Associations of Air Pollutants in East Jakarta with Community-Acquired Pneumonia (CAP) Hospitalization Rates in Persahabatan Hospital in 2023
DOI:
https://doi.org/10.36497/vnq9sr07Keywords:
Air pollutants, Community-acquired pneumonia (CAP), Air pollutants index (indeks standar pencemar udara/ISPU)Abstract
Background: Pneumonia is an acute inflammation of lung parenchyma with a prevalence of 2% in Indonesia. Risk factors for community-acquired pneumonia (CAP) include host factors, pathogens, and environmental factors such as air pollution. According to various international studies, several air pollution parameters have been linked to CAP, including particulate matter (PM), particularly PM10 and PM2.5, sulphur dioxide (SO₂), carbon monoxide (CO), ozone (O₃), and nitrogen dioxide (NO₂). This study aimed to assess the relationship between air pollutant levels and CAP hospitalizations rate at Persahabatan Hospital in 2023.
Methods: This retrospective cohort study was conducted at Persahabatan Hospital, involving all adult patients diagnosed with CAP who were hospitalized during 2023. Subjects were selected based on inclusion and exclusion criteria. Air pollutant data were obtained from the official website of Dinas Lingkungan Hidup (DLH) DKI Jakarta. Statistical analysis included Pearson or Spearman correlation tests, followed by multiple linear regression.
Results: A total of 729 subjects met the inclusion criteria. Most patients were over 56 years old (61.3%), had more than one comorbidity (73%), had a high PSI score between 91 and 130 (46.1%), and were unemployed (55.3%). The highest number of CAP hospitalizations occurred in October (88 patients, 12%), coinciding with the highest recorded PM2.5 level (ISPU 125, unhealthy category) and O₃ level (ISPU 28.4, good category) a month before in September. Statistical analysis showed a significant relationship between PM2.5 levels 7 days prior to admission (b=0.732;P <0.001), alongside a negative relation from the mean of O₃ level during the admission month (b=-1.601; P=0.009) with the number of CAP hospitalizations.
Conclusion: Average PM2.5 levels measured 7 days prior to hospitalization has a significant positive association with the number of CAP admissions, alongside a negative relation of average O₃ levels during the month of hospitalization, at Persahabatan Hospital in 2023.
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1. Burhan E, Isbaniah F, Hatim F, Djaharuddin I, Soedarsono, Harsini, et al. Pneumonia komunitas pedoman diagnosis & penatalaksanaan di Indonesia. Jakarta: Badan Penerbit FKUI; 2022. h. 4–64.
2. Susanto AD, Fitriani F, Astuti TW, Antono W, Purwitasari M, Ikhsan M, et al. Pencegahan dan penanganan dampak kesehatan akibat polusi udara luar ruangan. Jakarta: Badan Penerbit FKUI; 2019. h. 1–26.
3. Wang J, Li D, Ma Y, Tang L, Xie J, Hu Y, et al. Long-term exposure to ambient air pollutants and increased risk of pneumonia in the UK Biobank. Chest. 2023;164:39–52.
4. Sack C, Attia EF. What can big data teach us about air pollution and pneumonia? Chest. 2023;164:6–7.
5. Kaspersen KA, Antonsen S, Horsdal HT, Kjerulff B, Brandt J, Geels C, et al. Exposure to air pollution and risk of respiratory tract infections in adult Danish population—a nationwide study. Clin Microbiol Infect. 2024:30;122–9.
6. World Health Organization. WHO Global Air Quality Guidelines: Particulate Matter (PM2.5 and PM10), Ozone, Nitrogen Dioxide, Sulfur Dioxide and Carbon Monoxide. Switzerland: WHO; 2021; p. 1–300.
7. IQAir. World Air Quality Report Region & City PM2.5 ranking. 2023. p. 1–45.
8. Solihah KI, Martono DN, Haryanto B. Analysis of spatial distribution of PM2.5 and human behavior on air pollution in Jakarta. IOP Conf Ser: Earth Environ Sci. 2021:940;1–6.
9. Habibi J, Susanto AD, Ratnawati. Hubungan kadar polutan udara di Jakarta Timur dengan angka eksaserbasi penyakit paru obstruksi kronik (PPOK) di Rumah Sakit Rujukan Respirasi Nasional (RSRRN) Persahabatan tahun 2019. Jakarta: DPKR FKUI; 2019. h.1–18.
10. Andari F, Susanto AD, Wiyono WH. Hubungan polutan udara Jakarta Timur dengan angka kunjungan eksaserbasi asma di IGD Rumah Sakit Rujukan Respirasi Nasional (RSRRN) Persahabatan tahun 2019. Jakarta: DPKR FKUI; 2019. h. 1–22.
11. Zhang J, Ren D, Cao X, Wang T, Geng X, Li X, et al. Ambient air pollutants and hospital visits for pneumonia: a case-crossover study in Qingdao, China. BMC Public Health. 2021;21:1–11.
12. Liu S, Lim YH, Chen J, Strak M, Wolf K, Weinmayr G, et al. Long-term air pollution exposure and pneumonia-related mortality in a large pooled European cohort. Am J Respir Crit Care Med. 2022:205;1429–39.
13. Badan Pusat Statistik DKI Jakarta. Provinsi DKI Jakarta dalam angka. 2024. h. 119.
14. Wu J, Wu Y, Tian Y, Wi Y, Wang M, Wang X, et al. Association between ambient fine particulate matter and adult hospital admissions for pneumonia in Beijing, China. Atmos Environ. 2020;231:1–6.
15. Silveyra P, Fuentes N, Rivera L. Understanding the intersection of environmental pollution, pneumonia and inflammation: does gender play a role? In: Contemporary topics of pneumonia. InTech. 2017;1–34.
16. Peraturan Pemerintah Republik Indonesia Nomor 45 Tahun 2015 tentang Penyelenggaraan Program Jaminan Pensiun. 2015. h. 1–34.
17. Chu H, Xin J, Yuan Q, Zhang X, Pan W, Zeng X, et al. Evaluation of vulnerable PM2.5-exposure individuals: a repeated-measure study in an elderly population. Environ Sci Pollut Res Int. 2018;25:11833–40.
18. Kim HJ, Lee HW, Park J, Lee CH, Lee CH. Short-term exposure to fine particulate matter and pneumonia-related hospitalizations: a systematic review and meta-analysis. Environ Res Lett. 2020;15:1–11.
19. Croft DP, Zhang W, Lin S, Thurston SW, Hopke PK, van Wijngaarden E, et al. Associations between source-specific particulate matter and respiratory infections in New York State Adults. Environ Sci Technol. 2020;54:975–84.
20. Scibor M, Balcerzak B, Gakvarczyk A, Targosz N, Jasienska G. Are we safe inside? Indoor air quality in relation to outdoor concentration of PM10 and PM2.5 and to characteristics of homes. SCS. 2019;18:1–32.
21. Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, et al. The occupational burden of nonmalignant respiratory diseases. Am J Respir Crit Care Med. 2019;199:1312–34.
22. Pirozzi CS, Jones BE, VanDerslice JA, Zhang Y, Paine III R, Dean NC. Short-term air pollution and incident pneumonia a case-crossover study. Ann Am Thorac Soc. 2018;15:449–59.
23. Dinas Lingkungan Hidup Provinsi DKI Jakarta. Laporan akhir kegiatan pemantauan kualitas udara Provinsi DKI Jakarta tahun 2023. 2023. h. 1–215.
24. Chen Z, Chen D, Zhao C, Kwan M, Cai J, Zhuang Y, et al. Influence of meteorological conditions on PM2.5 concentrations across China: a review of methodology and mechanism. J Envint. 2020;139:1–21.
25. Safçi SB, Aybal E, Gungor O. Impact of air pollutants and meteorological parameters on severe pneumonia in older adults. Res sq. 2024:1–19.
26. Yee J, Cho YA, Yoo HJ, Yun H, Gwak HS. Short-term exposure to air pollution and hospital admission for pneumonia: a systematic review and meta-analysis. Environ Health. 2021;20:1–10.
27. Chen X, Liu J, Zhour J, Wang J, Chen C, Song Y, et al. Urban particulate matter (PM) suppresses airway antibacterial defence. Respir Res. 2018;19:1–11.
28. Li R, Jiang N, Liu Q, Huang J, Guo X, Liu F, et al. Impact of air pollutants on outpatient visits for acute respiratory outcomes. IJERPH. 2017;2:1–11.
29. Zanobetti A, Schwartz J. Air pollution and emergency admissions in Boston, MA. J Epidemiol Community Health. 2006;60:890–895.
30. Salimi F, Morgan G, Rolfe M, Samoli E, Cowie CT, Hanigan I, et al. Long-term exposure to low concentrations of air pollutants and hospitalisation for respiratory diseases: a prospective cohort study in Australia. Environ Int. 2018;121:415–20.
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