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The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period

Background: There is limited data on the association between ambient air pollution cardiorespiratory outcomes among adults especially among populations with low socio-economic status in low- and middle income countries. Objectives: A cross-sectional cohort study was conducted in four informal settle...

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Main Author: Allie, Tasneem
Other Authors: Dalvie, Aqiel
Format: Thesis
Language:Eng
Published: Department of Public Health and Family Medicine 2025
Subjects:
Medicine
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access_status_str Open Access
author Allie, Tasneem
author2 Dalvie, Aqiel
author_browse Allie, Tasneem
Dalvie, Aqiel
author_facet Dalvie, Aqiel
Allie, Tasneem
author_sort Allie, Tasneem
collection Thesis
description Background: There is limited data on the association between ambient air pollution cardiorespiratory outcomes among adults especially among populations with low socio-economic status in low- and middle income countries. Objectives: A cross-sectional cohort study was conducted in four informal settlements of the Western Cape to determine the association between annual NO2 and PM2.5 air pollution exposure and cardiorespiratory outcomes in adults. Methods: A questionnaire was administered to 506 participants who were guardians of learners in a primary study, to collect information on cardio-respiratory symptoms and relevant covariates. Land use regression modelling in R was used to estimate the annual average PM2.5 and NO2 exposure at each household. Cardio-respiratory outcomes included wheezing in the last 12 months, doctor diagnosed asthma, asthma symptoms score (calculated as the sum of positive responses to 3 asthma questions), chest pain, hypertension and hypercholesterolaemia. The quantile g computation package in R was used to assess the joint-effect of PM2.5 and NO2 on the outcome of interest. A concentration curve was determined, while adjusting for confounders (paraffin exposure, mould exposure, smoke exposure, low education, unemployed, sex and age). Results: Most of the participants were female (89.9%), with a median age of 40 (IQR=12.8). The annual median concentration of PM2,5 9.8 μg/m3 and NO2 was 16.86 μg/m3 , below the National Ambient Air Quality Standards (NAAQS) There was positive association between NO2 and shortness of breath on exertion (OR:4.02, 95% CI:2.21-7.65) adjusting for PM2,5 and other confounders. There were no other significant associations found between PM2.5 and NO2 levels and other cardiorespiratory outcomes including indoor air pollution. The concentration curve indicates an increased risk in self-reported shortness of breath on exertion with increasing NO2 concentrations above 10μg/m3 . Conclusion: The study found evidence of an association between annual NO2 and shortness of breath on exertion. The study also provides policy-relevant information from the concentration-response curve in demonstrating elevated risk at a level four-times lower than the current National Ambient Air Quality Standard (NAAQS) of 40µg/m3 . This indicates that the NAAQS should be more in keeping with the WHO Ambient Air Quality guidelines for NO2 at 10 μg/m3 and lower in low- and middle-income countries where underlying susceptibility may increase the observed risk.
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institution University of Cape Town (South Africa)
language Eng
last_indexed 2026-06-10T12:34:36.552Z
license_str Not specified — see source repository
provenance_str_mv Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository
publishDate 2025
publishDateRange 2025
publishDateSort 2025
publisher Department of Public Health and Family Medicine
publisherStr Department of Public Health and Family Medicine
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spelling oai:open.uct.ac.za:11427/41466 The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period Allie, Tasneem Dalvie, Aqiel Medicine Background: There is limited data on the association between ambient air pollution cardiorespiratory outcomes among adults especially among populations with low socio-economic status in low- and middle income countries. Objectives: A cross-sectional cohort study was conducted in four informal settlements of the Western Cape to determine the association between annual NO2 and PM2.5 air pollution exposure and cardiorespiratory outcomes in adults. Methods: A questionnaire was administered to 506 participants who were guardians of learners in a primary study, to collect information on cardio-respiratory symptoms and relevant covariates. Land use regression modelling in R was used to estimate the annual average PM2.5 and NO2 exposure at each household. Cardio-respiratory outcomes included wheezing in the last 12 months, doctor diagnosed asthma, asthma symptoms score (calculated as the sum of positive responses to 3 asthma questions), chest pain, hypertension and hypercholesterolaemia. The quantile g computation package in R was used to assess the joint-effect of PM2.5 and NO2 on the outcome of interest. A concentration curve was determined, while adjusting for confounders (paraffin exposure, mould exposure, smoke exposure, low education, unemployed, sex and age). Results: Most of the participants were female (89.9%), with a median age of 40 (IQR=12.8). The annual median concentration of PM2,5 9.8 μg/m3 and NO2 was 16.86 μg/m3 , below the National Ambient Air Quality Standards (NAAQS) There was positive association between NO2 and shortness of breath on exertion (OR:4.02, 95% CI:2.21-7.65) adjusting for PM2,5 and other confounders. There were no other significant associations found between PM2.5 and NO2 levels and other cardiorespiratory outcomes including indoor air pollution. The concentration curve indicates an increased risk in self-reported shortness of breath on exertion with increasing NO2 concentrations above 10μg/m3 . Conclusion: The study found evidence of an association between annual NO2 and shortness of breath on exertion. The study also provides policy-relevant information from the concentration-response curve in demonstrating elevated risk at a level four-times lower than the current National Ambient Air Quality Standard (NAAQS) of 40µg/m3 . This indicates that the NAAQS should be more in keeping with the WHO Ambient Air Quality guidelines for NO2 at 10 μg/m3 and lower in low- and middle-income countries where underlying susceptibility may increase the observed risk. 2025-06-20T17:16:42Z 2025-06-20T17:16:42Z 2025 2025-06-20T16:55:07Z Thesis / Dissertation Masters MPH http://hdl.handle.net/11427/41466 Eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape town
spellingShingle Medicine
Allie, Tasneem
The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period
thesis_degree_str Master's
title The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period
title_full The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period
title_fullStr The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period
title_full_unstemmed The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period
title_short The association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the Western Cape in a 12 month period
title_sort association between ambient air pollution and cardiorespiratory health outcomes of adults residing in informal settlements of the western cape in a 12 month period
topic Medicine
url http://hdl.handle.net/11427/41466
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AT allietasneem associationbetweenambientairpollutionandcardiorespiratoryhealthoutcomesofadultsresidingininformalsettlementsofthewesterncapeina12monthperiod

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