The Relationship Between Air Pollution and All-Cause Mortality in Singapore

Ho, Andrew Fu Wah; Zheng, Huili; Cheong, Kang Hao; En, Wee Liang; Pek, Pin Pin; Zhao, Xinxing; Morgan, Geoffrey G.; Earnest, Arul; Tan, Benjamin Yong Qiang; Ng, Yih Yng; Foo, Ling Li; Ong, Marcus Eng Hock

doi:10.3390/atmos11010009

Open AccessArticle

The Relationship Between Air Pollution and All-Cause Mortality in Singapore

by

Andrew Fu Wah Ho

^1,2,†

,

Huili Zheng

^3,†,

Kang Hao Cheong

^4,*

,

Wee Liang En

⁵,

Pin Pin Pek

⁶,

Xinxing Zhao

⁷,

Geoffrey G. Morgan

⁸,

Arul Earnest

⁹,

Benjamin Yong Qiang Tan

¹⁰,

Yih Yng Ng

¹¹,

Ling Li Foo

¹² and

Marcus Eng Hock Ong

^6,13

¹

SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore 169857, Singapore

²

Signature Research Programme in Cardiovascular & Metabolic Disorders, Duke-National University of Singapore Medical School, Singapore 169857, Singapore

³

National Registry of Diseases Office, Health Promotion Board, Singapore 169937, Singapore

⁴

Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore

⁵

Department of Infectious Diseases, Singapore General Hospital, Singapore 169857, Singapore

⁶

Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore

⁷

Singapore University of Technology and Design, Singapore 487372, Singapore

⁸

School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia

⁹

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia

¹⁰

Division of Neurology, Department of Medicine, National University Health System, Singapore 169857, Singapore

¹¹

Emergency Medicine Department, Tan Tock Seng Hospital, Singapore 169857, Singapore

¹²

National Registry of Diseases Office, Health Promotion Board, Singapore 169857, Singapore

¹³

Department of Emergency Medicine, Singapore General Hospital, Singapore 169857, Singapore

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^*

Author to whom correspondence should be addressed.

^†

Joint first author.

Atmosphere 2020, 11(1), 9; https://doi.org/10.3390/atmos11010009

Submission received: 11 October 2019 / Revised: 25 November 2019 / Accepted: 5 December 2019 / Published: 20 December 2019

(This article belongs to the Special Issue Bioaerosol Exposure and Risk Assessment)

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Abstract

Ambient air pollution is a risk factor for both acute and chronic diseases and poses serious health threats to the world population. We aim to study the relationship between air pollution and all-cause mortality in the context of a city-state exposed to the Southeast Asian haze problem. The primary exposure was ambient air pollution, as measured by the Pollutants Standards Index (PSI). The outcome of interest was all-cause mortality from 2010–2015. A time-stratified case-crossover design was performed. A conditional Poisson regression model, including environmental variables such as PSI, temperature, wind speed, and rainfall, was fitted to the daily count of deaths to estimate the incidence rate ratio (IRR) of mortality per unit increase in PSI, accounting for overdispersion and autocorrelation. To account for intermediate exposure effects (maximum lag of 10 days), a distributed lag non-linear model was used. There were 105,504 deaths during the study period. Increment in PSI was significantly associated with an increased risk of mortality. The adjusted IRR of mortality per the 10-unit increase in PSI was 1.01 (95%CI = 1.00–1.01). The lag effect was stronger when PSI was in the unhealthy range compared to the good and moderate ranges. At lag = 7 days, PSI appeared to have an adverse effect on mortality, although the effect was not significant. These findings provide evidence on the general health hazard of exposure to air pollution and can potentially guide public health policies in the region.

Keywords: transboundary; haze; air pollution; healthcare; environmental epidemiology; public health; mortality; Southeast Asia; particulate metter

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MDPI and ACS Style

Ho, A.F.W.; Zheng, H.; Cheong, K.H.; En, W.L.; Pek, P.P.; Zhao, X.; Morgan, G.G.; Earnest, A.; Tan, B.Y.Q.; Ng, Y.Y.; et al. The Relationship Between Air Pollution and All-Cause Mortality in Singapore. Atmosphere 2020, 11, 9. https://doi.org/10.3390/atmos11010009

AMA Style

Ho AFW, Zheng H, Cheong KH, En WL, Pek PP, Zhao X, Morgan GG, Earnest A, Tan BYQ, Ng YY, et al. The Relationship Between Air Pollution and All-Cause Mortality in Singapore. Atmosphere. 2020; 11(1):9. https://doi.org/10.3390/atmos11010009

Chicago/Turabian Style

Ho, Andrew Fu Wah, Huili Zheng, Kang Hao Cheong, Wee Liang En, Pin Pin Pek, Xinxing Zhao, Geoffrey G. Morgan, Arul Earnest, Benjamin Yong Qiang Tan, Yih Yng Ng, and et al. 2020. "The Relationship Between Air Pollution and All-Cause Mortality in Singapore" Atmosphere 11, no. 1: 9. https://doi.org/10.3390/atmos11010009

APA Style

Ho, A. F. W., Zheng, H., Cheong, K. H., En, W. L., Pek, P. P., Zhao, X., Morgan, G. G., Earnest, A., Tan, B. Y. Q., Ng, Y. Y., Foo, L. L., & Ong, M. E. H. (2020). The Relationship Between Air Pollution and All-Cause Mortality in Singapore. Atmosphere, 11(1), 9. https://doi.org/10.3390/atmos11010009

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