An Epidemiological Study on E ffects of Air Pollutants on Respiratory Morbidity among Adults

1. An Epidemiological Study on Effects of Air Pollutants on Respiratory Morbidity among Adults By MANOJ KUMAR Guides Prof. Rajesh Kumar Prof. S.K. Jindal Dr. Madhu Khullar

2. Air pollution is causing immense concern in India. Ambient Air Quality in Major Cities During 2002

3. Effect of London Smog

4. Acute Effects of Air Pollution

5. Chronic Effects of Air Pollution

6. AimThe study was aimed to evaluate effects of air pollutants on respiratory morbidity among adults Objectives • To monitor ambient air quality. • To estimate the prevalence of respiratory morbidity and lung functions. • To determine association between air pollution and respiratory morbidity.

7. Material And Methods Study Design-Cross-sectional study. • Household survey for morbidity. • Ambient air quality monitoring.

8. Mandi Gobindgarh Morinda Study area Reference area Area of 32 Km2 Area of 7 km2 Population 55,400 Population 21,800 Steel rolling mills and foundries. One sugar mill only. Study Area Mandi Gobindgarh Morinda

9. Mandi Gobindgarh Guru ki Nagri Prem Nagar Morinda Rest House Colony Purana Bazar Sampling Sites

10. Sampling Site Map of Morinda Map of Mandi Gobindgarh Guru ki Nagri Prem Nagar

11. Cluster Sampling Random selection of household and then next nearest household till 500 individuals enrolled from each of study site.

12. Sample Design

13. Study Tools • Questionnaire Respiratory symptoms and diseases, SES (Kuppuswami scale), Household environment, Smoking history, Occupational history • Physical Examination Height (cm.) Weight (kg.) Spirometery by portable ventilometer FVC, FEV1, PEFR, FEV1/FVC%

14. Exposure Monitoring • Air Sampling-weekly for two years SPM, NOx, SOx, O3 High Volume Air Sampler Twelve hourly CO Organic Vapors Sampler Eight hourly • Meterological data Wind velocity, Temperature and humidity

15. Data Collection

16. Variable Definitions • Cough: If an individual usually coughs from his/her chest first thing in the morning. • Phlegm: If an individual usually bring up phlegm from his/her chest first thing in the morning. • Dysponea:Shortness of breath when walking up a slight hill or others people of his/her age on the level ground or at his/her own pace on level ground or bath, washing or dressing . • Wheezing: Whistling sound while breathing.

17. Chronic bronchitis: If an individual usually has any cough or sputum from his/her chest during the day or night, twice or more, in winter for more than three months in a year, for two consecutive years. • Overcrowding: The degree of overcrowding can be expressed, as the number of persons per room, i.e., number of persons in the household divided by the number of rooms in the dwelling. • Year Of Residence: Those who were residing in the town for less than 10 years and others for more than 10 years in the town.

18. Dust Exposure At Place of Work • Mild: idle, shopkeepers, businessmen, secondary education teaching professionals, clerks, sales retail assistants, tailor etc. • Moderate: goldsmith, cobbler, electrician, fitter, heavy good vehicle driver, house keeper, halwai, maid servant, farmer, dhaba worker or those who are taking care of animals. • Severe: smiths and forges, sheet metal workers, labours in other construction modes, labour in building and wood working, road sweeper, cleaners, motor mechanics, petrol pump worker.

19. Categorize Using FVC Mild FVC >60% Moderate FVC 40-60% Severe FVC <40% Categorize Using FEV1 Mild FEV1 >60% Moderate FEV1 40-60% Severe FEV1 <40% Algorithm For Interpretation Of Spirometry Data Comparison of FEV1/FVC to its LLN FEV1/FVC  LLN for FEV1/FVC FEV1/FVC < LLN for FEV1/FVC FVC  LLN for FVCFVC <LLN for FVC NORMAL STUDY RESTRICTIVE DEFECT OBSTRUCTIVE DEFECT

20. Statistical Analysis • Concentration of SPM, SOx, NOx, CO and O3 was summarised as means and standard deviation. • Prevalence of respiratory symptoms & spirometric airflow limitation • Chi-square test • Student’s t-test • Mantel-Haenszel summary odds ratio • Logistic regression analysis • Interaction between the air pollution and smoking was also included in the models.

21. Socio-demographic Characteristics of Study Population *P<0.05

22. Air Pollution Levels *P<0.05

23. MALES FEMALES Prevalence of Respiratory Symptoms Morinda Mandi Gobindgarh *P<0.05

24. Prevalence of Respiratory Diseases Morinda Mandi Gobindgarh MALE FEMALE *P<0.05

25. Prevalence of Spirometric Abnormalities *P<0.05

26. Prevalence of Cough *P<0.05

27. Prevalence of Spirometric Obstruction *P<0.05

28. Association of Ambient Air Quality with Cough(Logistic regression analysis)

29. Association of Ambient Air Quality with Obstructive Defects

30. Association of Residence in Poor Air Quality with Chronic Respiratory Morbidities

31. Summary • High level of SPM in study town. • Chronic respiratory morbidity was higher in the study town. • Smoking, Non-LPG fuel users, Inadequate lighting, Inadequate Ventilation, Dampness and Occupational dust exposure was higher but SES was lower in study town. • Stratified analysis shows increased respiratory morbidity in poor air quality town in most of the categories of confounders. • Logistic regression analysis reveled that high SPM level is responsible for higher respiratory morbidity even after controlling the effect of age, sex, SES, Smoking, Non-LPG fuel, Inadequate lighting and ventilation, Dampness, Occupational dust exposure.

32. Study Strength • Household survey was done by choosing respondent from community by cluster sampling, thus selection bias was avoided. • Information bias was avoided by conducting interview and spirometry using same instrument and same investigator. • High response rate (>90%) avoided non-participant bias. • The data collection was concurrent in both the town and continued for two years. Thus, including any seasonal variations. • Not only inquiry on symptoms was conducting but spirometry was also done according to standard procedure given by A.T.S. and instrument was calibrated monthly.

33. Study Limitation • Assessment of air pollution and respiratory health was done at the same time in the study. • The occurrence of chronic respiratory disease require exposure to poor air quality for long period of time.

34. Annual Averages of SPM in Mandi Gobindgarh SPM (g/m3) • The data collected by the pollution control board shows that the quality of the ambient air in the study town was poor for a numbers of years and most of the migrant workers had resided in the town for considerable period of time.

35. Conclusion It is concluded that people of Mandi Gobindgarh, which had quite high SPM level, have significantly more symptoms of cough, phlegm, dysponea, wheeze, chronic bronchitis, asthma and have obstructive defects as compared to Morinda which had all air pollutants below permissible level.

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