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Air pollution and admissions for acute lower respiratory infections in young children of Ho Chi Minh City

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Abstract

This study assessed the effects of exposure to air pollution on hospitalization for acute lower respiratory infection (ALRI) among children under 5 years of age in Ho Chi Minh City (HCMC) from 2003 to 2005. Case-crossover analyses with time-stratified selection of control periods were conducted using daily admissions for pneumonia and bronchiolitis and daily, citywide averages of PM10, NO2, SO2, and O3 (8-h maximum average) estimated from the local air quality monitoring network. Increased concentrations of NO2 and SO2 were associated with increased admissions in the dry season (November to April), with excess risks of 8.50% (95%CI 0.80–16.79) and 5.85% (95%CI 0.44–11.55), respectively. PM10 could also be associated with increased admissions in the dry season, but high correlation between PM10 and NO2 (0.78) limits our ability to distinguish between PM10 and NO2 effects. In the rainy season (May–October), negative associations between pollutants and admissions were observed. Results of this first study of the health effects of air pollution in HCMC support the presence of an association between combustion-source pollution and increased ALRI admissions. ALRI admissions were generally positively associated with ambient levels of PM10, NO2, and SO2 during the dry season, but not the rainy season. Negative results in the rainy season could be driven by residual confounding present from May to October. Preliminary exploratory analyses suggested that seasonal differences in the prevalence of viral causes of ALRI could be driving the observed differences in effects by season.

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Abbreviations

ALRI:

Acute lower respiratory infection

CI:

Confidence interval

CH1:

Children’s Hospital Number 1

CH2:

Children’s Hospital Number 2

HCMC:

Ho Chi Minh City

HEPA:

HCMC Environmental Protection Agency

ICD-10:

International Classification of Diseases, 10th revision

IMCI:

WHO/UNICEF Integrated Management of Childhood Illness

NO2 :

Nitrogen dioxide

O3 :

Ozone

OR:

Odds ratio

PM10 :

Particulate matter ≤10 μm in aerodynamic diameter

PM2.5 :

Particulate matter ≤2.5 μm in aerodynamic diameter

RSV:

Respiratory syncytial virus

SD:

Standard deviation

SO2 :

Sulfur dioxide

WHO:

World Health Organization

References

  • Barnett AG, Williams GM, Schwartz J, Neller AH, Best TL, Petroeschevsky AL, Simpson RW (2005) Air pollution and child respiratory health: a case-crossover study in Australia and New Zealand. Am J Respir Crit Care Med 171(11):1272–1278

    Article  Google Scholar 

  • Braga AL, Saldiva PH, Pereira LA, Menezes JJ, Conceicao GM, Lin CA, Zanobetti A, Schwartz J, Dockery DW (2001) Health effects of air pollution exposure on children and adolescents in Sao Paulo, Brazil. Pediatr Pulmonol 31(2):106–113

    Article  CAS  Google Scholar 

  • Cohen A, Anderson HR, Ostro B, Pandey KD, Krzyzanowski M, Kuenzli N, Gutschmidt K, Pope CA, Romieu I, Samet JM, Smith KR (2004) Mortality impacts of urban air pollution. In: Ezzati MLA, Rodgers A, Murray CJL (eds) Comparative quantification of health risks: global and regional burden of disease due to selected major risk factors vol 2. World Health Organization, Geneva

    Google Scholar 

  • D’Ippoliti D, Forastiere F, Ancona C, Agabiti N, Fusco D, Michelozzi P, Perucci CA (2003) Air pollution and myocardial infarction in Rome—a case-crossover analysis. Epidemiology 14(5):528–535

    Article  Google Scholar 

  • Ghio AJ (2004) Biological effects of Utah Valley ambient air particles in humans: a review. J Aerosol Med Depos Clear Effects Lung 17(2):157–164

    Article  CAS  Google Scholar 

  • Ghio AJ, Cohen MD (2005) Disruption of iron homeostasis as a mechanism of biologic effect by ambient air pollution particles. Inhal Toxicol 17(13):709–716

    Article  CAS  Google Scholar 

  • Gouveia N, Fletcher T (2000) Respiratory diseases in children and outdoor air pollution in Sao Paulo, Brazil: a time series analysis. Occup Environ Med 57(7):477–483

    Article  CAS  Google Scholar 

  • Han X, Naeher LP (2006) A review of traffic-related air pollution exposure assessment studies in the developing world. Environ Int 32(1):106–120

    Article  CAS  Google Scholar 

  • Health Effects Institute (2006) PAPA-SAN Database. www.healtheffects.org

  • HEI International Scientific Oversight Committee (2004) Health effects of outdoor air pollution in developing countries of Asia: a literature review. Health Effects Institute, Boston

    Google Scholar 

  • HEI International Scientific Oversight Committee (2010) Outdoor air pollution and health in the developing countries of Asia: a comprehensive review. Special report 18. Health Effects Institute, Boston

    Google Scholar 

  • HEI Panel on the Health Effects of Traffic-Related Air Pollution (2009) Traffic-related air pollution: a critical review of the literature on emissions, exposure, and health effects. HEI special report 17. Health Effects Institute, Boston

    Google Scholar 

  • Hernandez-Cadena L, Barraza-Villarreal A, Ramirez-Aguilar M, Moreno-Macias H, Miller P, Carbajal-Arroyo LA, Romieu I (2007) Infant morbidity caused by respiratory diseases and its relation with the air pollution in Juarez City, Chihuahua, Mexico. Salud Publica Mex 49(1):27–36

    Article  Google Scholar 

  • Janes H, Sheppard L, Lumley T (2005a) Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias. Epidemiology 16(6):717–726

    Article  Google Scholar 

  • Janes H, Sheppard L, Lumley T (2005b) Overlap bias in the case-crossover design, with application to air pollution exposures. Stat Med 24(2):285–300

    Article  Google Scholar 

  • Karr C, Lumley T, Shepherd K, Davis R, Larson T, Ritz B, Kaufman J (2006) A case-crossover study of wintertime ambient air pollution and infant bronchiolitis. Environ Heal Perspect 114(2):277–281

    Article  CAS  Google Scholar 

  • Karr CJ, Rudra CB, Miller KA, Gould TR, Larson T, Sathyanarayana S, Koenig JQ (2009) Infant exposure to fine particulate matter and traffic and risk of hospitalization for RSV bronchiolitis in a region with lower ambient air pollution. Environ Res 109(3):321–327

    Article  CAS  Google Scholar 

  • Kelly FJ (2003) Oxidative stress: its role in air pollution and adverse health effects. Occup Environ Med 60(8):612–616

    Article  Google Scholar 

  • Kim JJ, Huen K, Adams S, Smorodinsky S, Hoats A, Malig B, Lipsett M, Ostro B (2008) Residential traffic and children’s respiratory health. Environ Health Perspect 116(9):1274–1279

    Article  CAS  Google Scholar 

  • Levy D, Lumley T, Sheppard L, Kaufman J, Checkoway H (2001) Referent selection in case-crossover analyses of acute health effects of air pollution. Epidemiology 12(2):186–192

    Article  CAS  Google Scholar 

  • Lin DY, Psaty BM, Kronmal RA (1998) Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics 54(3):948–963

    Article  CAS  Google Scholar 

  • Lumley T, Levy D (2000) Bias in the case-crossover design: implications for studies of air pollution. Environmetrics 11(6):689–704

    Article  CAS  Google Scholar 

  • Mehta S, Shin H, Burnett R, North T, Cohen AJ (2011) Ambient particulate air pollution and acute lower respiratory infections: a systematic review and implications for estimating the global burden of disease. Air Quality Atmos Health. doi:10.1007/s11869-011-0146-3

  • Mittleman MA (2005) Optimal referent selection strategies in case-crossover studies—a settled issue. Epidemiology 16(6):715–716

    Article  Google Scholar 

  • Romieu I, Samet JM, Smith KR, Bruce N (2002) Outdoor air pollution and acute respiratory infections among children in developing countries. J Occup Environ Med 44(7):640–649

    Article  Google Scholar 

  • Rothman KJ, Greenland S (1998) Modern epidemiology. Lippencott-Raven, Philadelphia

    Google Scholar 

  • Saldiva PH, Lichtenfels AJ, Paiva PS, Barone IA, Martins MA, Massad E, Pereira JC, Xavier VP, Singer JM, Bohm GM (1994) Association between air pollution and mortality due to respiratory diseases in children in Sao Paulo, Brazil: a preliminary report. Environ Res 65(2):218–225

    Article  CAS  Google Scholar 

  • Segala C, Poizeau D, Mesbah M, Willems S, Maidenberg M (2008) Winter air pollution and infant bronchiolitis in Paris. Environ Res 106(1):96–100

    Article  CAS  Google Scholar 

  • Smith KR, Samet JM, Romieu I, Bruce N (2000) Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax 55(6):518–532

    Article  CAS  Google Scholar 

  • Smith K, Mehta S, Maeusezahl-Feuz M (2004) Indoor air pollution from household use of solid fuels. In: LA Ezzati M, Rogers A, Murray CJL (eds) Global and regional burden of disease attributable to selected major risk factors, vol 2. World Health Organization, Geneva

    Google Scholar 

  • Thomas P, Zelikoff J (1999) Air pollutants: modulators of pulmonary host resistance against infection. In: Holgate ST, Samet JM, Koren HS, Maynard RL (eds) Air pollution and health. Academic, San Diego

    Google Scholar 

  • U.S. Department of Health and Human Services (2006) The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA

  • Viet Nam Register (2002) Integrated action plan to reduce vehicle emissions in VietNam. ADB. http://www.adb.org/Vehicle-Emissions/actionviet.asp

  • WHO-CAH (1997) The management of childhood illness in developing countries: rationale for an integrated strategy. WHO, Department of Child and Adolescent Health and Development, Geneva

    Google Scholar 

  • Williams B, Gouws E, Boschi-Pinto C, Bryce J, Dye C (2002) Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet 2:25–32

    Google Scholar 

  • World Health Organization (2004) The global burden of disease: 2004 update. WHO, Department of Health Statistics and Informatics in the Information, Evidence and Research Cluster Geneva, Switzerland

    Google Scholar 

  • Zelikoff JT, Schermerhorn KR, Fang KJ, Cohen MD, Schlesinger RB (2002) A role for associated transition metals in the immunotoxicity of inhaled ambient particulate matter. Environ Heal Perspect 110:871–875

    Article  CAS  Google Scholar 

  • Zelikoff JT, Chen LC, Cohen MD, Fang KJ, Gordon T, Li Y, Nadziejko C, Schlesinger RB (2003) Effects of inhaled ambient particulate matter on pulmonary antimicrobial immune defense. Inhal Toxicol 15(2):131–150

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This Technical Assistance was supported with funds from the Health Effects Institute’s Public Health and Air Pollution in Asia (PAPA) Program, the Poverty Reduction Cooperation Fund of the Asian Development Bank, (Technical Assistance 4714-VIE) and in-kind support from the Government of Viet Nam. The Working Group is grateful to the Clean Air Initiative for Asian Cities (CAI-Asia), for initiating communications between HEI, ADB, and the Government of Viet Nam, the local steering committee for the project, and the (PAPA) program’s International Scientific Oversight Committee for providing technical guidance and suggestions throughout the process, especially Drs. Michael Brauer, Ross Anderson, Kirk Smith, and Frank Speizer. We are grateful for useful comments provided by HEI’s Review Committee and external quality assurance consultant David Bush, and for administrative assistance provided by Tiffany North and Morgan Younkin.

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Authors and Affiliations

  1. Health Effects Institute, 101 Federal Street, Suite 500, Boston, MA, 02110, USA

    Sumi Mehta & Aaron Cohen

  2. Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Long H. Ngo

  3. HCMC University of Medicine & Pharmacy, Ho Chi Minh City, Vietnam

    Do Van Dzung

  4. University of Hong Kong, Pokfulam, Hong Kong

    T. Q. Thach

  5. HCMC Center for Occupational and Environmental Health, Ho Chi Minh City, Vietnam

    Vu Xuan Dan

  6. HCMC Environmental Protection Agency, Ho Chi Minh City, Vietnam

    Nguyen Dinh Tuan

  7. HCMC Department of Health, Ho Chi Minh City, Vietnam

    Le Truong Giang

Authors
  1. Sumi Mehta
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  2. Long H. Ngo
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  3. Do Van Dzung
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  4. Aaron Cohen
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  5. T. Q. Thach
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  6. Vu Xuan Dan
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  7. Nguyen Dinh Tuan
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Correspondence to Sumi Mehta.

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Mehta, S., Ngo, L.H., Van Dzung, D. et al. Air pollution and admissions for acute lower respiratory infections in young children of Ho Chi Minh City. Air Qual Atmos Health 6, 167–179 (2013). https://doi.org/10.1007/s11869-011-0158-z

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  • DOI: https://doi.org/10.1007/s11869-011-0158-z

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