Case-crossover study for the association between increased hospital admissions for respiratory diseases and the increase in atmospheric PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa.

Outdoor PM2.5 was sampled in Pretoria, 18 April 2017 to 28 February 2020. A case-crossover epidemiology study was associated for increased PM2.5 and trace elements with increased hospital admissions for respiratory disorders (J00-J99). The results included a significant increase in hospital admissions, with total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg·m-3 increase. For the trace elements, Ca of 4.0% (95% CI: 1.4%-6.8%), Cl of 0.7% (95% CI: 0.0%-1.4%), Fe of 3.3% (95% CI: 0.5%-6.1%), K of 1.8% (95% CI: 0.2-3.5) and Si of 1.3% (95% CI: 0.1%-2.5%). When controlling for PM2.5, only Ca of 3.2% (95% CI: 0.3, 6.1) and within the 0-14 age group by 5.2% (95% CI: 1.5, 9.1). Controlling for a co-pollutant that is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis.

Source apportionment of fine atmospheric particles in Bloemfontein, South Africa, using positive matrix factorization.

Air pollution is of major health and environmental concern globally and in South Africa. Studies on the sources of PM2.5 air pollution in low- and middle-income countries such as South Africa are limited. This study aimed to identify local and distant sources of PM2.5 pollution in Bloemfontein. PM2.5 samples were collected from June 16, 2020 to August 18, 2021. Trace element concentrations were determined by EDXRF spectroscopy. By use of the US EPA PMF 5.0 program, local sources were determined to be combustion/wood burning (49%), industry (22%), soil dust (10%), base metal/pyrometallurgical and traffic (9.6%) and water treatment/industry (9.4%). The HYSPLIT program was applied to determine distant PM2.5 source areas and the following clusters were identified: Mpumalanga province (52%), Northern Cape province (35%), Indian Ocean (8%) and Atlantic Ocean (6%). The majority of the air was found to come from the Mpumalanga province in the north-east, while the majority of local sources are ascribed to combustion/wood burning. Results from this study can be used to develop an Air Quality Management Plan for Bloemfontein.

Temperature modifies the association between air pollution and respiratory disease mortality in Cape Town, South Africa.

The aim of this 10-year study was to investigate whether and how temperature modifies the association between daily ambient PM10, NO2, SO2 air pollution and daily respiratory disease mortality in Cape Town. A time-stratified case-crossover epidemiological design was applied. Susceptibility by sex and age groups (15-64 years and ≥65 years) was also investigated. On days with medium Tapp levels, NO2 displayed a stronger association with respiratory mortality than PM10 or SO2. Females appeared to be more susceptible to NO2 at medium Tapp levels to males. The 15-64-year-old age group seemed to be more vulnerable to NO2 and PM10 at medium Tapp levels compared to the elderly (≥65 years). At high Tapp levels, females were more susceptible to PM10. The 15-64-year-old group were more vulnerable to NO2 and SO2. The results can be used in present-day early warning systems and in risk assessments to estimate the impact of increased air pollution and temperature.

Health risk assessment of PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa.

Exposure to outdoor air pollutants poses a risk for both non-carcinogenic and carcinogenic respiratory disease outcomes. A standardized health risk assessment (US EPA) utilizes air quality data, body mass and breathing rates to determine potential risk. This health risk assessment study assesses the hazard quotient (HQ) for total PM2.5 and trace elemental constituents (Br, Cl, K, Ni, S, Si, Ti and U) exposure in Pretoria, South Africa. The World Health Organization (WHO) air quality guideline (5 µg m-3) and the yearly South African National Ambient Air Quality Standard (NAAQS) (20 µg m-3) were the references dosages for total PM2.5. A total of 350 days was sampled in Pretoria, South Africa. The mean total PM2.5 concentration during the 34-month study period was 23.2 µg m-3 (0.7-139 µg m-3). The HQ for total PM2.5 was 1.17, 3.47 and 3.78 for adults, children and infants. Non-carcinogenic risks for trace elements K, Cl, S and Si were above 1 for adults. Seasonally, Si was the highest during autumn for adults (1.9) and during spring for S (5.5). The HQ values for K and Cl were highest during winter. The exposure to Ni posed a risk for cancer throughout the year and for As during winters.

Incident cardiovascular disease and long-term exposure to source-specific air pollutants in a Swedish cohort.

BACKGROUND: Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain. METHODS: Participants were enrolled in the Malmö Diet and Cancer cohort in 1991-1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 µm and 2.5 µm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study period. Cox proportional hazards models adjusted for possible confounders was used to estimate associations between air pollution 1-5 years prior to outcomes of incident CHF, fatal myocardial infarction (MI), major adverse coronary events (MACE), and ischemic stroke. RESULTS: Air pollution exposure levels (mean annual exposures to PM2.5 of 11 µg/m3 and NOx of 26 µg/m3) within the cohort were moderate in terms of environmental standards. After adjusting for confounders, we observed statistically significant associations between NOx and CHF (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.01-1.22) and NOx and fatal MI (HR 1.10, 95%CI 1.01-1.20) per interquartile range (IQR) of 9.6 µg/m3. In fully adjusted models, the estimates were similar, but the precision worse. In stratified analyses, the associations were stronger in males, ever-smokers, older participants, and those with baseline carotid artery plaques. Locally emitted and traffic-related air pollutants generally showed positive associations with CHF and fatal MI. There were no associations between air pollution and MACE or stroke. DISCUSSION/CONCLUSION: In an area with low to moderate air pollution exposure, we observed significant associations of long-term residential NOx with increased risk of incident CHF and fatal MI, but not with coronary events and stroke.

Particulate Matter (PM2.5) Characterization, Air Quality Level and Origin of Air Masses in an Urban Background in Pretoria.

Several sources have been identified as contributing to the concentration of ambient fine particulate matter, which has been associated to a variety of health issues. The chemical characteristics and sources of trace elements in PM2.5, as well as the air quality index, were investigated in this study. Twenty four-hour fine aerosol particles were collected in an urban area in Pretoria, South Africa, from April 2017 to April 2018. Eighteen trace elements were determined using an XEPOS 5 energy-dispersive X-ray fluorescence (EDXRF) spectrometer, while black and organic carbon were estimated using an optical transmissometer from the samples collected. The HYPLIT model (version 4.9) was used to estimate air mass trajectories. Health risk was calculated by comparing it to the World Health Organization's air quality index (AQI). The overall mean PM2.5 concentration of the collected sample equals 21 µg/m3. Majority of PM2.5 exceedances were reported during mid-autumn and winter seasons, as compared to daily WHO guidelines and South African standards. S had the highest concentrations, greater than 1 µg/m3. Ni, Se, Br and Sb showed they were extremely enriched, (EF > 10) and suggestive of anthropogenic or non crustal origin The 24-h PM, soot, BC and OC were significantly different by the geographical origin of air masses (p < 0.05). The AQI showed that 70% of the samples showed levels above the AQI range of good and healthy air. The findings include details on the concentration, composition, and potential sources of fine PM2.5, which is essential for policy formulation and mitigation strategies in South Africa's fight against air pollution.

Source apportionment of fine atmospheric particles using positive matrix factorization in Pretoria, South Africa.

In Pretoria South Africa, we looked into the origins of fine particulate matter (PM2.5), based on 1-year sampling campaign carried out between April 18, 2017, and April 17, 2018. The average PM2.5 concentration was 21.1 ± 15.0 µg/m3 (range 0.7-66.8 µg/m3), with winter being the highest and summer being the lowest. The XEPOS 5 energy dispersive X-ray fluorescence (EDXRF) spectroscopy was used for elemental analysis, and the US EPA PMF 5.0 program was used for source apportionment. The sources identified include fossil fuel combustion, soil dust, secondary sulphur, vehicle exhaust, road traffic, base metal/pyrometallurgical, and coal burning. Coal burning and secondary sulphur were significantly higher in winter and contributed more than 50% of PM2.5 sources. The HYSPLIT model was used to calculate the air mass trajectories (version 4.9). During the 1-year research cycle, five transportation clusters were established: North Limpopo (NLP), Eastern Inland (EI), Short-Indian Ocean (SIO), Long-Indian Ocean (LIO), and South Westerly-Atlantic Ocean (SWA). Local and transboundary origin accounted for 85%, while 15% were long-range transport. Due to various anthropogenic activities such as biomass burning and coal mining, NLP clusters were the key source of emissions adding to the city's PM rate. In Pretoria, the main possible source regions of PM2.5 were discovered to be NLP and EI. Effective control strategies designed at reducing secondary sulphur, coal burning, and fossil fuel combustion emissions at Southern African level and local combustion sources would be an important measure to combat the reduction of ambient PM2.5 pollution in Pretoria.

Indoor and outdoor PM10 levels at schools located near mine dumps in Gauteng and North West Provinces, South Africa.

BACKGROUND: Few studies in South Africa have investigated the exposure of asthmatic learners to indoor and outdoor air pollution at schools. This study compared outdoor PM10 and SO2 exposure levels in exposed (1-2 km from gold mine dumps) and unexposed schools (5 km or more from gold mine dumps). It also examined exposure of asthmatic children to indoor respirable dust at exposed and unexposed schools. METHODS: The study was conducted between 1 and 31 October 2012 in five schools from exposed and five from unexposed communities. Outdoor PM10 and SO2 levels were measured for 8-h at each school. Ten asthmatic learners were randomly selected from each school for 8-h personal respirable dust sampling during school hours. RESULTS: The level of outdoor PM10 for exposed was 16.42 vs. 11.47 mg.m-3 for the unexposed communities (p < 0.001). The outdoor SO2 for exposed was 0.02 ppb vs. 0.01 ppb for unexposed communities (p < 0.001). Indoor respirable dust in the classroom differed significantly between exposed (0.17 mg.m-3) vs. unexposed (0.01 mg.m-3) children with asthma at each school (p < 0.001). CONCLUSION: The significant differences between exposed and unexposed schools could reveal a serious potential health hazard for school children, although they were within the South African Air Quality Standards' set by the Department of Environmental Affairs. The indoor respirable dust levels in exposed schools could have an impact on children with asthma, as they were significantly higher than the unexposed schools, although there are no published standards for environmental exposure for children with asthma.

Chronic respiratory disease among the elderly in South Africa: any association with proximity to mine dumps?

BACKGROUND: There is increasing evidence that environmental factors such as air pollution from mine dumps, increase the risk of chronic respiratory symptoms and diseases. The aim of this study was to investigate the association between proximity to mine dumps and prevalence of chronic respiratory disease in people aged 55 years and older. METHODS: Elderly persons in communities 1-2 km (exposed) and 5 km (unexposed), from five pre-selected mine dumps in Gauteng and North West Province, in South Africa were included in a cross-sectional study. Structured interviews were conducted with 2397 elderly people, using a previously validated ATS-DLD-78 questionnaire from the British Medical Research Council. RESULTS: Exposed elderly persons had a significantly higher prevalence of chronic respiratory symptoms and diseases than those who were unexposed., Results from the multiple logistic regression analysis indicated that living close to mine dumps was significantly associated with asthma (OR = 1.57; 95% CI: 1.20 - 2.05), chronic bronchitis (OR = 1.74; 95 CI: 1.25 - 2.39), chronic cough (OR = 2.02; 95% CI: 1.58 - 2.57), emphysema (OR = 1.75; 95% CI: 1.11 - 2.77), pneumonia (OR = 1.38; 95% CI: 1.07 - 1.77) and wheeze (OR = 2.01; 95% CI: 1.73 - 2.54). Residing in exposed communities, current smoking, ex-smoking, use of paraffin as main residential cooking/heating fuel and low level of education emerged as independent significant risk factors for chronic respiratory symptoms and diseases. CONCLUSION: This study suggests that there is a high level of chronic respiratory symptoms and diseases among elderly people in communities located near to mine dumps in South Africa.

Allergic rhinitis, rhinoconjunctivitis and hayfever symptoms among children are associated with frequency of truck traffic near residences: a cross sectional study.

BACKGROUND: Allergic rhinitis (AR) is an increasing and common condition affecting many people globally, especially children. The aim of the study was to investigate the association between the frequency of truck traffic and allergic rhinitis symptoms, rhinoconjunctivitis and hayfever among 13 to 14 year old school children in Ekurhuleni Metropolitan Municipality, Gauteng Province, South Africa. METHODS: In a cross-sectional study design, 3764 children from 16 randomly selected high schools were eligible to participate, 3468 completed the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I questionnaire of which 3424 were suitable for analysis; the overall response rate was 92%. Data were analysed using multilevel logistic regression analysis. RESULTS: The prevalence of self-reported rhinitis ever, current rhinitis rhinoconjunctivitis and hayfever was 52, 40, 21 and 37% respectively. Rhinitis ever, current rhinitis and current rhinoconjunctivitis were significantly associated with the frequency of trucks passing near residences almost all day on weekdays, (OR 1.46 95% CI: 1.16 - 1.84), (OR 1.60 95% CI: 1.24-2.02) and (OR 1.42 95% CI: 1.09-1.84) respectively. No association was observed between truck traffic and hay fever in the multiple analyses. CONCLUSION: The study shows a high prevalence of allergic rhinitis symptoms amongst children. The results support the hypothesis that traffic related pollution plays a role in the prevalence of allergic rhinitis symptoms in children residing in the area.

Mine dumps, wheeze, asthma, and rhinoconjunctivitis among adolescents in South Africa: any association?

The study investigated the association between community proximity to mine dumps, and current wheeze, rhinoconjunctivitis, and asthma among adolescents. This study was conducted during May-November 2012 around five mine dumps in South Africa. Communities in close proximity to mine dumps had an increased likelihood of current wheeze OR 1.38 (95 % CI: 1.10-1.71), rhinoconjunctivitis OR 1.54 (95 % CI: 1.29-1.82), and a protective association with asthma OR 0.29 (95 % CI: 0.23-0.35). Factors associated with health outcomes included other indoor and outdoor pollution sources. Wheeze and rhinoconjunctivitis appear to be a public health problem in these communities. The findings of this study serve as a base for further detailed epidemiological studies for communities in close proximity to the mine dumps e.g. a planned birth cohort study.

Association between wheeze and selected air pollution sources in an air pollution priority area in South Africa: a cross-sectional study.

BACKGROUND: An association between wheeze (a symptom of asthma) and environmental tobacco smoke (ETS), types of fuel used for residential heating or cooking and the frequency of trucks passing near homes, has been reported mainly in developed countries. Little is known about the strength of such associations in developing countries. This study was conducted in residential areas situated in Ekurhuleni Metropolitan Municipality, namely Tembisa and Kempton Park, which form part of the Highveld region, a priority area in terms of air pollution in South Africa. METHODS: From 3764 eligible school children, aged between 13 and 14 years, from 16 selected high schools in the study area, 3468 completed a modified questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC). Data were analysed using multiple logistic regression models. RESULTS: The results are based on data from 3424 children. In the adjusted models, exposure to ETS at school was associated with wheeze ever (OR 1.22 95% CI: 1.03 - 1.45) and current wheeze (OR 1.33 95% CI: 1.08 - 1.64). When gas was most frequently used for residential heating the likelihood of wheeze ever increased by 47% (OR 1.47 95% CI: 1.15 - 1.88). Trucks passing near homes for almost the whole day during weekdays, increased the likelihood of wheeze ever (OR 1.32 95% CI: 1.01 - 1.73), current wheeze (OR 1.61 95% CI: 1.15 - 2.24) and current severe wheeze (OR 2.22 95% CI: 1.28 - 3.77). When data were stratified according to residential area, for children living in Tembisa, ETS exposure at home was associated with current wheeze (OR 1.36 95% CI: 1.06 - 1.77); gas most frequently used for residential heating was associated with wheeze ever (OR 1.68 95% CI: 1.23 - 2.28) and current wheeze (OR 1.61 95% CI: 1.08 - 2.39); paraffin most frequently used for residential heating was associated with current severe wheeze (OR 1.85 95% CI: 1.04 - 3.28). CONCLUSION: It was concluded that children living in one of the air pollution priority areas of South Africa, have an increased risk of wheezing due to exposure to both indoor and outdoor air pollution sources.

The effect of secondary inorganic aerosols, soot and the geographical origin of air mass on acute myocardial infarction hospitalisations in Gothenburg, Sweden during 1985-2010: a case-crossover study.

BACKGROUND: The relative importance of different sources of air pollution for cardiovascular disease is unclear. The aims were to compare the associations between acute myocardial infarction (AMI) hospitalisations in Gothenburg, Sweden and 1) the long-range transported (LRT) particle fraction, 2) the remaining particle fraction, 3) geographical air mass origin, and 4) influence of local dispersion during 1985-2010. METHODS: A case-crossover design was applied using lag0 (the exposure the same day as hospitalisation), lag1 (exposure one day prior hospitalisation) and 2-day cumulative average exposure (CA2) (mean of lag0 and lag1). The LRT fractions included PMion (sum of sulphate, nitrate and ammonium) and soot measured at a rural site. The difference between urban PM10 (particulate matter with an aerodynamic diameter smaller than 10 µm) and rural PMion was a proxy for locally generated PM10 (PMrest). The daily geographical origin of air mass was estimated as well as days with limited or effective local dispersion. The entire year was considered, as well as warm and cold periods, and different time periods. RESULTS: In total 28 215 AMI hospitalisations occurred during 26 years. PM10, PMion, PMrest and soot did not influence AMI for the entire year. In the cold period, the association was somewhat stronger for PMrest than for urban PM10; the strongest associations were observed during 1990-2000 between AMI and CA2 of PMrest (6.6% per inter-quartile range (IQR), 95% confidence interval 2.1 to 11.4%) and PM10 (4.1%, 95% CI 0.2% - 8.2%). Regarding the geographical air mass origins there were few associations. Days with limited local dispersion showed an association with AMI in the cold period of 2001-2010 (6.7%, 95% CI 0.0% - 13.0%). CONCLUSIONS: In the cold period, locally generated PM and days with limited local dispersion affected AMI hospitalisations, indicating importance of local emissions from e.g. traffic.

Association between Outdoor and Indoor Air Pollution Sources and Atopic Eczema among Preschool Children in South Africa.

The objective of the study was to investigate the association between outdoor and indoor air pollution sources and atopic eczema among preschool children in South Africa. A cross-sectional design, following the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III protocol, was applied. The study was conducted in Mabopane and Soshanguve Townships in the City of Tshwane Metropolitan Municipality in Gauteng, South Africa. A total population of 1844 preschool children aged 7 years and below participated in the study; 1840 were included in the final data analysis. Data were analyzed using multilevel logistic regression analysis. The prevalence of eczema ever (EE) and current eczema symptoms (ESs) was 11.9% and 13.3%, respectively. The use of open fires (paraffin, wood, or coal) for cooking and heating increased the likelihood of EE (OR = 1.63; 95% CI: 0.76-3.52) and current ESs (OR = 1.94; 95% CI: 1.00-3.74). Environmental tobacco smoke (ETS) exposure at home increased the likelihood of EE (OR = 1.66; 95% CI: 1.08-2.55) and current ESs (OR = 1.61; 95% CI: 1.07-2.43). Mothers or female guardians smoking cigarettes increased the likelihood of EE (OR = 1.50; 95% CI: 0.86-2.62) and current ESs (OR = 1.23; 95% CI: 0.71-2.13). The use of combined building materials in homes increased the likelihood of EE, and corrugated iron significantly increased the likelihood of current ESs. The frequency of trucks passing near the preschool children's residences on weekdays was found to be associated with EE and current ESs, with a significant association observed when trucks passed the children's residences almost all day on weekdays. Atopic eczema was positively associated with exposure to outdoor and indoor air pollution sources.

Health Risks of Temperature Variability on Hospital Admissions in Cape Town, 2011-2016.

Epidemiological studies have provided compelling evidence of associations between temperature variability (TV) and health outcomes. However, such studies are limited in developing countries. This study aimed to investigate the relationship between TV and hospital admissions for cause-specific diseases in South Africa. Hospital admission data for cardiovascular diseases (CVD) and respiratory diseases (RD) were obtained from seven private hospitals in Cape Town from 1 January 2011 to 31 October 2016. Meteorological data were obtained from the South African Weather Service (SAWS). A quasi-Poisson regression model was used to investigate the association between TV and health outcomes after controlling for potential effect modifiers. A positive and statistically significant association between TV and hospital admissions for both diseases was observed, even after controlling for the non-linear and delayed effects of daily mean temperature and relative humidity. TV showed the greatest effect on the entire study group when using short lags, 0-2 days for CVD and 0-1 days for RD hospitalisations. However, the elderly were more sensitive to RD hospitalisation and the 15-64 year age group was more sensitive to CVD hospitalisations. Men were more susceptible to hospitalisation than females. The results indicate that more attention should be paid to the effects of temperature variability and change on human health. Furthermore, different weather and climate metrics, such as TV, should be considered in understanding the climate component of the epidemiology of these (and other diseases), especially in light of climate change, where a wider range and extreme climate events are expected to occur in future.

A New Global Air Quality Health Index Based on the WHO Air Quality Guideline Values With Application in Cape Town.

Objectives: This study developed an Air Quality Health Index (AQHI) based on global scientific evidence and applied it to data from Cape Town, South Africa. Methods: Effect estimates from two global systematic reviews and meta-analyses were used to derive the excess risk (ER) for PM2.5, PM10, NO2, SO2 and O3. Single pollutant AQHIs were developed and scaled using the ERs at the WHO 2021 long-term Air Quality Guideline (AQG) values to define the upper level of the "low risk" range. An overall daily AQHI was defined as weighted average of the single AQHIs. Results: Between 2006 and 2015, 87% of the days posed "moderate to high risk" to Cape Town's population, mainly due to PM10 and NO2 levels. The seasonal pattern of air quality shows "high risk" occurring mostly during the colder months of July-September. Conclusion: The AQHI, with its reference to the WHO 2021 long-term AQG provides a global application and can assist countries in communicating risks in relation to their daily air quality.

Apparent temperature and acute myocardial infarction hospital admissions in Copenhagen, Denmark: a case-crossover study.

BACKGROUND: The influence of temperature on acute myocardial infarction (AMI) has not been investigated as extensively as the effects of broader outcomes of morbidity and mortality. Sixteen studies reported inconsistent results and two considered confounding by air pollution. We addressed some of the methodological limitations of the previous studies in this study. METHODS: This is the first study of the association between the daily 3-hour maximum apparent temperature (Tapp(max)) and AMI hospital admissions in Copenhagen. The study period covered 1 January 1999-31 December 2006, stratified in warm (April-September) and cold (October-March) periods. A case-crossover epidemiology study design was applied. Models were adjusted for public holidays and influenza, confounding by PM10, NO2 and CO was investigated, the lag and non-linear effects of Tapp(max) was examined, effect modification by age, sex and SES was explored, and the results of the case-crossover models were compared to those of the generalised additive Poisson time-series and generalised estimating equation models. RESULTS: 14,456 AMI hospital admissions (12,995 people) occurred during the study period. For an inter-quartile range (6 or 7°C) increase in the 5-day cumulative average of Tapp(max), a 4% (95% CI:-2%; 10%) and 9% (95% CI: 3%; 14%) decrease in the AMI admission rate was observed in the warm and cold periods, respectively. The 19-65 year old group, men and highest SES group seemed to be more susceptible in the cold period. CONCLUSION: An increase in Tapp(max) is associated with a decrease in AMI admissions during the colder months.

Short-Term Effects of PM10, NO2, SO2 and O3 on Cardio-Respiratory Mortality in Cape Town, South Africa, 2006-2015.

BACKGROUND: The health effect of air pollution is rarely quantified in Africa, and this is evident in global systematic reviews and multi-city studies which only includes South Africa. METHODS: A time-series analysis was conducted on daily mortality (cardiovascular (CVD) and respiratory diseases (RD)) and air pollution from 2006-2015 for the city of Cape Town. We fitted single- and multi-pollutant models to test the independent effects of particulate matter (PM10), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) from co-pollutants. RESULTS: daily average concentrations per interquartile range (IQR) increase of 16.4 µg/m3 PM10, 10.7 µg/m3 NO2, 6 µg/m3 SO2 and 15.6 µg/m3 O3 lag 0-1 were positively associated with CVD, with an increased risk of 2.4% (95% CI: 0.9-3.9%), 2.2 (95% CI: 0.4-4.1%), 1.4% (95% CI: 0-2.8%) and 2.5% (95% CI: 0.2-4.8%), respectively. For RD, only NO2 showed a significant positive association with a 4.5% (95% CI: 1.4-7.6%) increase per IQR. In multi-pollutant models, associations of NO2 with RD remained unchanged when adjusted for PM10 and SO2 but was weakened for O3. In CVD, O3 estimates were insensitive to other pollutants showing an increased risk. Interestingly, CVD and RD lag structures of PM10, showed significant acute effect with evidence of mortality displacement. CONCLUSION: The findings suggest that air pollution is associated with mortality, and exposure to PM10 advances the death of frail population.

Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa.

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.

Association between ambient air pollution and cause-specific mortality in Cape Town, Durban, and Johannesburg, South Africa: any susceptible groups?

Studies have confirmed that adverse human health effects that are associated with exposure to air pollution may differ depending on other factors such as age, gender, environmental conditions, and socio-economic factors. This study was conducted to assess the association between ambient air pollution and cause-specific mortality in the three big cities in South Africa and to determine the susceptible groups thereof. Cause-specific mortality data for all ages and PM10, NO2, and SO2 in Cape Town, Durban, and Johannesburg for the period from 1 January 2006 to 31 December 2010 were obtained. Statistical analyses were done to estimate the associations between air pollutants and cause-specific mortality. Susceptibility was therefore investigated in stratified analyses by sex and age (≥60 years) and environmental conditions (heat and cold) followed by models with interaction terms. Our estimates showed independent associations between these air pollutants, environmental conditions, and susceptible groups.