Effects of air pollution on respiratory hospital admissions in Istanbul, Turkey, 2013 to 2015

We examined the associations between the daily variations of air pollutants and hospital admissions for respiratory diseases in Istanbul, the largest city of Turkey. A time series analysis of counts of daily hospital admissions and outdoor air pollutants was performed using single-pollutant Poisson generalized linear model (GLM) while controlling for time trends and meteorological factors over a 3-year period (2013-2015) at different time lags (0-9 days). Effects of the pollutants (Excess Risk, ER) on current-day (lag 0) hospital admissions to the first ten days (lag 9) were determined. Data on hospital admissions, daily mean concentrations of air pollutants of PM10, PM2.5 and NO2 and daily mean concentrations of temperature and humidity of Istanbul were used in the study. The analysis was conducted among people of all ages, but also focused on different sexes and different age groups including children (0-14 years), adults (35-44 years) and elderly (>= 65 years). We found significant associations between air pollution and respiratory related hospital admissions in the city. Our findings showed that the relative magnitude of risks for an association of the pollutants with the total respiratory hospital admissions was in the order of: PM2.5, NO2, and PM10. The highest association of each pollutant with total hospital admission was observed with PM2.5 at lag 4 (ER = 1.50; 95% CI = 1.09-1.99), NO2 at lag 4 (ER = 1.27; 95% CI = 1.02-1.53) and PM10 at lag 0 (ER = 0.61; 95% CI = 0.33-0.89) for an increase of 10 mu g/m3 in concentrations of the pollutants. In conclusion, our study showed that short-term exposure to air pollution was positively associated with increased respiratory hospital admissions in Istanbul during 2013-2015. As the first air pollution hospital admission study using GLM in Istanbul, these findings may have implications for local environmental and social policies. (C) 2017 Elsevier Ltd. All rights reserved.