South African Medical Journal

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Estimating the burden of disease attributable to urban outdoor air pollution in South Africa in 2000

R Norman, E Cairncross, J Witi, D Bradshaw, South African Comparitive Risk Assessment Collaboration Grou


Objectives. To quantify the mortality burden attributed to urban
outdoor air pollution in South Africa in 2000.
Design. The study followed comparative risk assessment (CRA)
methodology developed by the World Heath Organization
(WHO). In most urban areas, annual mean concentrations
of particulate matter (PM) with diameters less than 10 μm
(PM10) from monitoring network data and PM with diameters
less than 2.5 μm (PM2.5) derived using a ratio method were
weighted according to population size. PM10 and PM2.5 data
from air-quality assessment studies in areas not covered by the
network were also included. Population-attributable fractions
calculated using risk coefficients presented in the WHO study
were weighted by the proportion of the total population (33%)
in urban environments, and applied to revised estimates of
deaths and years of life lost (YLLs) for South Africa in 2000.
Setting. South Africa.
Subjects. Children under 5 years and adults 30 years and older.
Outcome measures. Mortality and YLLs from lung cancer and
cardiopulmonary disease in adults (30 years and older), and
from acute respiratory infections (ARIs) in children aged 0 - 4
Results. Outdoor air pollution in urban areas in South Africa
was estimated to cause 3.7% of the national mortality from
cardiopulmonary disease and 5.1% of mortality attributable
to cancers of the trachea, bronchus and lung in adults aged 30
years and older, and 1.1% of mortality from ARIs in children
under 5 years of age. This amounts to 4 637 or 0.9% (95%
uncertainty interval 0.3 - 1.5%) of all deaths and about 42 000
YLLs, or 0.4% (95% uncertainty interval 0.1 - 0.7%) of all YLLs
in persons in South Africa in 2000.
Conclusion. Urban air pollution has under-recognised public
health impacts in South Africa. Fossil fuel combustion
emissions and traffic-related air pollution remain key targets
for public health in South Africa.

South African Medical Journal Vol. 97 (8) Part 2 2007: pp. 782-790

AJOL African Journals Online