title: Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations.
abstract: Health impacts of air pollution may differ depending on sex, education, socioeconomic status (SES), location at time of death, and other factors. In São Paulo, Brazil, questions remain regarding roles of individual and community characteristics. We estimate susceptibility to air pollution based on individual characteristics, residential SES, and location at time of death (May 1996-December 2010). Exposures for particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were estimated using ambient monitors. Time-stratified case-crossover analysis was used with individual-level health data. Increased risk of non-accidental, cardiovascular, and respiratory mortality were associated with all pollutants (P < 0.05), except O3 and cardiovascular mortality. For non-accidental mortality, effect estimates for those with > 11 years education were lower than estimates for those with 0 years education for NO2, SO2, and CO (1.66% (95% confidence interval: 0.23%, 3.08%); 1.51% (0.51%, 2.51%); and 2.82% (0.23%, 5.35%), respectively). PM10 cardiovascular mortality effects were (3.74% (0.044%, 7.30%)) lower for the high education group (> 11 years) compared with the no education group. Positive, significant associations between pollutants and mortality were observed for in-hospital deaths, but evidence of differences in air pollution-related mortality risk by location at time of death was not strong.
authors.affiliation: School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA.
authors.forename: Mercedes A
authors.initials: MA
authors.lastname: Bravo
authors.affiliation: School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA.
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Son
authors.affiliation: Faculty of Medicine, Departament of Preventative Medicine, University of São Paulo, Cerqueira Cesar, São Paulo, Brazil.
authors.forename: Clarice Umbelino
authors.initials: CU
authors.lastname: de Freitas
authors.affiliation: Faculty of Medicine, Departament of Preventative Medicine, University of São Paulo, Cerqueira Cesar, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Gouveia
authors.affiliation: School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D001938:Brazil / Q000453:epidemiology; D002248:Carbon Monoxide / Q000009:adverse effects / Q000032:analysis; D002318:Cardiovascular Diseases / Q000401:mortality*; D016022:Case-Control Studies; D003644:Death Certificates; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000009:adverse effects / Q000032:analysis; D010126:Ozone / Q000009:adverse effects / Q000032:analysis; D010316:Particle Size; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013458:Sulfur Dioxide / Q000009:adverse effects / Q000032:analysis
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D013458:Sulfur Dioxide; D010126:Ozone; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide