Brief Communication • Rev. Saúde Pública 47 (6) Dec 2013 • https://doi.org/10.1590/S0034-8910.2013047004713   copy

Association between exposure to particulate matter and hospital admissions for respiratory disease in children

Ana Cristina Gobbo Cesar Luiz Fernando C Nascimento João Andrade de Carvalho JrAbout the authors

Abstract

The aim of this study was to estimate the association between exposure to particulate matter less than 2.5 microns in diameter and hospitalization for respiratory disease. It was an ecological time series study with daily indicators of hospitalization for respiratory diseases in children up to 10 years old, living in Piracicaba, SP, Southeastern Brazil, between August 1, 2011 and July 31, 2012. A generalized additive Poisson regression model was used. The relative risks were RR = 1.008; 95%CI 1.001;1.016 for lag 1 and RR = 1.009; 95%CI 1.001;1.017 for lag 3. The increment of 10 μg/m3in particulate matter less than 2.5 microns in diameter implies increase in relative risk of between 7.9 and 8.6 percentage points. In conclusion, exposure to particulate matter less than 2.5 microns in diameter was associated with hospitalization for respiratory disease in children.

Pneumonia; Asthma; Respiratory Tract Diseases; Air Pollutants; Air Pollution; Particulate Matter; Child Health; Time Series Studies

INTRODUCTION

Respiratory disease may be associated with factors such as air pollution, both that produced by motor vehicles and that form burning biomass. 33 . Cançado JED, Saldiva PHN, Pereira LAA, Lara LBLS, Artaxo P, Martinelli LA, et al. The Impact of Sugar Cane-Burning Emissions on the Respiratory System of Children and the Elderly. Environ Health Perspect. 2006;114(5):725-9. DOI:10.1289/ehp.8485
https://doi.org/10.1289/ehp.8485... , 55 . Ignotti E, Valente JG, Longo KM, Freitas SR, Hacon SDS, Netto PA. Impact on human health of particulate matter emitted from burning in the Brazilian Amazon region. Rev Saude Publica. 2010;44(1):121-30. DOI:10.1590/S0034-89102010000100013
https://doi.org/10.1590/S0034-8910201000... , 77 . Nascimento LFC, Pereira LAA, Braga ALF, Módolo MCC, Carvalho Jr JA. Effects of air pollution on children’s health in a city in Southeastern Brazil. Rev Saude Publica. 2006;40(1):77-82. DOI:10.1590/S0034-89102006000100013
https://doi.org/10.1590/S0034-8910200600...

Data from the Brazilian Ministry of Health report more than 70 thousand hospitalizations in 2011 for children aged under 10, costing more than R$ 60 million (1 US$ ≈ R$ 2.00). aaMinistério da Saúde. DATASUS. Departamento de Informática do SUS. Morbidade Hospitalar do SUS - por local de residência – SP. Brasília (DF); 2013 [cited 2013 Jan 21]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/nrsp.def

Among the pollutants implicated in hospitalizations for respiratory disease in children, particulate matter less than 10 microns in diameter 77 . Nascimento LFC, Pereira LAA, Braga ALF, Módolo MCC, Carvalho Jr JA. Effects of air pollution on children’s health in a city in Southeastern Brazil. Rev Saude Publica. 2006;40(1):77-82. DOI:10.1590/S0034-89102006000100013
https://doi.org/10.1590/S0034-8910200600... stands out, especially that fraction which is less than 2.5 microns in diameter. 33 . Cançado JED, Saldiva PHN, Pereira LAA, Lara LBLS, Artaxo P, Martinelli LA, et al. The Impact of Sugar Cane-Burning Emissions on the Respiratory System of Children and the Elderly. Environ Health Perspect. 2006;114(5):725-9. DOI:10.1289/ehp.8485
https://doi.org/10.1289/ehp.8485... , 55 . Ignotti E, Valente JG, Longo KM, Freitas SR, Hacon SDS, Netto PA. Impact on human health of particulate matter emitted from burning in the Brazilian Amazon region. Rev Saude Publica. 2010;44(1):121-30. DOI:10.1590/S0034-89102010000100013
https://doi.org/10.1590/S0034-8910201000...

Brazil plays an important role in emitting air pollutants due to biomass burning. Preliminary data of the 2012 to 2013 cane sugar harvest predict that 600 thousand tons will be milled, 56.0% in the state of Sao Paulo. bbUnião da Indústria de Cana de Açúcar. Histórico de Produção e Moagem – Safra 2012/2013. São Paulo; 2013 [cited 2013 Jun 23]. Available from: http://www.unicadata.com.br/historico-de-producao-e-moagem.php?idMn=32&tipoHistorico=4&acao=visualizar&idTabela=1424&safra=2012%2F2013&estado=RS%2CSC%2CPR%2CSP%2CRJ%2CMG%2CES%2CMS%2CMT%2CGO%2CDF%2CBA%2CSE%2CAL%2CPE%2CPB%2CRN%2CCE%2CPI%2CMA%2CTO%2CPA%2CAP%2CRO%2CAM%2CAC%2CRR In Piracicaba, SP, sugar cane plantations cover around 80.0% of the surface, generating large quantities of particulate matter when the cane is burnt.3

The municipality of Piracicaba is one of the main producers of sugar and sugar cane alcohol in the world and is responsible for emissions of gases and particulates into the atmosphere when the sugar cane is burnt.

The aim of this study was to estimate the association between exposure to PM2.5and hospitalizations in children due to respiratory disease.

METHODS

This was an ecological time series study, with daily indicators of hospitalizations for respiratory disease (ICD 10: J12.0 to J18.9, J45.0, J45.1, J45.8, J45.9 and J46), in children aged from zero to ten years in Piracicaba, from August 1, 2011 to July 31, 2012. These data were obtained from the Datasus.1Estimated daily levels of carbon monoxide (CO in ppb), ozone (O3in μg/m3), nitrogen oxides (NOxin μg/m3) and particulate matter (PM2.5in μg/m3) were obtained from the CATT-BRAMS system. 44 . Freitas SR, Longo KM, Dias MAFS, Chatfield R, Dias PLS, Artaxo P, et al. The Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System (CATTBRAMS). Part 1: Model description and evaluation. Atmos Chem Phys Discuss. 2007;(7):8525-69. DOI:10.5194/acpd-7-8525-2007
https://doi.org/10.5194/acpd-7-8525-2007... , 66 . Longo KM, Freitas SR, Setzer A, Prins E, Artaxo P, Andreae MO. The Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System (CATTBRAMS). Part 2: Model sensitivity to the biomass burning inventories. Atmos Chem Phys Discuss. 2007;(7):8571-96. DOI:10.5194/acpd-7-8571-2007
https://doi.org/10.5194/acpd-7-8571-2007... The data on temperature and humidity were obtained from the ESALQ-USP web site ccUniversidade de São Paulo. Escola Superior de Agricultura “Luiz de Queiroz”. Departamento de Engenharia de Biossistemas. Piracicaba; 2013 [cited 2013 Jan 18]. Available from: http://www.leb.esalq.usp.br/posto.html and the apparent temperature was calculated using temperature and humidity. 22 . Barnett AG, Tong S, Clements ACA. What measure of temperature is the best predictor of mortality? Environ Res. 2010;110(6):604-11. DOI:10.1016/j.envres.2010.05.006
https://doi.org/10.1016/j.envres.2010.05...

Piracicaba is located at latitude 22º43’ S and longitude 47º39’ W, at an altitude of 547 meters. It is 164 km from the state capital and 75 km from Campinas. The territory covers around 1,400 km2and has a little over 350 thousand inhabitants. There were an estimated 199 thousand automobiles and motorcycles, and 12 thousand buses and vans in 2012 (IBGE). ddInstituto Brasileiro de Geografia e Estatística. Cidades: São Paulo – Piracicaba. Brasília (DF); 2013 [cited 2013 Jan 18]. Available from: http://www.ibge.gov.br/cidadesat/xtras/perfil.php?codmun=353870&search=S%C3%A3o%20Paulo|Piracicaba

Pearson’s correlation test was used to evaluate possible correlations between hospitalizations and estimated levels of PM2.5.

The effects of exposure to air pollution can lead to hospitalization on the same day or on following days. Thus, the effects on the respiratory apparatus were investigated on the day of hospitalization ( lag 0) and on the five following days ( lag 1 to lag 5). The generalized additive Poisson regression model was used as the outcome is a discrete, quantitative variable. The results of risk of hospitalization refer to exposure to PM2.5adjusted for other pollutants and for the apparent temperature. The Statistica v7 program was used for the analyses.

The estimated effects were relative risk (RR), corresponding to an increment of 10 μg/m3in the levels of PM2.5. The RR were converted into percentage increases. A level of significance of 5.0% was adopted in the analyses.

RESULTS

In individuals aged zero to ten years, there were 437 hospitalizations for respiratory disease. The daily mean was 1.2 (sd = 1.3), minimum 0.0 and maximum 8.0. The mean daily concentration of PM2.5was 28.6 µg/m3(sd = 16.7) and it did not exceed the limits set by the CETESB. eeCompanhia de Tecnologia de Saneamento Ambiental. Padrões de qualidade do ar. São Paulo; 2013 [cited 2013 Jan 18]. Available from: http://www.cetesb.sp.gov.br/ar/Informa??es-B?sicas/22-Padr?es-e-?ndices Minimum and maximum values were 1.0 and 113.0 µg/m3respectively. The daily levels exceeded the established level on some days, reaching the regular standard of air quality. The interquartile difference in PM2.5was 17.2 µg/m3and the mean daily apparent temperature was 19.8ºC (sd = 3.2). Hospitalizations were positively correlated with PM2.5(r = 0.12; p < 0.05). Apparent temperature showed negative correlation with PM2.5(r = -0.08; p > 0.05) and with hospitalizations (r = -0.20; p < 0.01).

The coefficients of regression and the respective standard errors for PM2.5in each lag showed significant p values for lags 1 and 3 after adjusting for other pollutants and for apparent temperature, and controlled for day of the week and season.

The relative risks and their respective 95% confidence intervals showed a positive association between hospitalizations and PM2.5(RR = 1.008; 95%CI 1.001;1.016 for lag 1 and RR = 1.009; 95%CI 1.001;1.017 for lag 3). The increase of 10 μg/m3of PM2.5meant an increase of between 7.9 ( lag 1) and 8.6 ( lag 3) percentage points in the relative risk ( Figure ).

Thumbnail
Figure
. Relative risk of respiratory disease in children under 10 and respective 95% confidence intervals for the pollutant PM2.5for each lag . Piracicaba, SP, August 1, 2011 to July 31, 2012.

DISCUSSION

The CATT-BRAMS 44 . Freitas SR, Longo KM, Dias MAFS, Chatfield R, Dias PLS, Artaxo P, et al. The Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System (CATTBRAMS). Part 1: Model description and evaluation. Atmos Chem Phys Discuss. 2007;(7):8525-69. DOI:10.5194/acpd-7-8525-2007
https://doi.org/10.5194/acpd-7-8525-2007... , 66 . Longo KM, Freitas SR, Setzer A, Prins E, Artaxo P, Andreae MO. The Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System (CATTBRAMS). Part 2: Model sensitivity to the biomass burning inventories. Atmos Chem Phys Discuss. 2007;(7):8571-96. DOI:10.5194/acpd-7-8571-2007
https://doi.org/10.5194/acpd-7-8571-2007... system used in this study considers the dynamics of the atmosphere. It is a mathematical model covering South America which considers the emission and transport of different gases and aerosol particulates, obtained by satellites that monitor the burning, providing daily estimates for different pollutants. One of the advantages of using this model is its application in cities where there are no pollutant measuring stations. The use of data estimated by this system, validated by Ignotti et al, 55 . Ignotti E, Valente JG, Longo KM, Freitas SR, Hacon SDS, Netto PA. Impact on human health of particulate matter emitted from burning in the Brazilian Amazon region. Rev Saude Publica. 2010;44(1):121-30. DOI:10.1590/S0034-89102010000100013
https://doi.org/10.1590/S0034-8910201000... enables the costs of research to be lowered and makes the process of analyzing the effects of atmospheric pollution on health easier.

Hospitalizations for respiratory disease in children under ten were positively and significantly associated with PM2.5one day and three days after exposure.

Epidemiological studies show that exposure to polluting gases and particulate matter is associated with higher incidence of symptoms in the lower respiratory tract, such as coughing, dyspnea and wheezing, especially in children. 11 . Arbex MA, Santos UP, Martins LC, Paulo Saldiva HN, Pereira LAA, Braga ALF. A poluição do ar e o sistema respiratório. J Bras Pneumol. 2012;38(5):643-55. DOI:10.1590/S1806-37132012000500015
https://doi.org/10.1590/S1806-3713201200...

In the municipality of Piracicaba, SP, in addition to pollutants emitted by burning fossil fuels, sugar cane is burnt between April and November, releasing particulate matter and gases into the atmosphere. According to Cançado et al, 33 . Cançado JED, Saldiva PHN, Pereira LAA, Lara LBLS, Artaxo P, Martinelli LA, et al. The Impact of Sugar Cane-Burning Emissions on the Respiratory System of Children and the Elderly. Environ Health Perspect. 2006;114(5):725-9. DOI:10.1289/ehp.8485
https://doi.org/10.1289/ehp.8485... pioneers in studies in that city, burning the cane fields in the pre-harvest increases atmospheric pollution in the region. Ignotti et al, 55 . Ignotti E, Valente JG, Longo KM, Freitas SR, Hacon SDS, Netto PA. Impact on human health of particulate matter emitted from burning in the Brazilian Amazon region. Rev Saude Publica. 2010;44(1):121-30. DOI:10.1590/S0034-89102010000100013
https://doi.org/10.1590/S0034-8910201000... assessing atmospheric pollution from burning biomass in the Amazonian region of Brazil, showed a positive association between exposure to PM2.5and the occurrence of respiratory disease, especially in the most vulnerable age groups (the elderly and children < 5 years old).

Application of Sao Paulo law no. 11.241/02, ffSão Paulo. Lei nº 11.241, de 19 de setembro de 2002. Dispõe sobre a eliminação gradativa da queima da palha da cana-de-açúcar e dá providências correlatas. Diario Oficial Estado Sao Paulo . 22 set 2002 [cited 2013 Jan 18]. Available from: www.cqgp.sp.gov.br/gt_licitacoes/legislacao/lei_11241_02.htm which deals with the gradual elimination of the practice of burning sugar cane, was not evaluated, nor were its possible social implications.

This study observed a negative correlation between hospitalization and apparent temperature, which takes into consideration physiological experience of exposure combined with humidity and temperature. This enables the effect of these variables on the individual’s health to be evaluated more effectively. 22 . Barnett AG, Tong S, Clements ACA. What measure of temperature is the best predictor of mortality? Environ Res. 2010;110(6):604-11. DOI:10.1016/j.envres.2010.05.006
https://doi.org/10.1016/j.envres.2010.05...

Motor vehicles can contribute to the release of pollutants. These, together with pollutants released from burning can sugar, contribute to increasing hospitalization in the winter, when there is lower humidity and temperatures. This affects the dispersion of atmospheric pollution.

A limitation of this study could be the fact that the CATT-BRAMS measurements are estimated at an altitude of 40m and not closer to the ground, where concentrations may be different.

To conclude, exposure to particulate matter smaller than 2.5 microns in diameter (PM2.5) was associated with hospitalizations for respiratory disease in children.

References

  • 1
    Arbex MA, Santos UP, Martins LC, Paulo Saldiva HN, Pereira LAA, Braga ALF. A poluição do ar e o sistema respiratório. J Bras Pneumol. 2012;38(5):643-55. DOI:10.1590/S1806-37132012000500015
    » https://doi.org/10.1590/S1806-37132012000500015
  • 2
    Barnett AG, Tong S, Clements ACA. What measure of temperature is the best predictor of mortality? Environ Res. 2010;110(6):604-11. DOI:10.1016/j.envres.2010.05.006
    » https://doi.org/10.1016/j.envres.2010.05.006
  • 3
    Cançado JED, Saldiva PHN, Pereira LAA, Lara LBLS, Artaxo P, Martinelli LA, et al. The Impact of Sugar Cane-Burning Emissions on the Respiratory System of Children and the Elderly. Environ Health Perspect. 2006;114(5):725-9. DOI:10.1289/ehp.8485
    » https://doi.org/10.1289/ehp.8485
  • 4
    Freitas SR, Longo KM, Dias MAFS, Chatfield R, Dias PLS, Artaxo P, et al. The Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System (CATTBRAMS). Part 1: Model description and evaluation. Atmos Chem Phys Discuss. 2007;(7):8525-69. DOI:10.5194/acpd-7-8525-2007
    » https://doi.org/10.5194/acpd-7-8525-2007
  • 5
    Ignotti E, Valente JG, Longo KM, Freitas SR, Hacon SDS, Netto PA. Impact on human health of particulate matter emitted from burning in the Brazilian Amazon region. Rev Saude Publica. 2010;44(1):121-30. DOI:10.1590/S0034-89102010000100013
    » https://doi.org/10.1590/S0034-89102010000100013
  • 6
    Longo KM, Freitas SR, Setzer A, Prins E, Artaxo P, Andreae MO. The Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System (CATTBRAMS). Part 2: Model sensitivity to the biomass burning inventories. Atmos Chem Phys Discuss. 2007;(7):8571-96. DOI:10.5194/acpd-7-8571-2007
    » https://doi.org/10.5194/acpd-7-8571-2007
  • 7
    Nascimento LFC, Pereira LAA, Braga ALF, Módolo MCC, Carvalho Jr JA. Effects of air pollution on children’s health in a city in Southeastern Brazil. Rev Saude Publica. 2006;40(1):77-82. DOI:10.1590/S0034-89102006000100013
    » https://doi.org/10.1590/S0034-89102006000100013

Publication Dates

  • Publication in this collection
    Dec 2013

History

  • Received
    28 Jan 2013
  • Accepted
    19 Aug 2013
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Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
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