Burden of Disease from Outdoor Air Pollution

Part of the Environmental Science and Technology Library book series (ENST, volume 24)


Anthropogenic outdoor air pollution caused a substantial number of premature deaths in the United Arab Emirates in 2008, and this mortality number is estimated to be the greatest among the eight priority environmental risk areas in this book. In this chapter we quantify the burden of disease, including premature deaths and health-care facility visits, associated with outdoor air pollution, specifically ambient particulate matter (PM) and ozone from anthropogenic sources, and we discuss the uncertainties associated with the estimates. The negative impacts of PM and ozone on public health have been well documented, particularly the mortality effect of PM. For morbidity, scientific studies have linked exposure to PM and ozone to a variety of health problems, particularly respiratory and cardiovascular diseases. Two different approaches were used to estimate outdoor PM and ozone concentrations across the UAE: the measurement-based approach and the air-­quality-model-based approach. The measurement-based approach relies on data from 10 fixed monitoring stations in Abu Dhabi emirate. The model-based approach uses Community Multiscale Air Quality modeling software to predict air quality based on estimates of air pollutant emissions and meteorological conditions. Using the measurement-based approach, this research estimates that in 2008 the total number of premature deaths in the UAE caused by exposure to ambient particulate matter was approximately 650. These account for about 7% of the total deaths occurring in the UAE in 2008. About 77 deaths were attributable to ground-level ozone in 2008. With respect to excess illness, in 2008 PM10 exposure caused a mean estimate of 15,000 health-care facility visits for respiratory and cardiac illnesses, accounting for about 3% of total medical visits. Ground-level ozone caused a mean estimate of 9,800 respiratory health-care facility visits in 2008, accounting for about 6% of total respiratory health-care facility visits in that year. Thus, in total, PM appears to cause a larger disease burden in the UAE than ozone. Using the CMAQ model-based approach, the estimated death numbers attributable to PM were smaller than the measurement-based estimates, whereas the estimated death numbers attributable to ozone are greater than those using the measurement-based approach. Also, the estimated health-care facility visits attributable to PM are smaller than the measurement-­based estimates.


Outdoor air pollution Ambient particulate matter Ground-level ozone Premature deaths and health-care facility visits Respiratory and cardiovascular diseases Attributable fraction Relative risk Concentration-response coefficients Community Multiscale Air Quality (CMAQ) modeling software Environmental burden of disease United Arab Emirates 


  1. Anderson, H.R., R.W. Atkinson, J.L. Peacock, L. Marston, and K. Konstantinou. 2004. Meta-­analysis of time-series studies and panel studies of particulate matter (PM) and ozone (O 3 ): Report of a WHO task group. Copenhagen: World Health Organization.Google Scholar
  2. Anenberg, S.C., L.W. Horowitz, D.Q. Tong, and J.J. West. 2010. An estimate of the global burden of anthropogenic ozone and fine particulate matter on premature human mortality using atmospheric modeling. Environmental Health Perspectives 118(9): 1189–1195.CrossRefGoogle Scholar
  3. Aunan, K., and X.C. Pan. 2004. Exposure-response functions for health effects of ambient air pollution applicable for China—A meta-analysis. The Science of the Total Environment 329(1–3): 3–16.CrossRefGoogle Scholar
  4. Bell, M.L., A. McDermott, S.L. Zeger, J.M. Samet, and F. Dominici. 2004. Ozone and short-term mortality in 95 U.S. urban communities, 1987–2000. Journal of the American Medical Association 292(19): 2372–2378.CrossRefGoogle Scholar
  5. Bell, M.L., F. Dominici, and J.M. Samet. 2005. A meta-analysis of time-series studies of ozone and mortality with comparison to the National Morbidity, Mortality, and Air Pollution Study. Epidemiology 16(4): 436–445.CrossRefGoogle Scholar
  6. Bell, M.L., R.D. Peng, and F. Dominici. 2006. The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations. Environmental Health Perspectives 114(4): 532–536.CrossRefGoogle Scholar
  7. Brown, K.W., W. Bouhamra, D.P. Lamoureux, J.S. Evans, and P. Koutrakis. 2008. Characterization of particulate matter for three sites in Kuwait. Journal of Air and Waste Management 58: 994–1003.CrossRefGoogle Scholar
  8. Cohen, A.J., H.R. Anderson, B. Ostro, K.D. Pandey, M. Krzyzanowski, N. Kunzli, K. Gutschmidt, et al. 2004. Mortality impacts of urban air pollution. In Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factor, 2nd ed, ed. M. Ezzati, A.D. Lopez, A. Rodgers, and C.J.L. Murray. Geneva: World Health Organization.Google Scholar
  9. Dockery, D.W., C.A. Pope III, X. Xu, J.D. Spengler, J.H. Ware, M.E. Fay, B.G. Ferris, and F.E. Speizer. 1993. An association between air pollution and mortality in six U.S. cities. The New England Journal of Medicine 329(24): 1753–1759.CrossRefGoogle Scholar
  10. Dominici, F., A. McDermott, M. Daniels, S.L. Zeger, and J.M. Samet. 2005. Revised analyses of the National Morbidity, Mortality, and Air Pollution Study: Mortality among residents of 90 cities. Journal of Toxicology and Environmental Health. Part A 68(13–14): 1071–1092.CrossRefGoogle Scholar
  11. Health Authority–Abu Dhabi. 2008. Health Statistics 2007.Google Scholar
  12. Ito, K., S.F. De Leon, and M. Lippmann. 2005. Associations between ozone and daily mortality: Analysis and meta-analysis. Epidemiology 16(4): 446–457.CrossRefGoogle Scholar
  13. Jerrett, M., R.T. Burnett, C.A. Pope III, K. Ito, G. Thurston, D. Krewski, Y. Shi, E. Calle, and M. Thun. 2009. Long-term ozone exposure and mortality. The New England Journal of Medicine 360(11): 1085–1095.CrossRefGoogle Scholar
  14. Krewski, D., R.T. Burnett, M.S. Goldberg, K. Hoover, J. Siemiatycki, M. Jerrett, M. Abrahamowicz, and W.H. White. 2000. Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of particulate air pollution and mortality: A special report of the Health Effects Institute’s particle epidemiology reanalysis project. Cambridge, MA: Health Effects Institute.Google Scholar
  15. Krewski, D., M. Jerrett, R.T. Burnett, R. Ma, E. Hughes, Y. Shi, M.C. Turner, et al. 2009. Extended follow-up and spatial analysis of the American Cancer Society study linking particulate air pollution and mortality. Research Report. Health Effects Institute 140: 5–114.Google Scholar
  16. Künzli, N., S. Medina, R. Kaiser, P. Quénel, F. Horak Jr., and M. Studnicka. 2001. Assessment of deaths attributable to air pollution: Should we use risk estimates based on time series or on cohort studies? American Journal of Epidemiology 153(11): 1050–1055.CrossRefGoogle Scholar
  17. Laden, F., J. Schwartz, F.E. Speizer, and D.W. Dockery. 2006. Reduction in fine particulate air pollution and mortality: Extended follow-up of the Harvard Six Cities Study. American Journal of Respiratory and Critical Care Medicine 173: 667–672.CrossRefGoogle Scholar
  18. Levy, J.I., J.K. Hammitt, and J.D. Spengler. 2000. Estimating the mortality impacts of particulate matter: What can be learned from between-study variability? Environmental Health Perspectives 108(2): 109–117.CrossRefGoogle Scholar
  19. Levy, J.I., T.J. Carrothers, J.T. Tuomisto, J.K. Hammitt, and J.S. Evans. 2001. Assessing the public health benefits of reduced ozone concentrations. Environmental Health Perspectives 109(21): 9–20.Google Scholar
  20. Levy, J.I., S.M. Chemerynski, and J.A. Sarnat. 2005. Ozone exposure and mortality: An empiric Bayes metaregression analysis. Epidemiology 16(4): 458–468.CrossRefGoogle Scholar
  21. Li, Y., J. MacDonald Gibson, P. Jat, G. Puggioni, M. Hasan, J. West, W. Vizuete, K. Sexton, and M. Serre. 2010. Burden of disease attributed to anthropogenic air pollution in the United Arab Emirates: Estimates based on observed air quality data. The Science of the Total Environment 408(23): 5784–5793. doi: 10.1016/j.scitotenv.2010.08.017.CrossRefGoogle Scholar
  22. National Research Council. 2008. Estimating mortality risk reduction and economic benefits from controlling ozone air pollution. Washington, D.C.: National Academies Press.Google Scholar
  23. Oak Ridge National Laboratory. 2007. LandScan global population dataset. Oak Ridge, Tenn.
  24. Ostro, B. 2004. Outdoor air pollution: Assessing the environmental burden of disease at national and local levels. Environmental Burden of Disease series, No. 5. Geneva: WHO.Google Scholar
  25. Ostro, B.D., and L. Chestnut. 1998. Assessing the health benefits of reducing particulate matter air pollution in the United States. Environmental Research (Section A) 76: 94–106.CrossRefGoogle Scholar
  26. Ostro, B.D., R. Broadwin, and M.J. Lipsett. 2000. Coarse and fine particles and daily mortality in the Coachella Valley, California: A follow-up study. Journal of Exposure Analysis and Environmental Epidemiology 10(5): 412–419.CrossRefGoogle Scholar
  27. Pope III, C.A., M.J. Thun, M.M. Namboodiri, D.W. Dockery, J.S. Evans, F.E. Speizer, and J.C.W. Heath. 1995. Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. American Journal of Respiratory and Critical Care Medicine 151: 669–674.Google Scholar
  28. Pope III, C.A., R.W. Hill, and G.M. Villegas. 1999. Particulate air pollution and daily mortality on Utah’s Wasatch Front. Environmental Health Perspectives 107(7): 567–573.CrossRefGoogle Scholar
  29. Pope III, C.A., R.T. Burnett, M.J. Thun, E.E. Calle, D. Krewski, K. Ito, and G.D. Thurston. 2002. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. Journal of the American Medical Association 287(9): 1132–1141.CrossRefGoogle Scholar
  30. Samet, J.M., S.L. Zeger, F. Dominici, F. Curriero, I. Coursac, D.W. Dockery, J. Schwartz, and A. Zanobetti. 2000. The national morbidity, mortality, and air pollution study, Part II: Morbidity and mortality from air pollution in the United States. Research Report. Health Effects Institute 94(II): 5–70.Google Scholar
  31. Schwartz, J., F. Laden, and A. Zanobetti. 2002. The concentration-response relation between PM2.5 and daily deaths. Environmental Health Perspectives 110(10): 1025–1029.CrossRefGoogle Scholar
  32. Sivertsen, B. 2010. Air quality monitoring and management in Abu Dhabi. Norwegian Institute for Air Research. In Presentation at workshop to design future air quality field measurement ­campaigns in the United Arab Emirates. Abu Dhabi, April 26–28.Google Scholar
  33. Slaughter, J.C., E. Kim, L. Sheppard, J.H. Sullivan, T.V. Larson, and C. Claiborn. 2005. Association between particulate matter and emergency room visits, hospital admissions and mortality in Spokane, Washington. Journal of Exposure Analysis and Environmental Epidemiology 15(2): 153–159.CrossRefGoogle Scholar
  34. U.S. Environmental Protection Agency (EPA). 1999. The benefits and costs of the Clean Air Act, 1990–2010. EPA-410-R-99-001. U.S. Environmental Protection Agency Office of Air and Radiation. EPA Report to Congress, November.Google Scholar
  35. UAE Ministry of Health. 2008. 2007 annual statistical report. Abu Dhabi: Preventive medicine sector.Google Scholar
  36. Whitford, J. 2008. Environment Agency—Abu Dhabi ambient air quality monitoring network 2007 Annual Report.Google Scholar
  37. World Health Organization (WHO). 2009a. Country profiles of environmental burden of disease: United Arab Emirates. Geneva: World Health Organization.
  38. World Health Organization (WHO). 2009b. International Classification of Diseases (ICD).
  39. Zeka, A., A. Zanobetti, and J. Schwartz. 2005. Short term effects of particulate matter on cause specific mortality: Effects of lags and modification by city characteristics. Occupational and Environmental Medicine 62(10): 718–725.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Gillings School of Global Public HealthUniversity of North Carolina–Chapel HillChapel HillUSA
  2. 2.Environment Agency–Abu DhabiAbu DhabiUnited Arab Emirates
  3. 3.Health Authority–Abu DhabiAbu DhabiUnited Arab Emirates

Personalised recommendations