Efeitos da exposição a poluentes do ar na saúde humana: internações por doenças respiratórias em Cuiabá, MT
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Data
2017-02-06
Autores
Machin, Adrian Blanco [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A poluição do ar é uma das principais causas de internação por doenças do aparelho respiratório. Efeitos negativos na saúde devido à exposição aos poluentes atmosféricos vêm causando aumentos nas internações hospitalares. O objetivo desse estudo consiste em identificar a associação entre a exposição ao material particulado fino, ajustado pelo monóxido de carbono sobre as internações hospitalares da rede pública por algumas doenças respiratórias na população de Cuiabá, MT, no período de 01 de janeiro de 2012 a 31 de dezembro de 2013. A metodologia utilizada fundamenta-se na pesquisa de estudo ecológico de série temporal. A variável dependente considerada foi o número de internações hospitalares concernentes às doenças: traqueite e laringite (J04.0 - J04.9), pneumonia (J12.0 - J18.9), bronquite e bronquiolite (J20.0 - J21.9), doença pulmonar obstructiva cônica (J44.0 - J44.9) e asma (J45.0 - J45.9), que representam em torno de 75% do total das doenças respiratórias (J00.0 – J99.9) e cujos códigos correspondem à CID 10, esses dados foram obtidos do DATASUS. As variáveis independentes consideradas foram as concentrações diárias dos poluentes PM2,5 e CO, estimados pelo modelo matemático CCATT-BRAMS. Os dados temperatura mínima e umidade relativa do ar foram obtidos do Instituto Nacional de Meteorologia e número de focos de queimadas do Sistema de Informações Ambientais. A abordagem estatística utilizou o modelo linear generalizado da regressão de Poisson com defasagens de 0 a 7 dias. Foram estimados custos financeiros e aumentos no número de internações decorrentes de aumentos na concentração de PM2,5 no ar. Os coeficientes fornecidos pela regressão de Poisson foram convertidos em risco relativo de internação adotando alfa = 5%. Foram 4998 internações segundo diagnóstico J-00 a J99 no período estudado, sendo 3876 internações (76,8%) por doenças específicas. A exposição ao PM2,5 quando ajustado com o CO, constitui fator de risco de internação nos 7 lags considerados, com valores entre RR=1,09 (IC95% 1,06 - 1,12) no Lag 7 e RR=1,12 (IC95% 1,09 – 1,15) no Lag 0, devido a que o CO potencializou a ação do PM2,5. Um aumento de 5 µg/m3 na concentração de PM2,5 implicou num aumento de até 1670 internações e custos acima dos R$ 1,68 milhão para o Sistema de Saúde Pública. Verificou-se portanto a associação da exposição a poluentes do ar e internações por doenças respiratórias bem como a exeqüibilidade de uso de modelo matemático.
Air pollution is one of the main causes of hospitalization for respiratory diseases. Negative health effects due to exposure to air pollutants are causing increases in hospital admissions. The objective of this study is to identify the association between exposure to fine particles, adjusted for carbon monoxide and hospitalizations in Public Health System by some respiratory diseases in the population of Cuiabá, MT, in the period of January 1, 2012 To December 31, 2013. The methodology used is based on the ecological study of time series. The dependent variable was the number of hospital admissions in relation to diseases: tracheitis and laryngitis (J04.0 - J04.9), pneumonia (J12.0 - J18.9), bronchitis and bronchiolitis (J20.0 - J21. 9), congestive pulmonary disease (J44.0 - J44.9), and asthma (J45.0 - J45.9), which account for about 75% of all respiratory diseases (J00.0 - J99.9) And whose codes correspond to ICD-10, these data were obtained from DATASUS. The independent variables were the daily concentration of pollutants PM2,5 and CO, estimated by the mathematical model CCATT-BRAMS. Data of minimum temperature and the relative humidity were obtained from the National Institute of Meteorology and the number of fires from the system of environmental information. The statistical approach used the linear model of Poisson regression with delay of 0 to 7 days (lag0 to lag7). Financial expenses and increases in the number of hospitalizations due to the increase in the PM2,5 concentration in the air were estimated. The coefficients provided by the Poisson regression became the relative risk of hospitalization considering alpha = 5%. There were 4998 hospitalizations according to J-00 to J99 diagnoses in the study period, with 3876 hospitalizations (76.8%) for the specific diseases. Exposure to PM2,5 when adjusted for CO, constitutes a risk factor for hospitalization in the 7 considered lags, ranging from RR = (CI 95%: 1.06 to 1.12) 1.09 in Lag 7 and RR = 1.12 (95% CI: 1.09 to 1.15) in Lag 0, because CO increases the action of PM2,5. An increase of 5 µg/m3 in the concentration of PM2,5 resulted in an increase up to 1670 hospitalizations and costs of R$ 1,68 million for the Public Health System. Therefore, the association of exposure to air pollutants and hospitalizations due to respiratory diseases, as well as the viability of the mathematical model in use, were verified.
Air pollution is one of the main causes of hospitalization for respiratory diseases. Negative health effects due to exposure to air pollutants are causing increases in hospital admissions. The objective of this study is to identify the association between exposure to fine particles, adjusted for carbon monoxide and hospitalizations in Public Health System by some respiratory diseases in the population of Cuiabá, MT, in the period of January 1, 2012 To December 31, 2013. The methodology used is based on the ecological study of time series. The dependent variable was the number of hospital admissions in relation to diseases: tracheitis and laryngitis (J04.0 - J04.9), pneumonia (J12.0 - J18.9), bronchitis and bronchiolitis (J20.0 - J21. 9), congestive pulmonary disease (J44.0 - J44.9), and asthma (J45.0 - J45.9), which account for about 75% of all respiratory diseases (J00.0 - J99.9) And whose codes correspond to ICD-10, these data were obtained from DATASUS. The independent variables were the daily concentration of pollutants PM2,5 and CO, estimated by the mathematical model CCATT-BRAMS. Data of minimum temperature and the relative humidity were obtained from the National Institute of Meteorology and the number of fires from the system of environmental information. The statistical approach used the linear model of Poisson regression with delay of 0 to 7 days (lag0 to lag7). Financial expenses and increases in the number of hospitalizations due to the increase in the PM2,5 concentration in the air were estimated. The coefficients provided by the Poisson regression became the relative risk of hospitalization considering alpha = 5%. There were 4998 hospitalizations according to J-00 to J99 diagnoses in the study period, with 3876 hospitalizations (76.8%) for the specific diseases. Exposure to PM2,5 when adjusted for CO, constitutes a risk factor for hospitalization in the 7 considered lags, ranging from RR = (CI 95%: 1.06 to 1.12) 1.09 in Lag 7 and RR = 1.12 (95% CI: 1.09 to 1.15) in Lag 0, because CO increases the action of PM2,5. An increase of 5 µg/m3 in the concentration of PM2,5 resulted in an increase up to 1670 hospitalizations and costs of R$ 1,68 million for the Public Health System. Therefore, the association of exposure to air pollutants and hospitalizations due to respiratory diseases, as well as the viability of the mathematical model in use, were verified.
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Palavras-chave
Poluição do ar, Material particulado, Monóxido de carbono, Doenças do aparelho respiratório, Air pollution, Particulate matter, Carbon monoxide, Respiratory diseases