title: Deaths and medical visits attributable to environmental pollution in the United Arab Emirates.
abstract: BACKGROUND
  This study estimates the potential health gains achievable in the United Arab Emirates (UAE) with improved controls on environmental pollution. The UAE is an emerging economy in which population health risks have shifted rapidly from infectious diseases to chronic conditions observed in developed nations. The UAE government commissioned this work as part of an environmental health strategic planning project intended to address this shift in the nature of the country's disease burden.
  
  
  RESULTS
  We assessed the burden of disease attributable to six environmental exposure routes outdoor air, indoor air, drinking water, coastal water, occupational environments, and climate change. For every exposure route, we integrated UAE environmental monitoring and public health data in a spatially resolved Monte Carlo simulation model to estimate the annual disease burden attributable to selected pollutants. The assessment included the entire UAE population (4.5 million for the year of analysis). The study found that outdoor air pollution was the leading contributor to mortality, with 651 attributable deaths (95% confidence interval [CI] 143-1,440), or 7.3% of all deaths. Indoor air pollution and occupational exposures were the second and third leading contributors to mortality, with 153 (95% CI 85-216) and 46 attributable deaths (95% CI 26-72), respectively. The leading contributor to health-care facility visits was drinking water pollution, to which 46,600 (95% CI 15,300-61,400) health-care facility visits were attributed (about 15% of the visits for all the diseases considered in this study). Major study limitations included (1) a lack of information needed to translate health-care facility visits to quality-adjusted-life-year estimates and (2) insufficient spatial coverage of environmental data.
  
  
  CONCLUSIONS
  Based on international comparisons, the UAE's environmental disease burden is low for all factors except outdoor air pollution. From a public health perspective, reducing pollutant emissions to outdoor air should be a high priority for the UAE's environmental agencies.
authors.affiliation: Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: MacDonald Gibson
authors.forename: Jens
authors.initials: J
authors.lastname: Thomsen
authors.forename: Frederic
authors.initials: F
authors.lastname: Launay
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harder
authors.forename: Nicholas
authors.initials: N
authors.lastname: DeFelice
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000397:Air Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D057231:Climate Change; D016001:Confidence Intervals; D004781:Environmental Exposure / Q000706:statistics & numerical data; D004782:Environmental Health / Q000706:statistics & numerical data*; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011634:Public Health / Q000706:statistics & numerical data; D012306:Risk; D014479:United Arab Emirates / Q000453:epidemiology; D014876:Water Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data