Urban air pollution and health: an ecological study of chronic rhinosinusitis in Cologne, Germany

doi:10.1016/S1353-8292(01)00040-5

Health & Place

Volume 8, Issue 2, June 2002, Pages 129-139

https://doi.org/10.1016/S1353-8292(01)00040-5 Get rights and content

Abstract

The study investigates the association between outdoor air pollution and chronic rhinosinusitis (CRS) in Cologne, Germany. First, using their addresses, all patients treated for CRS at the ENT Department of the University Hospital between 1990 and 1999 were assigned to one of the 85 city districts. Second, indicators of air pollution (SO₂, NO_x, TSP) were linked to these areas. Third, to control for socioeconomic confounding, data reflecting the socioeconomic and demographic composition of these districts were collected. Regression analyses reveal weak but consistent statistical effects of pollution on the prevalence of CRS in those parts of the city with air pollution levels above average.

Introduction

Chronic rhinosinusitis (CRS) is one of the most prevalent chronic diseases today and is associated with high health care costs (Krouse, 1999). Besides individual risk factors, such as smoking, allergies, anatomic conditions and other inherited dispositions, it is hypothesized that air quality is related to the development of CRS. The study presented here evaluates the strength of the association between outdoor air pollution and CRS in Cologne, Germany.

Previous research on the relationship between outdoor air pollution and CRS shows mixed results. Luttmann et al. (1994) examined the effect of air quality on respiratory symptoms by comparing schoolchildren from an industrial German city (Mannheim) with schoolchildren from two rural areas. This comparison was carried out in 1977, 1979 and 1985. One result of their study was that bronchitis, inflamed throat with fever and sinusitis was more prevalent in children living in the urban than in the rural location. In addition, their research showed that the relative risk for developing a respiratory disease in the city compared to the countryside decreased over time, reflecting the reduction in the level of sulfur dioxide (SO₂) pollution. A similar study conducted in Brazil (Sih, 1999) demonstrated that children living in an urban environment were more likely to be affected by rhinitis, sinusitis and upper respiratory infections in general than children living in rural locations. On the other hand, an epidemiological study in Korea (Min et al., 1996) found no difference between rural and urban areas with regard to the prevalence of chronic sinusitis. Yet the authors report on differences between regions which they attribute to the level of economic activity and crowding. In their review of research on the effects of particulate air pollution on acute respiratory conditions, Dockery and Pope (1994) report that upper respiratory symptoms and exposure to particulate pollution are only weakly related.

Although there are several studies reporting statistical relationships between (acute as well as chronic) sinusitis and outdoor air pollution, especially for children, the evidence is anything but conclusive. This study aims to help fill this gap by investigating the hypothesis that there is a positive correlation between the prevalence of severe forms of CRS and air pollution.

Section snippets

The site of the study

The city of Cologne—the site of the research reported here—is located in the German state of North Rhine, Westphalia on the river Rhine. It has a total area of 405 km² (156 mile²) and a population of approximately 1 million inhabitants. With temperatures ranging from a low of −8.6°C to a high of 33.5°C (16.7–92.3°F), a yearly mean of 11.4°C (52.5.°F) and 768.6 mm (20.3 in) precipitation Cologne enjoys temperate climatic conditions.¹

Results

The age-standardized rates of patients per 100,000 inhabitants per year who underwent surgery in the 1990s is shown in Fig. 2. This variable was categorized into five classes of the same size (quintiles) ranging from low to high rates. Districts with low rates of patients are concentrated in the eastern and partly in the southern part of the city. City districts marked by high rates of patients are disproportionately often located to the west of the Rhine. Especially, inner city sections seem

Conclusions

As is the case with most ecological studies in epidemiology, the data have several limitations that should be considered when trying to understand the results presented above (Morgenstern, 1995). First, the data on air pollution is limited with regard to the time points and the pollutants available. Outdoor air pollution—at least with respect to the classical pollutants SO₂, NO_x and TSP—has considerably declined in the past decades. It may not be these pollutants anymore that have major adverse

Acknowledgements

The author is a member of the Collaborative Research Center 419 (CRC 419) at the University of Cologne: ‘Environmental Problems of an Industrial Conurbation; Scientific Solution Strategies and Socio-Economic Implications’. Without the help of my collaborators, this paper would never have been written. I am especially indebted to Michael Damm, MD and Prof. Hans E. Eckel, MD from the ENT Department of the University Hospital and to Christoph Kassel. Mr. Damm coordinated the collection of patient

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^☆: This article is dedicated to Prof. Dr. Walter Kristof, Ph.D. who stimulated my interest in statistics through his enthusiasm as a teacher.

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Urban air pollution and health: an ecological study of chronic rhinosinusitis in Cologne, Germany☆

Abstract

Introduction

Section snippets

The site of the study

Results

Conclusions

Acknowledgements

Atmospheric Environment

International Journal of Pediatric Otorhinolaryngology

Using geographical information systems to link environment and health data

Acute respiratory effects of particulate air pollution

Annual Review of Public Health