Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations

Journal of Exposure Science & Environmental Epidemiology volume 26, pages 150–161 (2016)Cite this article

Subjects

Abstract

Health impacts of air pollution may differ depending on sex, education, socioeconomic status (SES), location at time of death, and other factors. In São Paulo, Brazil, questions remain regarding roles of individual and community characteristics. We estimate susceptibility to air pollution based on individual characteristics, residential SES, and location at time of death (May 1996–December 2010). Exposures for particulate matter with an aerodynamic diameter ≤10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were estimated using ambient monitors. Time-stratified case-crossover analysis was used with individual-level health data. Increased risk of non-accidental, cardiovascular, and respiratory mortality were associated with all pollutants (P<0.05), except O3 and cardiovascular mortality. For non-accidental mortality, effect estimates for those with >11 years education were lower than estimates for those with 0 years education for NO2, SO2, and CO (1.66% (95% confidence interval: 0.23%, 3.08%); 1.51% (0.51%, 2.51%); and 2.82% (0.23%, 5.35%), respectively). PM10 cardiovascular mortality effects were (3.74% (0.044%, 7.30%)) lower for the high education group (>11 years) compared with the no education group. Positive, significant associations between pollutants and mortality were observed for in-hospital deaths, but evidence of differences in air pollution-related mortality risk by location at time of death was not strong.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F . Ozone and short-term mortality in 95 US urban communities, 1987-2000. J Am Med Assoc 2004; 292: 2372–2378.

    Article  CAS  Google Scholar 

  2. Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. J Am Med Assoc 2006; 295: 1127–1134.

    Article  CAS  Google Scholar 

  3. Pope CAI, Ezzati M, Dockery DW . Fine-particulate air pollution and life expectancy in the United States. N Engl J Med 2009; 260: 376–386.

    Article  Google Scholar 

  4. Goncalves FLT, Carvalho LMV, Conde FC, Latorre MRDO, Saldiva PHN, Braga ALF . The effects of air pollution and meteorological parameters on respiratory morbidity during the summer in São Paulo city. Environ Int 2005; 31: 343–349.

    Article  CAS  Google Scholar 

  5. Gouveia N, De Freitas CU, Martins LC, Marcilio IO . Respiratory and cardiovascular hospitalizations associated with air pollution in the city of São Paulo, Brazil. Cad Saúde Pública 2006; 22: 2669–2677.

    Article  Google Scholar 

  6. Martins MCH, Fatigati FL, Vespoli TC, Martins LC, Pereira LAA, Martins MA et al. Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil. J Epidemiol Community Health 2004; 58: 41–46.

    Article  CAS  Google Scholar 

  7. Miraglia SGEK, Saldiva PHN, Bohm GM . An evaluation of air pollution health impacts and costs in São Paulo, Brazil. Environ Manage 2005; 35: 667–676.

    Article  Google Scholar 

  8. Ribeiro H, Cardoso MR . Air pollution and children's health in São Paulo (1986-1998). Soc Sci Med 2003; 57: 2013–2022.

    Article  Google Scholar 

  9. Santos UP, Terra-Filho M, Lin CA, Pereira LAA, Vieira TCB, Saldiva PHN et al. Cardiac arrhythmia emergency room visits and environmental air pollution in São Paulo, Brazil. J Epidemiol Community Health 2008; 62: 267–272.

    Article  CAS  Google Scholar 

  10. Carozza SE, Se Puumala, Chow EJ, Fox EE, Horel S, Johnson KJ et al. Parental educational attainment as an indicator of socioeconomic status and risk of childhood cancers. Br J Cancer 2010; 103: 136–142.

    Article  CAS  Google Scholar 

  11. Stewart J . Social Environment Notebook. In: Educational Status. University of California: San Francisco, NC, USA. 2009 Available on: http://www.macses.ucsf.edu/research/socialenviron/education.php//www.macses.ucsf.edu/research/socialenviron/education.php.

    Google Scholar 

  12. Bell ML, Davis DL, Gouveia N, Borja-Aburto VH, Cifuentes LA . The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City. Environ Res 2006; 100: 431–440.

    Article  CAS  Google Scholar 

  13. Bell ML, Dominci F, Ebisu K, Zeger SL, Samet JM . Spatial and temporal variation in PM2.5 chemical composition in the United States for health effect studies. Environ Health Perspect 2007; 115: 989–995.

    Article  CAS  Google Scholar 

  14. Chen B, Kan H . Air pollution and population health: a global challenge. Environ Health Prev Med 2008; 13: 94–101.

    Article  CAS  Google Scholar 

  15. Gouveia N, Fletcher T . Time series analysis of air pollution and mortality: effects by cause, age, and socioeconomic status. J Epidemiol Community Health 2000; 54: 750–755.

    Article  CAS  Google Scholar 

  16. O'Neill MS, Bell ML, Ranjit N, Cifuentes LA, Loomis D, Gouveia N et al. Air pollution and mortality in Latin America: the role of education. Epidemiology 2008; 19: 810–819.

    Article  Google Scholar 

  17. Schwartz J . What are people dying of on high air pollution days? Environ Res 1994; 64: 26–35.

    Article  CAS  Google Scholar 

  18. Tellez-Rojo MM, Romieu I, Ruiz-Velasco S, Lezana MA, Hernandez-Avila MM . Daily respiratory mortality and PM10 pollution in Mexico City: importance of considering place of death. Eur Respir J 2000; 16: 391–396.

    Article  CAS  Google Scholar 

  19. Zeka A, Zanobetti A, Schwartz J . Individual-level modifiers of the effects of particulate matter on daily mortality. Am Journ Epidemiol 2006; 163: 849–859.

    Article  Google Scholar 

  20. Cesaroni G, Badaloni C, Romano V, Donato E, Perucci CA, Forastiere F . Socioeconomic position and health status of people who live near busy roads: the Rome Longitudinal Study (RoLS). Environ Health 2010; 9: 41.

    Article  Google Scholar 

  21. Chaix B, Gustafsson S, Jerrett M, Kristersson H, Lithman T, Boalt A et al. Children's exposure to nitrogen dioxide in Sweden: investigating environmental injustice in an egalitarian country. J Epidemiol Community Health 2006; 60: 234–241.

    Article  Google Scholar 

  22. Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 2001; 345: 99–106.

    Article  CAS  Google Scholar 

  23. Mann JK, Tager IB, Lurmann F, Segal M, Quesenberry CP, Jr., Lugg MM et al. Air pollution and hospital admissions for ischemic heart disease in persons with congestive heart failure or arrhythmia. Environ Health Perspect 2002; 110: 1247–1252.

    Article  CAS  Google Scholar 

  24. SEADE. In: Regional SdPeD (ed.), Fundacao Sistema Estadual de Analise de Dados. Governo do Estado Sao Paulo: Sao Paulo, Brazil, 2002.

  25. Takiya H, Atlas Ambiental do Municipio de São Paulo - Perfil Socioeconomico. Prefeitura da cidade de São Paulo: São Paulo, Brazil, 2002.

  26. Maclure M . The case-crossover design: a method for studying transient effects on the risk of acute events. Am Journ Epidemiol 1991; 133: 144–153.

    Article  CAS  Google Scholar 

  27. Lee JT, Schwartz J . Reanalysis of the effects of air pollution on daily mortality in Seoul, Korea: a case-crossover design. Environ Health Perspect 1999; 107: 633–636.

    Article  CAS  Google Scholar 

  28. Levy D, Lumley T, Sheppard L, Kaufman J, Checkoway H . Referent selection in case-crossover analyses of acute health effects of air pollution. Epidemiology 2001; 12: 186–192.

    Article  CAS  Google Scholar 

  29. Medina-Ramon M, Schwartz J . Who is more vulnerable to die from ozone air pollution? Epidemiology 2008; 19: 672–679.

    Article  Google Scholar 

  30. Clougherty JE . A Growing role for gender analysis in air pollution epidemiology. Environ Health Perspect 2010; 118: 167–176.

    Article  CAS  Google Scholar 

  31. Bell ML, Peng RD, Dominici F, Samet JM . Emergency hospital admissions for cardiovascular diseases and ambient levels of carbon monoxide: results for 126 U.S. urban counties, 1999-2005. Circulation 2009; 120: 949–955.

    Article  CAS  Google Scholar 

  32. Burnett RT, Cakmak S, Me Raizenne, Stieb D, Vincent R, Krewski D et al. The association between ambient carbon monoxide levels and daily mortality in Toronto, Canada. J Air Waste Manag Assoc 1998; 48: 689–700.

    Article  CAS  Google Scholar 

  33. Linn WS, Szlachcic Y, gong H, Kinney PL, Berhane T . Air pollution and daily hospital admissions in metropolitan Los Angeles. Environ Health Perspect 2000; 105: 427–434.

    Article  Google Scholar 

  34. Morris R, Naumova EN, Munasinghe RL . Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large U.S. cities. Am J Public Health 1995; 85: 1361–1365.

    Article  CAS  Google Scholar 

  35. Morris RD, Naumova EN . Carbon monoxide and hospital admissions for congestive heart failure: Evidence of an icnreased effect at low temperature. Environ Health Perspect 1998; 106: 649–653.

    Article  CAS  Google Scholar 

  36. Monteiro CA, Cavalcante TM, Moura EC, Claro RM, Szwarcwald CL . Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003). Bull World Health Organ 2007; 85: 527–534.

    Article  Google Scholar 

  37. Anderson HR, Atkinson RW, Bremner SA, Marston L . Particulate air pollution and hospital admissions for cardiorespiratory diseases: are the elderly at greater risk? Eur Res J Suppl 2003; 40: 39s–46s.

    Article  CAS  Google Scholar 

  38. Fischer P, Hoek G, Brunekreef B, Verhoeff A, van Wijnen J . Air pollution and mortality in The Netherlands: are the elderly more at risk? Eur Res J Suppl 2003; 40: 34s–38ss.

    Article  CAS  Google Scholar 

  39. Hoek G, Brunekreef B, Goldbohm S, Fischer P, van den Brandt PA . Association between mortlaity and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet 2002; 360: 1203–1209.

    Article  Google Scholar 

  40. Ou CQ, Chung RY, Thach TQ, Chan KP, Chau YK, Yang L et al. The modifying effects of individual socioeconomic status on mortality risk associated with air pollution (abstract). Epidemiology 2006; 17: S96.

    Article  Google Scholar 

  41. Filleul L, Rondeau V, Cantagrel A, Dartigues JF, Tessier JF . Do subject characteristics modify the effects of particulate air pollution on daily mortality among the elderly? J Occup Environ Med 2004; 46: 1115–1122.

    Article  Google Scholar 

  42. Filleul L, Rondeau V, VAndentorren S, Le Moual N, Cantagrel A, Annes-Maesano I et al. Twenty five year mortality and air pollution: results from the French PAARC survey. Occup Environ Med 2005; 62: 453–460.

    Article  CAS  Google Scholar 

  43. Kryzanowski M, Wojtyniak B . Ten-year mortality in a sample of an adult population in relation to air pollution. J Epidemiol Community Health 1982; 36: 262–268.

    Article  Google Scholar 

  44. Pope CA, III, Burnett RT, Thun MJ, Calle EE, Krewdki D, Ito K et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. J Am Med Assoc 2002; 287: 1132–1141.

    Article  CAS  Google Scholar 

  45. Son JY, Lee JT, Kim H, Yi O, Bell ML . Susceptibility to air pollution effects on mortality in Seoul, Korea: a case-crossover analysis of individual-level effect modifiers. J Expo Sci Environ Epidemiol 2012; 22: 227–234.

    Article  CAS  Google Scholar 

  46. Zanobetti A, Schwartz J, Gold D . Are there sensitive subgroups for the effects of airborne particles? Environ Health Perspect 2000; 108: 841–845.

    Article  CAS  Google Scholar 

  47. Bell ML, Ebisu K, Belanger K . Ambient air pollution and low birth weight in Connecticut and Massachusetts. Environ Health Perspect 2007; 115: 1118–1125.

    Article  CAS  Google Scholar 

  48. Jerrett M, Burnett RT, Brook J, Kanaroglou P, Giovis C, Finkelstein N et al. Do socioeconomic characteristics modify the short term associations between air pollution and mortality? Evidence from a zonal time series in Hamilton, Canada. J Epidemiol Community Health 2004; 58: 31–40.

    Article  CAS  Google Scholar 

  49. O'Neill M, Jerrett M, Kawachi I, Levy JI, Cohen A, Gouveia N et al. Health, wealth, and air pollution: advancing theory and methods. Environ Health Perspect 2003; 111: 1861–1870.

    Article  Google Scholar 

  50. Jaime PC, Monteiro CA . Fruit and vegetable intake by Brazilian adults. Cad Saúde Pública 2005; 21: S19–S24.

    Article  Google Scholar 

  51. Janssen I, Boyce WF, Simpson K, Pickett W . Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical activity in Canadian adolescents. Am J Clin Nutr 2006; 83: 139–145.

    Article  CAS  Google Scholar 

  52. Kawachi I, Subramanian SV . Neigbourhood influences on health. J Epidemiol Community Health 2007; 61: 3–4.

    Article  CAS  Google Scholar 

  53. Morland K, Wing S, Diez Roux AV, Poole C . Neighborhood characteristics associated with the location of food stores and food service plans. Am J Prev Med 2002; 22: 23–29.

    Article  Google Scholar 

  54. Reynolds P, Von Behren J, Gunier R, Goldberg D, Hertz A, Smith D . Traffic patterns and childhood cancer incidence rates in California, United States. Cancer Causes Control 2002; 13: 665–673.

    Article  Google Scholar 

  55. Shenassa E, Stubbendick A, Brown MJ . Social disparities in housing and related pediatric injury: a multilevel study. Am J Pu blic Health 2004; 94: 633–639.

    Article  Google Scholar 

  56. Kawachi I, Berkman L . Neighborhoods and Health. Oxford University Press: New York, USA. 2003.

    Book  Google Scholar 

  57. Hajat A, Diez Roux AV, Adar SD, Auchincloss AH, Lovasi GS, O'Neill MS et al. Air pollution and individual and neigbhorhood socioeconomic status: evidence from the Multi-Ethnic Study of Atherosclerosis (MESA). Environ Health Perspect 2013; 121: 1325–1333.

    Article  Google Scholar 

  58. Wheeler BW, Ben-Shlomo Y . Environm ental equity, air quality, socioeconomic status, and respiratory health: A linkage analysis of routine data from the Health Survey for England. J Epidemiol Community Health 2005; 59: 948–954.

    Article  Google Scholar 

  59. Bravo MA, Bell ML . Spatial heterogeneity of PM10 and O3 in São Paulo, Brazil, and implications for human health studies. J Air Waste Manag Assoc 2011; 61: 69–77.

    Article  CAS  Google Scholar 

  60. Neto RS, Duarte G, Paez A . Gender and commuting time in Sao Paulo Metropolitan Region. Urban Studies. 2014, 1–16.

Download references

Acknowledgements

This work was supported by the U.S. Environmental Protection Agency (EPA RD 83479801).

Author information

Authors and Affiliations

  1. School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA

    Mercedes A Bravo, Jiyoung Son & Michelle L Bell

  2. Faculty of Medicine, Departament of Preventative Medicine, University of São Paulo, Cerqueira Cesar, São Paulo, Brazil

    Clarice Umbelino de Freitas & Nelson Gouveia

Authors
  1. Mercedes A Bravo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiyoung Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clarice Umbelino de Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nelson Gouveia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michelle L Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelle L Bell.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Exposure Science and Environmental Epidemiology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bravo, M., Son, J., de Freitas, C. et al. Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations. J Expo Sci Environ Epidemiol 26, 150–161 (2016). https://doi.org/10.1038/jes.2014.90

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jes.2014.90

Keywords

Search

Advanced search

Quick links