfur dioxide (SO2 ) and ozone (O3 )) and particulate matter (PM10 and PM2.5 ), have been found to exacerbate existing respiratory health conditions, leading to premature death and increased hospitalizations in low- and middle-income countries [1,2]. The WHO [3] estimates that almost 90% of air-pollution-related deaths occur in low-and middle-income countries, with nearly 2/3 occurring in Southeast Asia and Western Pacific regions. With one of the fastest growing economies in the Southeast region, air pollution has become a major public health concern in Malaysia [5]. Air pollution monitoring has indicated that there is a decrease in levels of some pollutants over time [7]; the impact of localized air pollution on health remains a major concern in urban Malaysia [2,5]

Methods

Results

Conclusion