Clarice Umbelino de Freitas

Hospitalizações por causas respiratórias e cardiovasculares associadas à contaminação atmosférica no Município de São Paulo, Brasil

The recognition that current air pollution levels cause harmful health effects makes the definition of the air quality regulatory process imperative. This study examines the association between exposure to air pollution and hospital admissions in the city of Sao Paulo, aiming to support the development of measures to reduce such health risks. The authors conducted an ecological time series study of hospital admissions for respiratory and cardiovascular diseases in children and the elderly in relation to daily air pollution levels, using generalized additive Poisson regression models. All air pollutants except ozone showed a statistically significant association with admissions for respiratory and cardiovascular diseases. An increase of 10µg/m3 in fine particulate matter was associated with a 4.6% increase in asthma admissions in children and a 4.3% increase in admissions for chronic obstructive pulmonary disease and 1.5% for ischemic heart disease in the elderly. These associations are consistent with a large body of literature in this area and indicate that the current air pollution levels in Sao Paulo have an important negative impact on the populations health.

Hospital admissions and mortality: association with air pollution in São Paulo, Brazil, 1993 to 1997

OBJECTIVE To investigate short-term effects of air pollution on respiratory morbidity of children under 15 and elderly mortality. METHODS The study was carried out in the city of São Paulo, Brazil. Daily hospital admissions due to respiratory conditions in children under 15 and mortality of adults over 64 years of age were obtained for the period ranging from 1993 to 1997. Daily levels of PM10, CO and O3 were collected for the same period. Poisson regression analysis was used in generalized additive models, which were adjusted for temporal trends, seasonality, day of the week, temperature and relative humidity as well as serial autocorrelation. RESULTS A 10th to 90th percentile variation of pollutants was significantly associated with respiratory admissions of children and PM10 (%RR=10.0), CO (%RR=6.1), and O3 (%RR=2.5). Similar results were observed for mortality in elderly people and PM10 (%RR=8.1) and CO (%RR=7.9). CONCLUSIONS The study results are consistent with other studies showing an association of short-term variations of air pollution and increase of morbidity and mortality in large urban centers.

Poluição do ar e efeitos na saúde nas populações de duas grandes metrópoles brasileiras

Com a crescente preocupacao acerca dos efeitos nocivos da poluicao do ar na saude da populacao, faz-se necessario a investigacao e quantificacao destes efeitos em nosso meio. Realizou-se um estudo de series temporais com esse objetivo nas duas maiores metropoles brasileiras: Sao Paulo e Rio de Janeiro. Informacoes diarias sobre mortalidade, internacoes hospitalares, niveis atmosfericos dos principais poluentes do ar e de variaveis meteorologicas foram obtidos nas duas cidades, a partir de fontes de informacao secundarias. Esses dados foram analisados utilizandose tecnicas de analise de series temporais em modelos lineares por meio de Equacoes de Estimacao Generalizada e/ ou por meio de modelos nao-parametricos, com a utilizacao de Modelos Aditivos Generalizados. Foram encontradas associacoes estatisticamente significantes entre aumentos nos niveis de poluentes atmosfericos e aumentos na mortalidade e nas hospitalizacoes, por causas respiratorias e cardiovasculares, em criancas e idosos, em ambos municipios, mesmo apos ajuste por tendencias de longo prazo, sazonalidade, dia da semana, feriados, temperatura e umidade. Conclui-se que os niveis de poluicao vivenciados atualmente em Sao Paulo e no Rio de Janeiro sao suficientes para causar agravos a saude da populacao. Medidas articuladas entre os diversos setores que gerenciam a vida urbana nessas metropoles sao fundamentais para buscar a melhoria da qualidade do ar e, consequentemente, da saude da populacao nessas cidades. Palavras-chave: poluicao do ar, efeitos na saude; mortalidade; morbidade, series temporais.

Can living in the surroundings of a petrochemical complex be a risk factor for autoimmune thyroid disease

BACKGROUND Based on a suspicion raised by a health professional and due to a subsequent legal request, a cross-sectional study was made with a comparison group to investigate a possible excess of Hashimotos thyroiditis-HT and antibodies-ATA in the surroundings of a Petrochemical Complex. METHODS People of both sexes aged over 20 years were investigated in a random sample of residents in the area surrounding the Petrochemical Complex. Controls were investigated in an area with steel industries. In the areas searched, participants were chosen randomly and stratified a priori by sex and age group. As a result, 90.5% of the expected sample was obtained, totaling 1533 individuals. HT and ATA prevalences were compared by the chi-square test. Logistic regression was used to control the possible confounding factors for HT and ATA. RESULTS Both TH (9.3%) and ATA (17.6%) prevalences were higher in the Petrochemical Complex area than in the control area (3.9% and 10.3%, respectively). After controlling the possible confounding factors, the POR for living in the surroundings of the Complex and presenting HT was 2.39 (CI95%: 1.42-4.03). According to the ATA criterion, the POR for living in the surroundings of the Complex was 1.78 (CI95%: 1.23-2.60). CONCLUSIONS The authors have found higher prevalence and risk of developing thyroiditis and anti-thyroid antibodies among residents of areas surrounding the Petrochemical Complex and think these findings need to be further studied in similar areas.

Associated factors for higher lead and cadmium blood levels, and reference values derived from general population of São Paulo, Brazil

Human activities are associated with emissions of various metals into the environment, among which the heavy metals lead and cadmium stand out, as they pose a risk to human life even at low concentrations. Thus, accurate knowledge of the levels of these metals exhibited by the overall population, including children, is important. The aim of this study was to estimate the concentrations of lead and cadmium in the blood of adults, adolescents and children residing in the city of São Paulo, assess factors associated with higher lead and cadmium blood levels, and to establish reference values for this population. The study sample consisted of 669 adults over 20 years old, 264 adolescents aged 12 to 19 years old and 391 children under 11 years old from both genders. The samples were collected at the end of 2007 and during 2008 in different city zones. Higher blood lead concentration was significantly associated with gender, smoking, offal intake, area of residence and age. The blood cadmium concentration was significantly associated with gender, smoking, consumption of distilled beverages and age. The reference values of lead and cadmium established for adults above 20 years old were 33 μg/L and 0.6 μg/L, respectively, for adolescents (12 to 19 years old) were 31 μg/L and 0.6 μg/L, respectively and for children under 11 years old were 29 μg/L and 0.2 μg/L, respectively. The results of this study indicate that the exposure levels of the investigated population to lead and cadmium are low.

Poluição do ar e doenças respiratórias e cardiovasculares: estudo de séries temporais em Cubatão, São Paulo, Brasil

This study evaluated the association between air pollution and hospital admissions due to respiratory and cardiovascular diseases in Cubatao, Sao Paulo State, Brazil. Generalized additive Poisson regression models were used to model daily concentrations of particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) and daily hospital admissions counts. Explanatory variables were temperature, relative humidity, day of the week, and holidays. For each increment of 10µg/m3 in PM10, we found an excess of 4.25 % (95%CI: 2.82; 71), 5.74% (95%CI: 3.80; 7.71), and 2.29% (95%CI: 0.86; 3.73) in admissions due to respiratory diseases for all ages, respiratory diseases in children under 5 years old, and cardiovascular diseases in adults over 39 years of age, respectively. For SO2, the increase was 3.51% (IC95%: 1.24; 5.83) for cardiovascular diseases in adults more than 39 years. For O3, the increase was 2.85% (IC95%: 0.77; 4.98) for cardiovascular diseases in adults more than 39 years of age and 3.91% (IC95%: 1.37; 6.51) for respiratory diseases in children under 5 years old. Air pollution has serious impacts on health in Cubatao, thus emphasizing the need for air quality control policies.This study evaluated the association between air pollution and hospital admissions due to respiratory and cardiovascular diseases in Cubatão, São Paulo State, Brazil. Generalized additive Poisson regression models were used to model daily concentrations of particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) and daily hospital admissions counts. Explanatory variables were temperature, relative humidity, day of the week, and holidays. For each increment of 10µg/m³ in PM10, we found an excess of 4.25 % (95%CI: 2.82; 71), 5.74% (95%CI: 3.80; 7.71), and 2.29% (95%CI: 0.86; 3.73) in admissions due to respiratory diseases for all ages, respiratory diseases in children under 5 years old, and cardiovascular diseases in adults over 39 years of age, respectively. For SO2, the increase was 3.51% (IC95%: 1.24; 5.83) for cardiovascular diseases in adults more than 39 years. For O3, the increase was 2.85% (IC95%: 0.77; 4.98) for cardiovascular diseases in adults more than 39 years of age and 3.91% (IC95%: 1.37; 6.51) for respiratory diseases in children under 5 years old. Air pollution has serious impacts on health in Cubatão, thus emphasizing the need for air quality control policies.

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

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.

Air pollution and its impacts on health in Vitoria, Espirito Santo, Brazil

ABSTRACT OBJECTIVE To analyze the impact of air pollution on respiratory and cardiovascular morbidity of children and adults in the city of Vitoria, state of Espirito Santo. METHODS A study was carried out using time-series models via Poisson regression from hospitalization and pollutant data in Vitoria, ES, Southeastern Brazil, from 2001 to 2006. Fine particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) were tested as independent variables in simple and cumulative lags of up to five days. Temperature, humidity and variables indicating weekdays and city holidays were added as control variables in the models. RESULTS For each increment of 10 µg/m3 of the pollutants PM10, SO2, and O3, the percentage of relative risk (%RR) for hospitalizations due to total respiratory diseases increased 9.67 (95%CI 11.84-7.54), 6.98 (95%CI 9.98-4.17) and 1.93 (95%CI 2.95-0.93), respectively. We found %RR = 6.60 (95%CI 9.53-3.75), %RR = 5.19 (95%CI 9.01-1.5), and %RR = 3.68 (95%CI 5.07-2.31) for respiratory diseases in children under the age of five years for PM10, SO2, and O3, respectively. Cardiovascular diseases showed a significant relationship with O3, with %RR = 2.11 (95%CI 3.18-1.06). CONCLUSIONS Respiratory diseases presented a stronger and more consistent relationship with the pollutants researched in Vitoria. A better dose-response relationship was observed when using cumulative lags in polynomial distributed lag models.

Effects of Particulate Matter and Its Chemical Constituents on Elderly Hospital Admissions Due to Circulatory and Respiratory Diseases

Various fractions of particulate matter have been associated with increased mortality and morbidity. The purpose of our study is to analyze the associations between concentrations of PM2.5, PM2.5–10, PM10 and their chemical constituents (soluble ions) with hospital admissions due to circulatory and respiratory diseases among the elderly in a medium-sized city in Brazil. A time series study was conducted using Poisson regression with generalized additive models adjusted for confounders. Statistically significant associations were identified between PM10 and PM2.5–10 and respiratory diseases. Risks of hospitalization increased by 23.5% (95% CI: 13.5; 34.3) and 12.8% (95% CI: 6.0; 20.0) per 10 μg/m3 of PM2.5-10 and PM10, respectively. PM2.5 exhibited a significant association with circulatory system diseases, with the risk of hospitalization increasing by 19.6% (95% CI: 6.4; 34.6) per 10 μg/m3. Regarding the chemical species; SO42−, NO3−, NH4+ and K+ exhibited specific patterns of risk, relative to the investigated outcomes. Overall, SO42− in PM2.5–10 and K+ in PM2.5 were associated with increased risk of hospital admissions due to both types of diseases. The results agree with evidence indicating that the risks for different health outcomes vary in relation to the fractions and chemical composition of PM10. Thus, PM10 speciation studies may contribute to the establishment of more selective pollution control policies.

Poluição do ar em cidades brasileiras: selecionando indicadores de impacto na saúde para fins de vigilância

Objective: to assess the health impact of air pollution in Brazilian cities and to select effect indicators for surveillance purposes. Methods: based on hospital inpatient and fine particulate matter (PM10) data, a study was performed using time series models, in particular Generalized Additive Models with Poisson regression to estimate the impact of air pollution on health. We analyzed hospital admissions for total respiratory illnesses (TRI), admissions for respiratory diseases in children under 5 years old (RDC) and admissions for cardiovascular diseases in adults (CVD) in 21 cities. The best effect indicator was selected based on the proportion of statistically significant results. Results: we found a significant relationship in 81% of locations for TRI, 89% for RDC and 50% for CVD. Conclusions: significant relationships were found for most cities. RDC were considered the best effect indicator, closely followed by TRI. Both can therefore be used for surveillance purposes.