Gender differences in association between air pollution and daily mortality in Green Lungs of Poland – population-based study with almost 3,000,000 person-years of observation
Authors: Kuzma L , Pogorzelski S , Struniawski K , Kralisz P , Zalewska-Adamiec M , Bachorzewska-Gajewska H , Dobrzycki S 
Published: November 2020

Abstract

Introduction
Air pollution is considered to be one of the main risk factors for public health, in particular its impact on the disorders of the pulmonary and cardiovascular system and the related mortality.

Purpose
This study was carried out to assess the influence of the atmospheric conditions and air pollutants on mortality in the population of the big city in the eastern Poland.

Materials and methods
Based on the data from the Central Statistical Office, the number and causes of the deaths of the city residents in the period 2008–2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Multivariate Poisson regression was used for statistical analysis.

Results
A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% (N=16,370). The main causes of deaths in the female population were chronic ischemic heart disease (N=1683; 10.42%) and cerebral infarction (N=1617; 10.01%), while in the male population, in addition to chronic ischemic heart disease (N=1530; 8.57%), deaths were caused mainly by malignant neoplasm of the bronchus and lung (N=1555; 8.71%). During the analysis, it was observed that the 1-day norm of sulfur dioxide (SO2) recommended by the World Health Organization (WHO) guidelines was sporadically exceeded (N=18, 0.50% of analyzed days), while the daily norm for the particulate matter with a diameter of 2.5 μm or less (PM2.5) was exceeded on 688 days (23.60% of analyzed days). In the female group, excluding the seasonal impact, an increase of SO2 concentration by 1-μg/m3 (RR 1.05, 95% confidence interval (CI) 1.01–1.10; P=0.009) and a 10°C decrease of temperature (RR 1.04, 95% CI 1.02–1.07; P=0.003) were related to an increase in the number of daily deaths. In the male group, a stronger effect of SO2concentration on mortality was noted; the RR for 1-μg/m3 increase of SO2 was 1.10 (95% CI 1.04–1.18; P=0.002). In the subgroup analysis of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was PM2.5; the RR for 10-μg/m3 increase of PM2.5 was 1.07 (95% CI 1.02–1.12; P=0.01).

Conclusions
Air quality and atmospheric conditions had an impact on the mortality of Białystok residents, and this effect was more pronounced in the male population. The main air pollutants that influenced the rate of mortality were SO2and PM2.5. In the female population, an additional factor that influenced the total mortality and mortality due to cardiovascular diseases was temperature. It is worth emphasizing that the impact of SO2 on mortality was clear within “safe” range recommended by WHO. More research on that topic is necessary, but our results bring questions whether the recommended norms should be stricter, or is there a safe concentration of SO2 in the air at all.

Funding Acknowledgement
Type of funding source: None