Effect of Particulate Matter and Nitrogen Dioxide Levels on Chronic Bronchitis Incidence and Mortality in Marmara Region: Retrospective Cohort Study

Objective: The harmful effects of air pollution on human health have been proven by epidemiological studies. The aim of this study was to investigate the effect of two parameters that are determinants of air quality: particulate matter (PM10) and nitrogen dioxide (NO2) pollution levels on the incidence of chronic bronchitis and deaths due to air pollution. Material and Methods: We made the calculations by entering the 2018 population, mortality and PM10 and NO2 values of 11 provinces in the Marmara Region (İstanbul, Kocaeli, Edirne, Tekirdağ, Kırklareli, Sakarya, Bilecik, Bursa, Balıkesir, Çanakkale and Yalova) into the AirQ+ program [World Health Organization (WHO)]. All calculations made by AirQ+ are based on methodologies and dose-response functions established by epidemiological studies. In the calculations, the PM10 and NO2 limit value has been accepted as 20 μg/m3 . Results: It has been determined that the annual average PM10 level of all provinces in our study and the annual average NO2 level of eight provinces did not comply with the limit values recommended by WHO. Consistent with the particulate matter values, the highest incidence of chronic bronchitis among provinces are 43.71% [confidence interval (CI) 95%, relative risk (RR): 18.43-59.31] in Bursa and Sakarya 38.5% (CI 95%, RR: 15.71- 52.96); the highest number of people with chronic bronchitis attributed to air pollution has been found to be 2,349 (minimum 912-maximum 3,404) in İstanbul. Conclusion: Findings indicate the incidence of chronic bronchitis attributed to air pollution and the share of air pollution in deaths. Studies in different cities may contribute to the literature.