Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations

J Expo Sci Environ Epidemiol. 2016 Mar-Apr;26(2):150-61. doi: 10.1038/jes.2014.90. Epub 2015 Jan 14.

Abstract

Health impacts of air pollution may differ depending on sex, education, socioeconomic status (SES), location at time of death, and other factors. In São Paulo, Brazil, questions remain regarding roles of individual and community characteristics. We estimate susceptibility to air pollution based on individual characteristics, residential SES, and location at time of death (May 1996-December 2010). Exposures for particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were estimated using ambient monitors. Time-stratified case-crossover analysis was used with individual-level health data. Increased risk of non-accidental, cardiovascular, and respiratory mortality were associated with all pollutants (P < 0.05), except O3 and cardiovascular mortality. For non-accidental mortality, effect estimates for those with > 11 years education were lower than estimates for those with 0 years education for NO2, SO2, and CO (1.66% (95% confidence interval: 0.23%, 3.08%); 1.51% (0.51%, 2.51%); and 2.82% (0.23%, 5.35%), respectively). PM10 cardiovascular mortality effects were (3.74% (0.044%, 7.30%)) lower for the high education group (> 11 years) compared with the no education group. Positive, significant associations between pollutants and mortality were observed for in-hospital deaths, but evidence of differences in air pollution-related mortality risk by location at time of death was not strong.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Air Pollutants / adverse effects*
  • Air Pollutants / analysis
  • Air Pollution / adverse effects*
  • Air Pollution / analysis
  • Brazil / epidemiology
  • Carbon Monoxide / adverse effects
  • Carbon Monoxide / analysis
  • Cardiovascular Diseases / mortality*
  • Case-Control Studies
  • Death Certificates
  • Environmental Monitoring
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Nitrogen Dioxide / adverse effects
  • Nitrogen Dioxide / analysis
  • Ozone / adverse effects
  • Ozone / analysis
  • Particle Size
  • Particulate Matter / adverse effects
  • Particulate Matter / analysis
  • Respiratory Tract Diseases / mortality*
  • Risk Factors
  • Sex Distribution
  • Socioeconomic Factors
  • Sulfur Dioxide / adverse effects
  • Sulfur Dioxide / analysis

Substances

  • Air Pollutants
  • Particulate Matter
  • Sulfur Dioxide
  • Ozone
  • Carbon Monoxide
  • Nitrogen Dioxide