Effects of dust storm events on emergency admissions for cardiovascular and respiratory diseases in Sanandaj, Iran
© Ebrahimi et al.; licensee BioMed Central Ltd. 2014
Received: 27 April 2014
Accepted: 27 July 2014
Published: 6 August 2014
In recent years, increasing dust storms from western neighboring countries of Iran influenced western and central parts of the country. In this case, level of concentration of atmospheric particulate matter greater than 10 μm (PM10) remained higher for several days compared to the levels before the event. Accordingly, Suspended particulate matters of dust storms in western Iran have caused PM10 pollution in Sanandaj (capital of the Iranian province of Kurdistan) and other Iranian cities. The present study aimed to evaluate possible effects of dust storms on incidence of cardiovascular and respiratory diseases among residents of Sanandaj.
Materials and methods
Dust storm events defined based on the Environmental Protection Administration and Meteorological Announcements, 21 March 2009 to 21 June 2010. Data related to the dust events associated with cardiovascular and respiratory diseases were obtained from the Center for Disaster and Emergency Medicine of Sanandaj, Iran. PM10 concentration and air quality data were obtained from air quality monitoring agency of Kurdistan Provincial Directorate of Environment Protection. Daily PM10 measurements were performed automatically according to β-ray absorption. Data were statistically analyzed using SPSS and Pearson's correlation coefficient. Also, linear regression model was used to investigate the relationship between variables.
The average PM10 levels during dust episodes (187 μg/m3) were significantly higher than the other days (48.7 μg/m3). In addition, correlation coefficient between PM10 level and number of cardiovascular and emergency service during dust events were equal to 0.48 (P <0.05) and 0.19 (P >0.05) respectively.
Our findings showed significant increase in emergency admissions for cardiovascular and respiratory diseases during dust storms episode in Sanandaj. Although correlation between respiratory diseases and dust storm events were statistically insignificant (0.19), numbers of cardiovascular diseases were significantly correlated with dust storm events (0.48).
Arid or semi-arid environments, covering about 33% of the total world land area, are the major origin of dust events (World Meteorological Organization, 2013 #1). Dust storms occur when high winds at a threshold speed blow over low vegetation and soil areas that lack moisture content and are vulnerable to disturbance . Increasing dust storms originating from western neighboring countries of Iran in recent years have influenced western and even central parts of Iran. Furthermore, PM10 (particulate matter greater than 10 μm) concentrations remained greater than before the episode for several days. These dust storms are associated with various environmental and socio-economic problems .
In 2010, air quality index of Sanandaj was interpreted as good (19%), moderate (57%), unhealthy for sensitive groups (15%), unhealthy (5%), very unhealthy (2%) and hazardous (2%) . In some cases, measured concentrations of particles in the dust storms reached to more than 6,000 μg/m3. Although, World Health Organization defines 24-hour average concentration of PM10 for ambient air and its annual average as 50 and 20 μg/m3 respectively .
PM10 particles cause or aggravate a number of diseases and mortalities due to cardiovascular or respiratory conditions. People with cardiovascular or respiratory diseases such as congestive cardiovascular failure, coronary artery disease, asthma or chronic obstructive pulmonary disease and old people are more likely refer to emergency care centers, hospitalized or even die in some cases. Furthermore, cardiac irregularities and cardiovascular attacks were attributed to exposure to particles ,. In a study conducted in China by Meng et al. reported increasingly frequent hospitalization for pneumonia during dust storms . According to the WHO report, during the late 1990s, exposure to PM10 has caused the occurrence of 700 annual deaths due to acute respiratory infections in children under 4 years old in Europe . With the increase of 100 μg/m3 in the 24 h average concentration of PM10, pneumonia and chronic obstructive pulmonary disease cases increased by 19% and 27%, respectively . Ostro et al. (1999) found an association between PM10 and daily mortality in the Coachella Valley, a desert resort and retirement area east of Los angles (CA, USA) where coarse particles of geological origin typically comprise approximately 50–60% of PM10 and can exceed 90% during wind events . The present study is aimed to evaluate possible effects of dust storms on the incidence of cardiovascular and respiratory diseases in Sanandaj during spring 2010.
Data on the incidence of diseases associated with dust events
Patients with cardiovascular and respiratory diseases who received medical services from the CDMME in Sanandaj during dust event days were considered for the study. According to the international classification of diseases, following codes are available for the two diseases: cardiovascular diseases with international code of 459–390, and respiratory diseases with the international code of 519–490. Therefore, the diseases which were in the above range (according to the international classification of diseases) were considered as cardiovascular and respiratory diseases.
Data on PM10 concentration and air quality in Sanandaj
Sanandaj City possesses two pollution measurement stations (ECOTECH Company, Australia). These stations are capable of measuring air pollutants including carbon monoxide (CO), sulfur anhydride (SO2), particulate matter with 10 microns in diameter (PM10), nitrogen oxides (NOX) and ozone (O3). The first station is located in the State Environmental Protection Administration and the second in the campus of the health department of Kurdistan University of Medical Sciences. The monitoring stations were fully automated and provided daily readings of PM10 levels (by β-ray absorption). Measurement data were frequently calibrated by a private company.
The diseases associated with dust storms and various concentrations of PM10 were analyzed using Microsoft Excel and linear regression. Equation of the regression line was used to indicate correlation between these two variables.
Description of the air quality index for the days of spring for PM 10 pollutant
Unhealthy for sensitive groups
Figure 4 shows number of days with high level of PM10 in spring. The number on pollutant days on March-April, April-May and May-June were 7, 8 and 16 days, respectively.
The maximum, minimum and, average daily levels of PM 10 on stormy days of spring
Standard deviationα ≈ 0.95
The correlation between the concentration of PM 10 and the incidence of cardiovascular and respiratory diseases
Regression line equation
y = 0.0135x + 5.5029
y = 0.0021x + 1.7
Average PM10 level during dust event days (187 μg/m3) was significantly higher than the comparison days (48.7 μg/m3). During storm event days other pollutants related to combustion (SO2, NO2, CO) were almost constant; therefore, any effects due to the occurrence of dust storms can be attributed to an increase in PM10 concentration.
Kwon et al. showed that during dust storms PM10 concentration from geological sources reached 50% to 60% and sometimes to 90% . Several studies have shown that in dust storms, effect of fine particles is higher than coarse particles -. However, Dockery et al. found no difference between the impact of fine and coarse particles . Castillejos et al. conducted a daily time-series analysis of mortality in relation to measurements of PM2.5, PM10, and PM10-2.5 in south western Mexico City in the years 1992–1995, they found that the effect of coarse particles was stronger for respiratory diseases than for total mortality, cardiovascular diseases, or other non injury causes of death .
Hefflin et al. investigated the effect of dust storms on the number of emergency referrals in one of the south-eastern states of Washington. During the dust storm events, 24 h PM10 concentrations in two consecutive days were more than 1000 μg/m3. Numbers of patients with bronchitis referring to the center were about 3.5% per each 100 μg/m3 increase in PM10 concentration . According to the results of the present study, for each 100 μg/m3 increase in the PM10 concentration, 1.35% and 0.021% increase in the incidence of cardiovascular and respiratory diseases was observed respectively.
Pan et al. found a significant correlation between the dust storms and increased hospital admissions. The most common diseases during stormy days were pharynx, larynx, cornea, nasal and cervical inflammations .
Yang et al. investigated the effect of dust storms on the occurrence of cerebrovascular accident, 7 days before and 7 days after the dust storms events in Taiwan during 1996–2001. They found a significant difference between the storms events and the incidence of stroke 3 days after the events. However, no statistically significant difference was observed between the storm events and the incidence of cardiovascular attacks 3 days after the events .
Chiu et al. studied possible association between dust storms and hospital admissions of chronic obstructive pulmonary diseases 7 days before and after the dust storms events in Taiwan during 1996–2001. They found no significant difference between storm events and the incidence of chronic obstructive pulmonary diseases .
Chen et al. studied effect of dust storms on hospital admissions of cardiovascular diseases, 7 days before and 7 days after the dust storms events in Taiwan during 1996–2001. No significant differences were found between storms events and cardiovascular conditions .
Occurrence of dust storms could increase the probability of cardiovascular and respiratory diseases in Sanandaj. Although the correlation between respiratory diseases and the dust storms was not statistically significant, a statistically significant correlation was observed between cardiovascular diseases and dust storms events.
This study was a research priority in Kurdistan University of Medical Sciences. Hereby, many thanks go to the Deputy of Research and Deputy of Health, Kurdistan University of Medical Sciences for their cooperation and assistance.
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