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Cited by 476Air Quality and Health ImpactsClimate Change and Health ImpactsIndoor Air Quality and Microbial Exposure

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Public Health and Air Pollution in Asia (PAPA): A Multicity Study of Short-Term Effects of Air Pollution on Mortality

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Wong, Chit-Ming, Vichit-Vadakan, Nuntavarn, Kan, Haidong, Qian, Zhengmin·2008·Environmental Health Perspectives
DOI 10.1289/ehp.11257PMC PMC2535622
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Abstract

BACKGROUND AND OBJECTIVES: Although the deleterious effects of air pollution from fossil fuel combustion have been demonstrated in many Western nations, fewer studies have been conducted in Asia. The Public Health and Air Pollution in Asia (PAPA) project assessed the effects of short-term exposure to air pollution on daily mortality in Bangkok, Thailand, and in three cities in China: Hong Kong, Shanghai, and Wuhan. METHODS: Poisson regression models incorporating natural spline smoothing functions were used to adjust for seasonality and other time-varying covariates that might confound the association between air pollution and mortality. Effect estimates were determined for each city and then for the cities combined using a random effects method. RESULTS: In individual cities, associations were detected between most of the pollutants [nitrogen dioxide, sulfur dioxide, particulate matter < or = 10 microm in aerodynamic diameter (PM(10)), and ozone] and most health outcomes under study (i.e., all natural-cause, cardiovascular, and respiratory mortality). The city-combined effects of the four pollutants tended to be equal or greater than those identified in studies conducted in Western industrial nations. In addition, residents of Asian cities are likely to have higher exposures to air pollution than those in Western industrial nations because they spend more time outdoors and less time in air conditioning. CONCLUSIONS: Although the social and environmental conditions may be quite different, it is reasonable to apply estimates derived from previous health effect of air pollution studies in the West to Asia.

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Crossref · 10.1289/ehp.11257

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Figure 1 Bangkok, Hong Kong, Shanghai, and Wuhan. Numbers in parentheses indicate the number of monitoring stations used in each city.
Figure 1 Bangkok, Hong Kong, Shanghai, and Wuhan. Numbers in parentheses indicate the number of monitoring stations used in each city.CC0 · PubMed Central
Figure 2 Box plots of the air pollutants for the four cities. Boxes indicate the interquartile range (25th percentile–75th percentile); lines within boxes indicate medians; whiskers and circles below boxes represent minimum values; and circles above boxes indicate maximum values.
Figure 2 Box plots of the air pollutants for the four cities. Boxes indicate the interquartile range (25th percentile–75th percentile); lines within boxes indicate medians; whiskers and circles below boxes represent minimum values; and circles above boxes indicate maximum values.CC0 · PubMed Central
Figure 3 Excess risk (%) of mortality [point estimates (95% CIs)] for a 10-μg/m3 increase in average concentration of lag 0–1 days for three age groups.
Figure 3 Excess risk (%) of mortality [point estimates (95% CIs)] for a 10-μg/m3 increase in average concentration of lag 0–1 days for three age groups.CC0 · PubMed Central
Figure 4 CR curves for all natural-cause mortality at all ages in all four cities for the average concentration of lag 0–1 days for NO2 (A), SO2 (B), PM10 (C), and O3 (D). The thin vertical lines represent the IQR of pollutant concentrations. The thick lines represent the WHO guidelines (WHO 2005) of 40 μg/m3 for 1-year averaging time for NO2 (A), 20 μg/m3 for 24-hr averaging time for SO2 (B), 20 μg/m3 for 1-year averaging time for PM10 (C), and 100 μg/m3 for daily maximum 8-hr mean for O3 (D).
Figure 4 CR curves for all natural-cause mortality at all ages in all four cities for the average concentration of lag 0–1 days for NO2 (A), SO2 (B), PM10 (C), and O3 (D). The thin vertical lines represent the IQR of pollutant concentrations. The thick lines represent the WHO guidelines (WHO 2005) of 40 μg/m3 for 1-year averaging time for NO2 (A), 20 μg/m3 for 24-hr averaging time for SO2 (B), 20 μg/m3 for 1-year averaging time for PM10 (C), and 100 μg/m3 for daily maximum 8-hr mean for O3 (D).CC0 · PubMed Central

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Citations

Cites

Show all 22 references

Research works printed but not linked: 6

  1. Anderson, 2004, Meta-analysis of Time-series Studies and Panel Studies of Particulate Matter (PM) and Ozone (O3)
  2. HEI, 2004, Health Effects of Outdoor Air Pollution in Developing Countries of Asia: A Literature Review
  3. Ostro, 2004, Outdoor Air Pollution: Assessing the Environmental Burden of Disease at National and Local Levels
  4. R Development Core Team, 2007, R: A Language and Environment for Statistical Computing, Version 2.5.1
  5. WHO, 1977, Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision
  6. WHO, 2005, Air Quality Guidelines for Particulate Matter, Ozone, Nitrogen Dioxide and Sulfur Dioxide - Global Update 2005

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Metadata

Authors
Wong, C.-M., Vichit-Vadakan, N., Kan, H., & Qian, Z.
Affiliations
  • University of Hong Kong (HK)
  • Faculty of Public Health, Thammasat University, Pathumthani, Thailand
  • National Institutes of Health (US)
  • Pennsylvania State University (US)
Corresponding author
Wong, Chit-Ming
ORCID
Venue
Environmental Health Perspectives
Publisher
American Chemical Society (ACS)
Published
2008-07-09
Volume
116
Issue
9
Pages
1195-1202
ISSN
  • 0091-6765 (ISSN-L)
  • 1552-9924
DOI
10.1289/ehp.11257
PMC
PMC2535622
OpenAlex
W2165456540
Cited by
476
References
22
Citations by year
2026: 12 · 2025: 16 · 2024: 20 · 2023: 19 · 2022: 40 · 2021: 31 · 2020: 33 · 2019: 32 · 2018: 28 · 2017: 31 · 2016: 26 · 2015: 28 · 2014: 29 · 2013: 31 · 2012: 33
FWCI
15.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Environmental Health Perspectives (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
Funders
  • U.S. Environmental Protection Agency
  • Health Effects Institute
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Keywords
air pollution, short-term exposure, mortality, cardiovascular mortality, respiratory mortality, natural death, nitrogen dioxide, sulfur dioxide, particulate matter, ozone, Asian cities, Bangkok, Hong Kong, Shanghai, Wuhan, fossil fuel combustion, exposure assessment
MeSH terms
Aged, Air Pollution, Asia, Dose-Response Relationship, Drug, Humans, Middle Aged, Public Health

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