[Meteorological variables and air pollution and their association with hospitalizations due to respiratory diseases in children: a case study in São Paulo, Brazil]

Short-term relation between air pollutants and hospitalizations for respiratory diseases: analysis by temporal association rules

This study investigates the relation between exposure to critical air pollution events with multipollutant (CO, PM₁₀, PM_2.5, NO₂, O₃, and SO₂) and hospitalizations for respiratory diseases in the metropolitan area of São Paulo (RMSP) and in the countryside and coastline, from 2017 to 2021. Data mining analysis by temporal association rules searched for frequent patterns of respiratory diseases and multipollutants associated with time intervals. In the results, pollutants PM₁₀, PM_2.5, and O₃ showed high concentration values in the three regions, SO₂ on the coast, and NO₂ in the RMSP. Seasonality was similar between pollutants and between cities and concentrations significantly higher in winter, except for O₃, which was present in warm seasons. Hospitalizations were recurrent during the transition from summer to colder periods. In approximately 35% of the total days with hospitalization greater than the annual average, one or more pollutants had a high concentration. The rules showed that PM_2.5, PM₁₀, and O₃ pollutants are strongly associated with increased hospitalizations in the RMSP (PM_2.5 and PM₁₀ with 38.5% support and 77% confidence) and in Campinas (PM_2.5 with 66.1% support and 94% confidence) and the pollutant O₃ with maximum support of 17.5%. On the coast, SO₂ was related to high hospitalizations (43.85% support and 80% confidence). The pollutants CO and NO₂ were not associated with the increase in hospitalizations. The ratio delay indicates the pollutants that were associated with hospitalizations, having concentration remained above the limit for three days, oscillating in smaller hospitalizations on the 1st day and again higher on the 2^nd and 3^rd days of delay, in a decreasing way. In conclusion, high pollutant exposure is significantly associated with daily hospitalization for respiratory problems. The cumulative effect of air pollutants increased hospitalization in the following days, in addition to identifying the pollutants and which pollutant combinations are most harmful to health in each region.

Spatial patterns and temporal variations of pollutants at 56 air quality monitoring stations in the state of São Paulo, Brazil

This study applied two data mining tasks: clustering and association rules to a dataset of pollutants in the state of São Paulo. The clustering task was applied to temporal patterns and geospatial distributions of pollutants, and the association rules were used to identify prevailing meteorological conditions when there were high concentrations of pollutants from 2017 to 2019. The results indicated good adequacy of the cluster, indicating different pollution levels per group, with a silhouette coefficient from 0.26 to 0.72. In the spatial evaluation, the groups severely polluted were located in the metropolitan region, on the coast and, some inland cities, by industrial, vehicular, burning, agriculture, and other emissions. The cluster identified a strong presence of O₃ and PM_2.5 in 65% and 72% of the monitored stations in several areas of the state. As for the distance between the sources of pollution, the groups of PM₁₀ and NO₂ were geographically distant, while PM_2.5, CO, SO₂, and O₃ were closer, suggesting a spatial relationship of exposure. Seasonality was similar between groups, with significantly higher concentrations in winter, except for O₃, for which higher concentrations occurred in summer. Meteorological conditions contributed to critical episodes of pollution (support and confidence greater than 80%), with low temperature and humidity, low rainfall, and milder wind associated with increased pollutants. In conclusion, investigating spatial representativeness allows revealing spatial and temporal patterns of pollutants and unfavorable meteorological conditions to diffusion. Thus, ideal and effective measures can be taken to avoid critical periods of exposure based on the behavior of pollutants in different regions and related climate changes.

Impacto das mudanças climáticas e da qualidade do ar em hospitalizações por doenças respiratórias em municípios da Região Metropolitana de São Paulo (RMSP), Brasil

Resumo Este estudo teve por objetivo analisar os possíveis impactos das mudanças climáticas na saúde respiratória nos municípios de Santo André e São Caetano do Sul. Foram analisados dados meteorológicos históricos (temperatura, precipitação, umidade relativa e pressão atmosférica), de qualidade do ar (concentrações de MP10 e O3) e de saúde respiratória (taxas de incidência de internações por doenças respiratórias - TIIDR), relacionados através de modelos estatísticos de Regressão Linear Múltipla (RLM). Dados meteorológicos de projeções climáticas futuras (2019-2099) de três modelos climáticos (um global e dois regionalizados) em dois cenários de emissão foram aplicados aos modelos de RLM. Os resultados das projeções mostraram um aumento de até 10% nas TIIDR em relação aos níveis atuais para São Caetano do Sul no período de 2070-2099. Em Santo André as projeções indicaram redução de até 26% nas TIIDR. A variável de maior peso nos modelos de RLM de Santo André foi a temperatura (-2,15x) indicando que o aquecimento é inversamente proporcional ao aumento nas TIIDR, enquanto em São Caetano do Sul a pressão atmosférica teve o maior peso (2,44x). Para próximos trabalhos recomenda-se a inclusão de projeções futuras de concentrações de poluentes atmosféricos.

Brazilian National Policy of Comprehensive Women's Health Care and mortality during climacteric period: has anything changed?

Background

The National Policy for Integral Attention to Women’s Health Care (PNAISM) was implemented in 2004, with monitoring of potential benefits. One of the life cycles of women contemplated in this health policy was the importance of health care during the climacteric. Prevention and health promotion are actions carried out by the Brazil National Health System and enshrined in health Brazilian policies for women. Thus, our purpose was to identify climacteric women’s main causes of death as well as the mortality trends of such causes, especially after implementation of PNAISM.

Methods

An ecological study was conducted from 2018 to 2020. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the National Health Information, divided into periods 1996–2004 and 2005–2016 the latter to correspond with the implementation of the National Policy. The death records of Brazilian women aged 40 to 64 years who had a designated cause of death were retrieved. Trends and differences between periods were evaluated using linear regression. The significance level was set at 5%.

Results

The main causes of death in women from 1996 to 2016 were circulatory system diseases (22.47%, 697,636 deaths), neoplasms (19.69%, 611,495 deaths), respiratory system diseases (5.5%, 170,716 deaths), endocrine, nutritional, and metabolic disorders (5.27%, 163,602 deaths), and digestive system diseases (3.74%, 116.280 deaths). Analyzing the changes in the major causes of death of climacteric women after implementation of the PNAISM we observed that mortality from circulatory system diseases and endocrine and nutritional diseases were significantly declined in post-PNAISM period: (β = − 3.63; 95% CI – 4.54 to − 2.73 r² = 0.87; p < 0.001; β = − 0.51; 95% CI, − 0.71 to − 0.31; R² = 0.73; p < 0.001, respectively). No changes were observed in mortality from neoplasms and respiratory system diseases in post-PNAISM period (p = 0,765; p = 0,233, respectively).

Conclusions

After implementation of the PNAISM, we observed a downward trend in rates of mortality from diseases of the circulatory and digestive systems and from endocrine, nutritional, and metabolic diseases but stability in the rates of death from neoplasm and respiratory system diseases.