Environ Geochem Health (2019) 41:929–937

https://doi.org/10.1007/s10653-018-0190-0
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ORIGINAL PAPER

Temperature inversion and air pollution relationship,

and its effects on human health in Hanoi City, Vietnam
Thi Thuy Trinh . Thi Tham Trinh . Thi Trinh Le . The Duc Hanh Nguyen .
Binh Minh Tu

Received: 28 February 2018 / Accepted: 11 September 2018 / Published online: 18 September 2018
Ó Springer Nature B.V. 2018

Abstract This study aimed to investigate the effects
of temperature inversions on the concentration of
some pollutants in the atmosphere in Hanoi City,
Vietnam, during the period from 2011 to 2015. This
work also aimed to evaluate relationships between the
thermal inversion and health effects that are associated
with air pollution. During this period, the temperature
inversions were most frequently presenting from
November to March in Hanoi City. Air quality data
was gathered from air quality monitoring stations
located in the study area. The data showed that levels
of NO2, SO2, PM10 and PM2.5 increased when the
inversions strengthened. Cases of two types of
diseases (acute respiratory diseases and cardiovascular
diseases), which are linked to atmospheric air pollu-
tion, were considered on number of patients under 15
and above 60 years old at National Geriatric Hospital
and National Otorhinolaryngology Hospital. There
was significant increase in the daily average number of
hospital visits with increasing surface-based
T. T. Trinh  T. T. Trinh (&)  T. T. Le 
T. D. H. Nguyen
Faculty of Environment, Hanoi University of Natural
Resources and Environment, No 41A, Phu Dien Road,
North Tu Liem District, Hanoi, Vietnam
e-mail: tttham@hunre.edu.vn
B. M. Tu (&)
Faculty of Chemistry, VNU University of Science,
Vietnam National University, 19 Le Thanh Tong Street,
Hoan Kiem District, Hanoi, Vietnam
e-mail: tubinhminh@gmail.com
inversions. The statistical analysis showed that the
temperature inversions correlated with concentration
of air pollutants and the number of patients in 5 years.
Keywords Thermal inversion  Ambient air quality 
Acute respiratory diseases  Cardiovascular diseases
Introduction
A temperature inversion is a thin layer of the
atmosphere where the normal decrease of temperature
with height switches to increase of temperature with
height. There are generally four types of inversions at
different levels. In this study, the surface and subsi-
dence inversion layer has been considered only at the
low troposphere. There are two basic types of low-
level inversions (Iacobellis et al. 2009). A low-level
inversion acts as a ‘‘hat’’ which keeps normal
convective overturning of the atmosphere from pen-
etrating through the inversion. As a result, the
pollutants are trapped in the atmospheric region which
is nearest to the Earth’s surface. The increase in
pollutant concentrations leads to degradation of air
quality in the troposphere, which seriously affects the
human health (Ahrens 2009).
A major environmental problem in urban areas is
degradation of environment, especially air quality. Air
pollution generates significant risks and impacts on the
human health. High concentrations of pollutants in the

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930
atmosphere cause public health problems, particularly
acute respiratory and cardiovascular diseases (Romieu
et al. 2002).
In the Guadalajara Metropolitan Zone, Jalisco,
Mexico, during the period 2003–2007, the maximum
variation of temperature inversion intensity occurred
from November to May, while the range was reduced
in rainy months. From December to March, there were
high concentrations of PM10, NO2, NOx, CO and SO2
which prolong the duration time of temperature
inversions and low humidity. At the same time, during
the 5-year study period, there were 213,510 ± 41,209
cases of acute respiratory diseases per year, in which
acute respiratory infections, pneumonia and bronchi-
tis, asthma, and tonsillitis accounted for 98%, 1.1%,
0.5% and 0.4%, respectively. The number of patients
from November to March was highest when the
temperature inversions occurred at high frequency
(Ramı́rez-Sánchez and Garcı́a-Guadalupe 2013).
In the study of Beard et al. (2012), pollutant
concentrations and adjusted odds of emergency
department visit for asthma were higher during
inversions than non-inversions, with stronger associ-
ations when the number of inversion days increased. A
1-year ecological study conducted during 2003 eval-
uated relationships between the occurrence of inver-
sions and air pollution associated diseases in Oman
(Abdul-Wahab et al. 2005).
In Vietnam, the ‘‘Impact of air pollution on health’’
program, implemented by the United States Environ-
mental Protection Agency in Ho Chi Minh City,
investigated the relationship between daily air pollu-
tion levels and hospitalizations for acute lower respi-
ratory infections (ALRI) in children. In several recent
reports, air quality in Hanoi, Vietnam, was predicted
to deteriorate and the frequency of temperature
inversions is growing. Therefore, the analysis and
assessment of the impact of air quality on public health
in the days of inversion are essential.
The study site is urban area of Hanoi Capital,
Vietnam (population of 7,588,000). The area is
defined by 23°530 –21°230 N, 105°440 –106°020 E. In
Hanoi, air pollutants are emitted into the atmosphere
from various industrial processes and fossil fuel
burning for transportation. By 2017, about 5 million
motorcycles, 485,000 cars and about 1.2 million
vehicles from other provinces regularly participate in
traffic in Hanoi area. More than 70% of air pollutants
come from burning of fossil fuels in transport. Coarse
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Environ Geochem Health (2019) 41:929–937
PM (particles with aerodynamic diameters between
2.5 and 10 lm) is generated largely by physical
processes, including resuspension of soil and road
dust, vehicular abrasion (i.e., tire and brake wear), and
fugitive dust emission from industrial sources. Ana-
lytically, we aimed to evaluate the presence of
temperature inversions, concentrations of air pollu-
tants and their influence on acute respiratory diseases,
cardiovascular diseases in adults above 60 and chil-
dren under 15 years old.
Materials and methods
We collected various information referring to daily air
temperature in Celsius degrees registered by the
meteorological stations Hanoi (48820 VVNB, Depart-
ment of Atmospheric Science—http://weather.uwyo.
edu/upperair/sounding.html) to identify the days with
temperature inversions. Data from the meteorological
tower in Hanoi were available for 2011–2015. When
temperature inversions occurred, temperature differ-
ence was observed between the 100 and 600 m heights
in summer, and the 300 m and 1800 m heights in
winter at 7 h (00Z) and 19 h (12Z). The medium daily
values of some reference pollutants, for example,
nitrogen oxide NOx, sulfur dioxide SO2, PM10, PM2.5,
were calculated from monitoring data by the automatic
air quality monitoring station Centre for Environ-
mental Monitoring, located on the East-Northern of
the city. The techniques used for NOx, SO2, PM10 and
PM2.5 monitoring are Chemiluminescence, UV fluo-
rescence, and Beta Attenuation monitor, respectively.
Other meteorological data (wind speed and direction)
were also acquired from monitoring station Centre for
Environmental Monitoring.
At the same time, information about patients in
Hanoi was accessed from National Geriatric Hospital
and National Otorhinolaryngology Hospital to quan-
tify acute respiratory and cardiovascular diseases. The
data was collected from 2011 to 2015.
Correlations and variations between temperature
inversions and air pollution, temperature inversions
and patients from 2011 to 2015 in Hanoi city were
analyzed using Statistical Package for the Social
Sciences (SPSS).
Environ Geochem Health (2019) 41:929–937
Results and discussion
Behavior of temperature inversions in Hanoi
from 2011 to 2015
We identified inversion layers where temperature
increases with height. Cases where the temperature
remains constant in a vertical interval or isothermal
layer were excluded. The inversion layer usually
appears from 300 to 1800 m heights in the winter time
and from 100 to 600 m heights in the summer. The
skewT–logP diagram (Fig. 1) from the sounding taken
in Hanoi at 00Z on March 7, 2015, and on September
Inver-
sion
Inver-
sion
B
Fig. 1 Soundings at the meteorological sites during winter and
summer. a Soundings at the meteorological site of ZBAA at
00Z, January 28, 2011, and March 07, 2015 (the winter).
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
931
10, 2015, showed that the inversion layer on 10
September was wider than on 7 March. The inversion
layer acts as a lid to prevent air at ground level from
rising and dispersing, leading to the accumulation of
particulates and pollutants (Ji et al. 2012).
By analyzing the frequency of the temperature
inversions, we found that the number of inversion days
was higher from November to March compared with
other months (Fig. 2). The highest numbers of days of
elevated inversion occurrence were on March 2014
(24 days) and January 2012 (23 days). The months
with the least occurrence of elevated inversions were
August and September 2011, and July 2015
b Soundings at the meteorological site of ZBAA at 00Z, May 10,
2011, and September 06, 2015 (the summer)
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932 Environ Geochem Health (2019) 41:929–937

Fig. 2 Monthly average levels of pollutants in air and the number of inversion day per month in Hanoi during period from 2011 to 2015

(3 months). The night inversions might occur during
any month; however, they are less frequent in warmer
seasons and in some situations, for example, sudden
changes of wind speed and temperature.
Wind rose diagrams comparing data from April to
October and other months show differing patterns of
wind speed and direction (Fig. 3). From November to
March, wind directions were variable, with roughly
80% of all winds coming from either East-Northeast
(ENE), East-Southeast (ESE), Southeast (SE) or
South-Southeast (SSE) directions, compared to pre-
dominantly Southeast winds between April and

Fig. 3 Maps of wind roses from 2011 to 2015

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Environ Geochem Health (2019) 41:929–937 933

October. Overall, wind speeds were generally lower
during winter with mean value of 1.54 m/s in winter,
and 1.24 m/s in summer.
The probability of negative influence over the
situations of atmospheric pollution was during cold
weather when the temperature inversions occurred
most frequently.
Relationships between temperature inversions
and air pollution in Hanoi from 2011 to 2015
Figure 2 shows monthly average concentration of
NOx, SO2, PM10 and PM2.5 in the air and the number of
inversion days in Hanoi in 5 years. The monthly
concentrations of pollutants were high from Novem-
ber to March which prolong the duration times of
temperature inversions and low humidity of the
environment. The data in the period of 2011–2015
indicate that mean concentration of NOx and SO2
increased from 73.4 to 84.6 lg/m3 and from 10.9 to
26.8 lg/m3 in normal days, respectively. In inversion
days, these values were from 85.4 to 95.6 lg/m3 and
14.2 to 29.6 lg/m3, respectively. The average levels of
NOx and SO2 in inversion days were higher than those
in normal days. By comparing NOx and SO2 in
inversion and normal days from 2011 to 2015, we
found that NOx increased from 2.1 to 16.3% and SO2
increased from 10.4 to 34.4%. Although the PM levels
decreased from 2011 to 2015, PM10 and PM2.5
inversion values were 22.3% and 21.9%, respectively,
higher than normal values in Hanoi (Table 1). Wallace
and Kanaroglou (2009) also found significant
increases in PM2.5 and NO2 during inversions in
Ontario, Canada; however, the authors did not calcu-
late the correlation between inversion and these
increases.
The correlation between monthly average of NOx,
SO2, PM10, PM2.5 and the total vertical inversion days
is described in Fig. 4. There are negligible correlations
between all variables. The correlation between num-
ber of inversion days per month and concentrations of
NOx, SO2, PM10, PM2.5 was very low (r2 = 0.127,
0.182, 0.223 and 0.249, respectively). Gramsch et al.
(2014) also detected a low correlation between daily
average PM2.5 and the intensity of the inversion in
Santiago de Chile (r2 = 0.1233). These figures indicate
that it is possible to find a low correlation between air
quality and thermal inversions. From these analyses

Table 1 Descriptive statistics of NOx, SO2, PM10, PM2.5 and surface meteorology from 2011 to 2015
Years 2011 2012 2013 2014 2015
Normal Day 253 209 211 236 246
Mean SD Mean SD Mean SD Mean SD Mean SD

Average NOx (lg/m3) 73.8 13.7 74.7 14.1 81.0 12.5 94.0 11.9 84.2 9.7
Average SO2 (lg/m3) 10.5 8.1 12.7 10.8 10.7 3.8 12.2 5.2 26.8 20.0
Average PM10 (lg/m3) 99.8 28.5 46.4 19.3 78.3 24.7 65.3 30.4 59.1 21.0
Average PM2.5 (lg/m3) 62.1 21.3 32.8 14.4 52.5 20.0 54.1 27.8 36.8 16.0
Wind speed km/h 1.3 1.1 1.4 1.0 1.5 1.3 1.4 1.5 2.0 1.6
Temperature °C 23.3 36.1 23.9 41.1 24.4 40.4 24.5 44.5 24.5 36.1
Relative humidity % 77.0 15.4 78.0 13.2 79.0 12.1 79.0 16.4 79.0 15.3
Inversion Day 112 157 154 129 119

Average NOx (lg/m3) 93.0 29.3 74.7 12.6 86.6 12.5 98.3 12.5 96.2 9.6
Average SO2 (lg/m3) 16.2 14.4 15.7 42.1 12.1 7.0 16.4 7.0 29.4 18.9
Average PM10 (lg/m3) 118.7 27.0 57.0 29.6 95.3 35.9 74.1 35.9 73.6 40.9
Average PM2.5 (lg/m3) 75.6 19.2 41.7 19.5 63.9 26.7 69.3 46.9 49.2 27.7
Wind speed km/h 1.3 1.1 1.3 1.2 1.5 1.4 1.2 1.3 1.5 1.3
Temperature °C 24.5 39.1 24.7 34.1 26.5 33.2 26.7 34.6 27.3 30.1
Relative humidity % 74.0 16.3 75.0 17.1 77.0 15.8 77.0 16.1 76.0 17.3

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934
Fig. 4 Concentration of pollutants (lg/m3) versus vertical inversion day during from 2011 to 2015
for all pollutants, it is clear that the air quality changes
the behavior of pollutants under inversion scenarios.
When temperature inversion occurs, several other
meteorological variables change accordingly. The
wind speed and humidity are lower in the inversion
days. All these variables have influence on the
pollutant concentration in the atmosphere. As
expected, temperature is lower under thermal inver-
sion conditions. During the inversion day, gentle
winds placed the zones downwind of major highway
traffic, thus compounding the effect of the inversion.
Relationships between temperature inversions
and human health in Hanoi from 2011 to 2015
Adults over 60 and children under 15 are sensitive to
the changes of ambient air quality. Therefore, in this
study, we selected the patients at these ages suffering
from respiratory and cardiovascular diseases related to
the air quality. During the period 2011–2015, there
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Environ Geochem Health (2019) 41:929–937
were 3459 cardiovascular diseases consultations for
adult above 60 years at National Geriatric Hospital
and 7319 hospital visits of children under 15 years old
at National Otorhinolaryngology Hospital. At
National Geriatric Hospital, the number of visits was
high from December to March when thermal inver-
sions occurred at high frequency. Besides, the data of
air quality and hospitalization were sufficient and
informative, permitting a thorough exploration of
patterns of hospital admission relative to pollution
levels in Hanoi. The associations between pollutant
exposure and acute respiratory diseases for children
under 15 years old in the wet season were very similar
to the study in Ho Chi Minh City (Le et al. 2012). On
the contrary, at National Otorhinolaryngology Hospi-
tal, the number of children for acute respiratory
infections in Hanoi decreased in June, July and August
with less occurrence temperature inversions. Associ-
ation between exposure to air pollutants and hospital
admissions for acute respiratory diseases and
Environ Geochem Health (2019) 41:929–937
cardiovascular diseases was positive during dry season
(November–April) and negative during rainy season
(May–October) (Le et al. 2012). Although we could
not specifically identify such sources of bias, factors
influencing the results in the rainy season could
potentially affect results in the dry season as well.
Respiratory illness is more prevalent during the rainy
season, when there are certainly other competing risk
factors playing a stronger role than air pollution.
Pollutant levels are at their lowest during the rainy
season. There are complex relationships among
specific pollutants and health especially respiratory.
The main cause of respiratory infections is virus-
related (e.g., Rhinoviruses, Respiratory syncytial
virus, RSVs) or bacteria-related (e.g., Streptococcus
pneumoniae, Haemophilus influenza.). Meanwhile, in
Vietnam, these viruses and bacteria usually grow
Fig. 5 Monthly average hospital visits at National Geriatric Hospital (NGH) and National Otorhinolaryngology Hospital (NOH)
between 2011 and 2015
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
935
rapidly in the rainy season. Other studies have looked
for potential effect modification by season but sea-
sonal differences in effects are location-dependent.
Studies conducted in North America and Western
Europe found effects in the winter season, when both
pollution levels and disease incidence were likely to be
high (Karr et al. 2009; Ségala et al. 2008); A case-
crossover study conducted by Barnett et al. (2005) in
Australia and New Zealand with different seasonal
patterns of temperature and disease found stronger
effects in the warm season.
However, by comparing patient data on inversions
day and normal day, data analysis revealed that the
means of monthly hospital visits at both hospitals
during inversion day were slightly higher than those in
normal day (Fig. 5).
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936
Fig. 6 Monthly average hospital visits and number of inversion days from 2011 to 2015. a National Otorhinolaryngology Hospital.
b National Geriatric Hospital
An analysis of the simple regression correlations,
variance analysis (ANOVA) and t-student test of
hospital visits with temperature inversions showed the
significant correlation between the number of inver-
sion days and the figure on hospital visit. Increases in
average hospital visits in both hospitals were observed
on inversion days. Figure 6 indicates that the differ-
ence for the Acute Respiratory Diseases at National
Otorhinolaryngology Hospital is variable at 20.4%
(r2 = 0.204, p = 0.01) and 63.7% (r2 = 0.637,
p = 0.01) for the Cardiovascular Diseases at National
Geriatric Hospital in the period of 2011–2015. The
inversions will not only increase the levels of pollution
but also expose the citizens who reside or work in the
urban area.
Conclusions
This study sought to investigate the effects of
temperature inversions on concentration of pollutants
in ambient air in the urban area. Data on inversion days
collected from the meteorological stations in Hanoi
between 2011 and 2015 showed that the temperature
inversions occurred for long time at high frequency in
winter (from November to March). The occurrence of
thermal inversions was lowest in July and August.
During the period of inversions, the concentrations of
pollutants in ambient air tended to be higher than those
in the normal time. The regression analysis revealed
that all correlation coefficients (r2) between
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Environ Geochem Health (2019) 41:929–937
temperature inversions and air pollution were small
due to the lack of inversions depth and inversion
strength data.
The results of this study highlight the impact of
temperature inversions on acute respiratory and car-
diovascular diseases in Hanoi. The average daily
emergency visits in the two hospitals from 2011 to
2015 during the period of inversions were higher than
those in the normal days. The study showed significant
correlations between the temperature inversions and
two types of diseases commonly associated with
atmospheric pollution.
Acknowledgements This study was supported by the Project
‘‘Research on the effects of temperature inversions on air quality
in Hanoi and some neighboring provinces,’’ Ministry of
National Resources and Environment. We gratefully
acknowledge the kind cooperation of the Ministry of Natural
Resources and Environment for partially supporting this study.
The authors would like to thank the personnel of National
Geriatric Hospital and National Otorhinolaryngology Hospital
for their help with the field work.
References
Abdul-Wahab, S. A., Bakheit, C. S., & Siddiqui, R. A. (2005).
Study the relationship between the health effects and
characterization of thermal inversions in the Sultanate of
Oman. Atmospheric Environment, 39, 5466–5471.
Ahrens, C. D. (2009). Meteorology today: An introduction to
weather, climate, and the environment (9th ed.). Indepen-
dence, KY: Cengage Learning Customer & Sales Support.
Barnett, A. G., Williams, G. M., Schwartz, J., Neller, A. H.,
Best, T. L., Petroeschevsky, A. L., et al. (2005). Air
Environ Geochem Health (2019) 41:929–937
pollution and child respiratory health: A case-crossover
study in Australia and New Zealand. American Journal of
Respiratory and Critical Care Medicine, 171(11),
1272–1278.
Beard, J. D., Beck, C., Graham, R., Packham, S. C., Traphagan,
M., Giles, R. T., et al. (2012). Winter temperature inver-
sions and emergency department visits for Asthma in Salt
Lake County, Utah 2003-2008. Environmental Health
Perspectives, 120(10), 1385–1390.
Gramsch, E., Aceres, D. C., Oyola, P., Reyes, F., Asquez, Y. V.,
Rubio, M. A., et al. (2014). Influence of surface and sub-
sidence thermal inversion on PM2.5 and black carbon
concentration. Atmospheric Environment, 98, 290–298.
Iacobellis, S. F., Norris, J. R., Kanamitsu, M., & Tyree, A. M.
(2009). Climate variability and California low-level tem-
perature inversions. In California Climate Change Center.
Scripps Institution of Oceanography (pp. 1–48).
Ji, D. S., Wang, Y. S., Wang, L. L., Chen, L. F., Hu, B., Tang, G.
Q., et al. (2012). Analysis of heavy pollution episodes in
selected cities of northern China. Atmospheric Environ-
ment, 50, 338–348.
Karr, C. J., Rudra, C. B., Miller, K. A., Gould, T. R., Larson, T.,
Sathyanarayana, S., et al. (2009). Infant exposure to fine
particulate matter and traffic and risk of hospitalization for
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
937
RSV bronchiolitis in a region with lower ambient air pol-
lution. Environmental Research, 109(3), 321–327.
Le, T. G., Ngo, L., Mehta, S., Do, V. D., Thach, T. Q., et al.
(2012). Effects of short-term exposure to air pollution on
hospital admissions of young children for acute lower
respiratory infections in Ho Chi Minh City, Vietnam. Re-
search Report (Health Effects Institute), 169, 5–72.
Ramı́rez-Sánchez, H. U., & Garcı́a-Guadalupe, M. E. (2013).
Temperature inversions, meteorological variables and air
pollutants and their influence on acute respiratory disease
in the guadalajara metropolitan zone, Jalisco, Mexico.
Romieu, I., Samet, J., Smith, K., & Bruce, A. N. (2002). Outdoor
air pollution and acute respiratory infection among chil-
dren in developing countries. Journal of Occupational and
Environmental Medicine, 44(7), 640–649.
Ségala, C., Poizeau, D., Mesbah, M., Willems, S., & Maiden-
berg, M. (2008). Winter air pollution and infant bronchi-
olitis in Paris. Environmental Research, 106(1), 96–100.
Wallace, J., & Kanaroglou, P. (2009). The effect of temperature
inversions on ground-level nitrogen dioxide (NO2) and
particulate matter (PM2.5) using temperature profiles from
the Atmospheric Infrared Sounder (AIRS). Science of the
Total Environment, 407, 5085–5095.
123
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