Spatial analysis of long-term exposure to air pollution and cardiorespiratory mortality in Brisbane, Australia

Air pollution is ranked by the World Health Organisation as one of the top ten contributors to the global burden of disease and injury. Epidemiological studies have shown that exposure to air pollution is associated with cardiorespiratory diseases. However, most of the previous studies have looked at this issue using air pollution data from a single monitoring site or average values from a few monitoring sites in a city. There is increasing concern that the relationships between air pollution and mortality may vary with geographical area, particularly for a big city. This thesis consisted of three interlinked studies that aimed to examine the spatial variation in the relationship between long-term exposure to air pollution and cardiorespiratory mortality in Brisbane, Australia. The first study evaluated the long-term air pollution trends in Brisbane, Australia. Air pollution data used in this study were provided by the Queensland Environmental Protection Agency (QEPA). The data comprised the daily average concentrations of particulate matter less then 10 µm in aerodynamic diameter (PM10), nitrogen dioxide (NO2), ozone (O3) and sulphur dioxide (SO2) between 1 January 1980 and 31 December 2004 in two monitoring sites (i.e. Eagle farm and Rocklea), and in other available monitoring sites between 1 January 1996 and 31 December 2004. Computerised data files of daily mortality between 1 January 1996 and 31 December 2004 in Brisbane city were provided by the Office of Economic and Statistical Research of the Queensland Treasury. Population data and the Socio-Economic Indexes for Areas (SEIFA) data in 2001 were obtained from the Australian Bureau of Statistics (ABS) for each statistical local area (SLA) of the Brisbane city. The long-term air pollution (the daily maximum 1-hour average or daily 24-hour average concentrations of NO2, O3 and PM10) trends were evaluated using a polynomial regression model in two monitoring sites (Eagle Farm and Rocklea) in Brisbane, Australia, between 1980 and 2003. The study found that there were significant up-and-down features for air pollution concentrations in both monitoring sites in Brisbane. Rocklea recorded a substantially higher number of days with concentrations above the relevant daily maximum 1-hour or 24-hour standards than that in Eagle Farm. Additionally, there was a significant spatial variation in air pollution concentrations between these areas. Therefore, the results indicated a need to examine the spatial variation in the relationship between long-term exposure to air pollution and cardiorespiratory mortality in Brisbane. The second study examined the spatial variation of SO2 concentrations and cardiorespiratory mortality in Brisbane between 1999 and 2001. Air pollutant concentrations were estimated using geographical information systems (GIS) techniques at a SLA level. Spatial distribution analysis and a multivariable logistic regression model were employed to investigate the impact of gaseous air pollution on cardiorespiratory mortality after adjusting for potential confounding effects of age, sex, calendar year and SEIFA. The results of this study indicate that for every 1 ppb increase in annual average SO2 concentration, there was an estimated increase of 4.4 % (95 % confidence interval (CI): 1.4 - 7.6 %) and 4.8 % (95 % CI: 2.0 - 7.7 %) in cardiovascular and cardiorespiratory mortality, respectively. We estimated that the excess number of cardiorespiratory deaths attributable to SO2 was 312 (3.4% of total cardiorespiratory deaths) in Brisbane during the study period. Our results suggest that long-term exposure to SO2, even at low levels, is a significant hazard to population health. The final study examined the association of long-term exposure to gaseous air pollution (including NO2, O3 and SO2) with cardiorespiratory mortality in Brisbane, Australia, 1996 - 2004. The pollutant concentrations were estimated using GIS techniques at a SLA level. Logistic regression was used to investigate the impact of NO2, O3 and SO2 on cardiorespiratory mortality after adjusting for potential confounding effects of age, sex, calendar year and SEIFA. The study found that there was an estimated 3.1% (95% CI: 0.4 - 5.8%) and 0.5% (95% CI: -0.03 - 1.3 %) increase in cardiorespiratory mortality for 1 ppb increment in annual average concentration of SO2 and O3, respectively. However there was no significant relationship between NO2 and cardiorespiratory mortality observed in the multiple gaseous pollutants model. The results also indicated that long-term exposure to gaseous air pollutants in Brisbane, even at the levels lower than most cities in the world (especially SO2), were associated with cardiorespiratory mortality. Therefore, spatial patterns of gaseous air pollutants and their impact on health outcomes need to be assessed for an evaluation of long-term effects of air pollution on population health in metropolitan areas. This study examined the relationship between air pollution and health outcomes. GIS and relevant mapping technologies were used to display the spatial patterns of air pollution and cardiorespiratory mortality at a SLA level. The results of this study show that long-term exposure to gaseous air pollution was associated with cardiorespiratory mortality in Brisbane and this association appeared to vary with geographic area. These findings may have important public health implications in the control and prevention of air pollution-related health effects, since now many countries and governments have paid more attention to control wide spread air pollution and to protect our environment and human health