Air Quality, Atmosphere & Health

https://doi.org/10.1007/s11869-020-00818-6

Effect of socioeconomic status on the relationship

between short-term exposure to PM2.5 and cardiorespiratory
mortality and morbidity in a megacity: the case of Santiago de Chile
Ernesto Pino-Cortés 1 & Luis A. Díaz-Robles 2 & Valeria Campos 2 & Fidel Vallejo 2 & Francisco Cubillos 2 & Jaime Gómez 3 &
Francisco Cereceda-Balic 3 & Joshua Fu 4 & Samuel Carrasco 1 & Juan Figueroa 5

Received: 24 February 2020 / Accepted: 16 March 2020

# Springer Nature B.V. 2020

Abstract
This work analyzes the relationship between short-term exposure to fine particulate matter and its incidence of respiratory and
cardiorespiratory diseases. It involved the socioeconomic status of the population distributed in representative areas of Santiago
de Chile, the capital city of Chile. The data used were collected from monitoring stations of fine particulate matter concentrations,
classification of cardio-respiratory diseases, and the annual age distribution of the population in the representative areas of this
megacity. Also, morbidity and mortality data and the distribution of the forecast of health by geographic zones within the
Metropolitan Region were variables of input. The relative risk results showed that the level of risk from exposure to air pollution
is not defined solely by the level of exposure to the pollutant when crossing the information considered. Therefore, the age
distribution or quality of life of the population will define the susceptibility of this, being able to increase the risk of becoming ill
or dying by being exposed to air pollution. This work showed that the exposed results serve as input data for the realization of
studies in this area, regarding the cost-benefit that would be obtained by reducing pollutant emissions to the atmosphere, as well
as valuable information to develop better air quality management policies.

Keywords Particulate matter PM2.5 . Cardiorespiratory morbidity and mortality . Socioeconomic status . Relative risk . Air quality
management

Introduction weather patterns are detrimental to the pollutants removal

Santiago de Chile megacity (8 million people) is the capital of
Chile. It is located in the Metropolitan Region in the Central
zone of the country. Its geography is dominated by a 50-km
valley, having four natural limits: Coastal Mountains at the
West, the Andes Mountains at the East, Chacabuco
Mountains at the North, and Antillana Hill at the South. This
city has a Mediterranean climate (Roco et al. 2015), and the
* Luis A. Díaz-Robles
alonso.diaz.r@usach.cl
1
Escuela de Ingeniería Química, Pontificia Universidad Católica de
Valparaíso, Valparaíso, Chile
2
Departamento de Ingeniería Química, Facultad de Ingeniería,
Universidad de Santiago de Chile, Santiago, Chile
3
Universidad Técnica Federico Santa María, Valparaíso, Chile
4
University of Tennessee, Knoxville, TN, USA
5
Universidad Católica del Maule, Talca, Chile
from airshed, especially during fall and winter. The presence
of the Pacific subtropical anticyclone for much of the year
generates the emergence of the phenomenon of temperature
inversion and subsidence due to heavy coastal fog (named
“vaguada costera” in Spanish). This complex geography plus
the unfavorable fall-winter meteorology favors the generation
of a very stable layer of air near the surface, which inhibits
turbulence and vertical air movement in these basins. During
the summer, surface heating allows the erosion of the inver-
sion layer on the airshed, resulting in a significant improve-
ment in ventilation. However, the emissions mainly from mo-
bile, industrial, and residential heating sources, plus solar ra-
diation, favor the formation of secondary particles in this city.
On the other hand, increased economic rate of the city during
the past 20 years has been impacted by several atmospheric
pollution episodes, especially by fine particulate matter
(PM2.5). Santiago de Chile represented one of the most pollut-
ant capital in the world (WHO 2016). That is why Chile’s
government has imposed air primary quality standards to pro-
tect the health of the population against this problem. The
 Air Qual Atmos Health

polluted zone is designed as “saturated” or “latent” when the
registry of the concentration of the pollutants is over 100% or
80% of the national standards, respectively. In this context, the
environmental authorities declared the Metropolitan Region of
Santiago as Saturated Zone due to coarse particulate matter
(PM10), Ozone, Suspended Particulate and Carbon Monoxide,
and Latent Zone by Nitrogen Dioxide on August 1, 1996, due
to the high frequency of the episodes of atmospheric pollution
(Chile, 1996). This mitigation politic had affirmative action,
causing a relative reduction of those pollutants’ concentration
in the megacity, but the registries of the particulate matter dur-
ing the last years have values over the standard (Ministerio del
Medio Ambiente 2011). On November 15, 2014, the 67th
Order declared the Metropolitan Region of Santiago as
Saturated Zone by the daily concentration of PM2.5. This action
developed the decontamination plan for this pollutant in this
zone, which finally was executed by the end of 2017
(Ministerio del Medio Ambiente 2017).
Currently, Santiago de Chile city has air quality and mete-
orological monitoring stations online in 11 communes (geopo-
litical and administrative division in Chile). However, the
concentrations of PM10 and PM2.5 have significant differences
among the stations in this area for annual and daily average
(Toro et al. 2014). This noticeable variation in air quality can
be observed through a comparison of the socio-economic sit-
uation in different areas of Santiago, which is divided into 32
communes. According to Orellana (2015), the communes of
Vitacura, Las Condes, and Lo Barnechea have the highest ur-
ban life quality index (ULQI) in Chile. They are located in the
Northeastern sector of Santiago de Chile. However, in that
index, the communes of Independencia and Cerro Navia, lo-
cated on the West of this area, have the worst ULQI registries,
showing a significant difference among those zones of the city.
Table 1 shows some data from studies realized in the
Metropolitan Region of Santiago, which have found an in-
crease in the mortality and morbidity health risk due to expo-
sure to particulate matter. Nevertheless, these researches are
limited to the reality of all communes, without differences
among them. So, if it is required to analyze some specific
areas, wrong results could be generated using regional re-
cords. None of these previous studies have analyzed or deter-
mined the health risks due to the exposure to PM2.5 and the

Table 1 Epidemiological studies available for the Metropolitan Region in Chile associated with mortality and morbidity effect

Effect Cause Age group Pollutant β Standard error β Source

Mortality Cardiovascular > 64 PM10 0.00087 4.7 × 10−4 (Díaz-Robles et al. 2015)
Respiratory All PM10 0.00128 6.8 × 10−4 (Díaz-Robles et al. 2015)
Specific respiratory All PM10 0.00155 7.3 × 10−4 (Díaz-Robles et al. 2015)
−4
Cardio respiratory All PM10 0.00064 3.3 × 10 (Díaz-Robles et al. 2015)
Cardio respiratory >64 PM10 0.00085 4.0 × 10−4 (Díaz-Robles et al. 2015)
−2
All causes All PM10 0.075 1.3 × 10 (Ostro et al. 1996)
Respiratory All PM10 0.127 3.2 × 10−2 (Ostro et al. 1996)
−2
Cardiovascular All PM10 0.076 2.2 × 10 (Ostro et al. 1996)
Cardiovascular All PM10 0.00113 3.3 × 10−2 (Cakmak et al. 2007)
Respiratory All PM10 0.00201 4.5 × 10−2 (Cakmak et al. 2007)
−2
All causes All PM2.5 0.00064 6.7 × 10 (Cifuentes et al. 2000)
Cardiovascular All PM2.5 0.0071 1.1 × 10−2 (Valdés et al. 2012)
−2
Respiratory All PM2.5 0.0175 2.2 × 10 (Valdés et al. 2012)
Morbidity Specific cardiovasculars All PM10 0.00092 4.3 × 10−4 (Díaz-Robles et al. 2015)
−4
Respiratory 16–64 PM10 0.00097 4.9 × 10 (Díaz-Robles et al. 2015)
Chronic respiratory All PM10 0.00096 5.4 × 10−4 (Díaz-Robles et al. 2015)
Cardio respiratory 16–64 PM10 0.00066 2.9 × 10−4 (Díaz-Robles et al. 2015)
−4
Cardio respiratory > 64 PM10 0.00069 3.0 × 10 (Díaz-Robles et al. 2015)
Cardiovascular All PM2.5 0.00491 – (Román et al. 2009)
Cardiovascular All PM10 0.00138 – (Román et al. 2009)
Venous thromboembolism All PM2.5 0.00225 4.1·10−4 (Dales et al. 2010)
Pulmonary embolism All PM2.5 0.00225 3.1 × 10−4 (Dales et al. 2010)
−3
Headache All PM2.5 0.00367 1.4 × 10 (Dales et al. 2009)
Migraine All PM2.5 0.00465 2.1 × 10−3 (Dales et al. 2009)
Air Qual Atmos Health

Table 2 Lineal relation of hourly

data for variables between Pudahuel—Cerro Navia Parque O’Higgins-Independencia
Pudahuel and Cerro Navia’s
stations and Independencia and Variable Relation R2 Relation R2
Parque O′Higgins’s stations
PM2.5 y = 0.9028x 0.9510 y = 0.8969x 0.8316
Temperature y = 1.0650x 0.9515 y = 1.0988x 0.9400
Relative humidity y = 0.9764x 0.8672 y = 0.9393x 0.8412
Wind velocity y = 0.9742x 0.9604 y = 0.8710x 0.6809

different socioeconomic status existing among the different
zones or communes of this megacity. If this knowledge is
known, the environmental, social, and economic authorities
will improve the public policies and the decision-making, es-
pecially if there is social and environmental inequality.
To contribute to a better environmental justice, the main goal
of this study was to obtain a health risk relationship among the
effect of short-term exposure to PM2.5 with respiratory and car-
diovascular mortality and morbidity, comparing different zones
of the Metropolitan Region of Santiago de Chile. With these
results, it will be possible to generate relevant information for
future studies of cost-benefits from control measures to be ap-
plied in different areas of this megacity. Therefore, to improve
the air quality under a socioeconomic status point of view.
Data and methods
Zones of analysis
The air monitoring stations were selected considering the most
quantity of historically available data and at least four or more
years of antique. The meteorological values (temperature,
wind velocity, and relative humidity) and air quality variables
of the nearest geographic stations were grouped to obtain the
average, because the analysis of the historic registries showed
similar behavior, as observed in Table 2.
The total area of the Metropolitan Region was divided into
four zones, represented by the monitoring stations located on
it, to obtain and compare the relative risk (RR) in different
zones. Those were named as North-Centre Zone (Santiago
and Independence stations), West Zone (Pudahuel and Cerro
Navia stations), East Zone (Las Condes station), and South
Zone (La Florida station). Also, the population of each zone
was characterized to compare the results with each other. In
another way, the variables of health registries from every sta-
tion were summed to obtain the values for each zone.
In Fig. 1, the location and annual average PM2.5 concen-
tration for each station analyzed are observed. All the moni-
toring stations overpass the national standard (20 μg/m3) for
this pollutant, being Las Condes and Independencia, with the
lowest values.
Processing of the health, the meteorology, and the air
quality data
The mortality and morbidity health data were obtained from
the Department of Statistics and Health Information (DEIS in

Fig. 1 Geographical distribution

of the monitoring stations studied
and its annual average PM2.5
concentrations
 Air Qual Atmos Health

Table 3 Classification of diseases

of interest Classification Definition ICD-10 code

MCardT or ECardT Total cardiac mortality or morbidity I00–I99

MCardG1 or ECardG1
MCardG2 or ECardG2
MCardG3 or ECardG3
MRespT or ERespT
MRespG1 or ERespG1
MRespG2 or ERespG2
MRespG3 or ERespG3
MCRT or ECRT
MCRG1 or ECRG1
MCRG2 or ECRG2
MCRG3 or ECRG3
Group 1 cardiac mortality or morbidity
Group 2 cardiac mortality or morbidity
Group 3 cardiac mortality or morbidity
Total respiratory mortality or morbidity J00–J99
Group 1 respiratory mortality or morbidity
Group 2 respiratory mortality or morbidity
Group 3 respiratory mortality or morbidity
Total cardio respiratory mortality or morbidity Group I and group J
Group 1 cardio respiratory mortality or morbidity
Group 2 cardio respiratory mortality or morbidity
Group 3 cardio respiratory mortality or morbidity

Spanish) of the Minister of Health in Chile. The annual regis-
tries of hospitality outcomes between 2005 and 2012 and the
deaths for the period 2004 and 2013 were collected. The
health data for Vitacura, Las Condes and Lo Barnechea
(East), Pudahuel and Cerro Navia (West), Santiago and
Independencia (North-Centre), and La Florida (South) were
used in this study. These data were separated into three age
groups: under 5 years (group 1; G1); greater than or equal to
5 years and less than 64 years (group 2; G2); and older than
64 years (group 3; G3). Those diseases that affect the respira-
tory and cardiovascular system were evaluated. That is why
the codes were used for each cause according to the
International Classification of Diseases, in its tenth version
(ICD-10), which is shown in Table 3.
The meteorology and air quality data were obtained
from the National Air Quality Information System
(SINCA, in Spanish, see sinca.mma.gob.cl/). The 24-h
average of PM2.5 was extracted from the 6 study mon-
itoring stations. Also, the hourly records of meteorolog-
ical variables corresponding to temperature, relative hu-
midity, and wind speed were obtained, which were se-
lected as possible confounders for the model. Lost data
of meteorology or air quality were imputed through
ARIMA regressions or multivariable linear regression
models (Sanhueza et al. 2009; Díaz-Robles et al.
2015). From this first stage, the complete database was
obtained with the daily resolution for each defined zone.

Fig. 2 Evolution of the population of the Metropolitan Region during the study period
Air Qual Atmos Health
Fig. 3 Distribution of health
insurance in the different zones of
the Metropolitan Region due to
respiratory diseases (2012 year)
Development of mathematical models and estimation
of relative risks
For the development of the models, the National Morbidity,
Mortality and Air Pollution Study (NMMAPS) protocol was
used using multivariate Poisson regression with Generalized
Additive Model (GAM) techniques, as they have been done in
other studies (Samet et al. 2000; Dominici et al. 2002, 2005;
Daniels et al. 2004). In this case, the tendency and seasonality
as confounding variables for the model were added to the
meteorological and air quality variables mentioned above.
Besides, it was assumed up to 5 days of lag. On the other
hand, to determine the standard error, the exact generalized
additives model GAM.EXACT was used. It was made
through the statistical software R-project, version 3.2.0, the
year 2015.
The equation of the model, in general terms, is as follows:
logðuÞ ¼ a0 þ a1 ⋅DOW þ a2 ⋅S ðT ; df Þa3 ⋅S ðM ; df Þ þ β⋅PM2:5 þ ε
ð1Þ
where u is the effect on health, mortality, or morbidity; ai is the
model adjustment coefficients; DOW is the effect of the days
of the week; S is the spline function applied to smooth vari-
ables; T is the trend variable and seasonality; M is the meteo-
rological variables; PM2.5 is the pollutant of interest; β is the
unit risk coefficient; ε is the model error; and df is the degrees
of freedom for the variables.
Fig. 4 Incidence of mortality per 100,000 inhabitants due to
cardiovascular and respiratory causes in the different zones of the
Metropolitan Region (2013 year)
In the case of the trend, 7 degrees of freedom per year of
study were used. Regarding the meteorological variables, 6
degrees of freedom were occupied for temperature and 3 for
relative humidity and wind speed, respectively, as several
studies suggest (Samet et al. 2000; Dominici et al. 2002,
2005; Daniels et al. 2004).
Once the pollutant coefficient (β) was determined, the rela-
tive risk of each disease associated with an increase of 10 μg/
m3 of PM2.5 was calculated through the following equation:
RR ¼ expðβ⋅ΔPM2:5Þ ð2Þ
Results and discussion
Characterization of the population of the study zones
The East zone had the highest total population among the
study areas (see Fig. 2). The distribution by age groups was
similar for each year of study. It diminishes any effect that a
change in the distribution by age groups in the areas of interest
could have on the results of relative risks. It was observed also
that between 2004 and 2013, the total population of all the
zones increased, being the North-Centre Zone the one of
higher growths in this period. This latter exceeded the values
of the West and South zones, respectively, from the year 2012.
On the other hand, G1 decreased in the analyzed period in
all zones, showing adequate behavior according to the decrease
in the birth rate in Chile in recent years (World Bank 2019). In
Fig. 5 Incidence of morbidity per 100,000 inhabitants due to
cardiovascular and respiratory causes in the different zones of the
Metropolitan Region (2012 year)
 Air Qual Atmos Health

Table 4 Relative risk of morbidity effect

Zone Effect Beta EE ICI RR ICS Lag Confounder

East ECardT 0.00264 0.00079 1.0110 1.0267 1.0427 0 Tx.3

ECardG2 0.00301 0.00124 1.0057 1.0305 1.0560 0 Hri.3
ECardG3 0.00227 0.00102 1.0026 1.0230 1.0437 0 Vto
ERespG2 0.00348 0.00111 1.0131 1.0354 1.0581 0 Ti.5
ECRT 0.00197 0.00056 1.0088 1.0199 1.0311 0 Tx
ECRG2 0.00335 0.00083 1.0174 1.0341 1.0511 0 Tx
South ECardT 0.00145 0.00073 1.0003 1.0146 1.0292 5 Tx
ECardG2 0.00219 0.00102 1.0019 1.0221 1.0428 5 HRx
ERespG3 0.00423 0.00153 1.0124 1.0432 1.0750 1 HR.2
ECRT 0.00142 0.00051 1.0041 1.0143 1.0245 5 Tx
ECRG2 0.00195 0.00074 1.0050 1.0197 1.0347 5 HRx.1
ECRG3 0.00186 0.00088 1.0013 1.0187 1.0365 1 Tx.2
North Centre ECardT 0.00203 0.00058 1.0089 1.0205 1.0322 0 Hri.2
ECardG2 0.00219 0.00086 1.0050 1.0221 1.0395 0 Hri.2
ECardG3 0.00202 0.00081 1.0044 1.0204 1.0367 0 Ti.3
ERespT 0.00165 0.00062 1.0044 1.0166 1.0289 0 Hri.3
ERespG2 0.00215 0.00092 1.0034 1.0217 1.0403 0 HRx.1
ECRT 0.00158 0.00041 1.0077 1.0159 1.0242 0 Vto.4
ECRG2 0.00205 0.00062 1.0083 1.0208 1.0333 0 HRx.1
ECRG3 0.00171 0.00066 1.0041 1.0172 1.0304 0 Ti.1
West ECardT 0.00135 0.00066 1.0006 1.0136 1.0269 4 Ti.1
ECardT 0.00171 0.00066 1.0041 1.0172 1.0305 5 Ti.1
ECardG2 0.00204 0.00091 1.0026 1.0206 1.0390 4 Hri.1
ECardG2 0.00218 0.00091 1.0039 1.0221 1.0405 5 Hri.1
ECardG3 0.00223 0.00108 1.0013 1.0226 1.0444 5 Hri.5
ERespT 0.00128 0.00064 1.0001 1.0129 1.0257 5 HRx.2
ERespG2 0.00219 0.00094 1.0036 1.0222 1.0412 4 HRx.1
ERespG2 0.00255 0.00094 1.0070 1.0258 1.0449 5 HRx.1
ERespG3 0.00352 0.00146 1.0066 1.0359 1.0660 1 HRx.3
ECRT 0.00105 0.00046 1.0015 1.0105 1.0196 4 Hri.1
ECRT 0.00143 0.00046 1.0053 1.0144 1.0235 5 Hri.1
ECRG2 0.00210 0.00065 1.0084 1.0213 1.0343 4 Hri.1
ECRG2 0.00240 0.00065 1.0113 1.0243 1.0374 5 Hri.1
ECRG3 0.00183 0.00080 1.0026 1.0184 1.0345 0 HRx.3

this group, the percentage in the Western Zone almost doubles
the value of the Central-North zone. However, in the case of
G3, the latter zone is the highest percentage in its distribution.
A relevant analysis is that which is related to the medical
insurance of the inhabitants of each of the study areas. As
shown in Fig. 3, 68% of the population of the East Zone has
a Private Health Insurance (ISAPRE). In general, these insti-
tutions are those that offer a better quality of service in hospital
care centers when a person is affected by any disease. On the
other hand, the South, North-Centre, and West Zones exceed
50% of the population affiliated with Public Health Insurance
(FONASA), coinciding with the low level of quality of life of
the population of the communes that make up these zones
(Orellana 2017). The public hospital care service generally
has more reduced quality in medical care than the other ser-
vices mentioned above (Koch et al. 2017; Rotarou and
Sakellariou 2017).
The number of hospital admissions and deaths per 100,000
inhabitants for each age group and the two diseases of the
study was determined to avoid the effect of the populated
zone. When comparing the study zones and age groups, in
obtaining the relative risk, G1 did not show statistically sig-
nificant results, so it is not shown in Fig. 4. It is observed that
the North-Centre Zone is the one that registers the highest
incidences of mortality, grouping all the inhabitants. On the
other hand, G3 of the East Zone is the one with the most
Air Qual Atmos Health

Table 5 Relative risk of mortality effect

Zone Effect Beta EE ICI RR ICS Lag Confounder

East MRespT 0.00724 0.00302 1.0132 1.0751 1.1407 4 Tm.5

MRespG3 0.00734 0.00310 1.0127 1.0761 1.1436 4 Tm.5
South MCRG2 0.00574 0.00289 1.0008 1.0591 1.1208 3 Tx
North Centre MCardT 0.00248 0.00109 1.0034 1.0251 1.0472 1 Tx.3
MCardT 0.00274 0.00112 1.0055 1.0278 1.0505 2 Tx.3
MCardG2 0.00630 0.00317 1.0009 1.0650 1.1333 1 Tx.1
MCardG3 0.00266 0.00122 1.0027 1.0270 1.0519 2 Tx.3
MCRT 0.00224 0.00096 1.0037 1.0226 1.0420 1 Tx.4
MCRT 0.00265 0.00096 1.0077 1.0268 1.0463 2 Tx.4
MCRG3 0.00212 0.00104 1.0008 1.0214 1.0424 1 Tx.4
MCRG3 0.00263 0.00104 1.0059 1.0267 1.0479 2 Tx.4
West MCardT 0.00310 0.00109 1.0097 1.0315 1.0537 1 Tm.1
MCardT 0.00248 0.00108 1.0036 1.0251 1.0471 2 Tm.1
MCardT 0.00288 0.00108 1.0077 1.0292 1.0513 3 Tm.1
MCardG2 0.00513 0.00217 1.0088 1.0526 1.0984 1 HRx.3
MCardG3 0.00293 0.00138 1.0023 1.0298 1.0580 1 Tx.1
MRespT 0.00420 0.00213 1.0003 1.0429 1.0874 1 Tm.2
MRespT 0.00585 0.00218 1.0160 1.0602 1.1065 2 Tm.2
MRespG3 0.00562 0.00265 1.0043 1.0578 1.1142 2 Vto.3
MCRT 0.00281 0.00095 1.0095 1.0285 1.0479 1 Tm.2
MCRT 0.00321 0.00096 1.0133 1.0327 1.0523 2 Tm.2
MCRT 0.00314 0.00096 1.0127 1.0319 1.0515 3 Tm.2
MCRT 0.00222 0.00096 1.0035 1.0225 1.0418 4 Tm.2
MCRG2 0.00473 0.00193 1.0094 1.0484 1.0889 1 HRx.3
MCRG2 0.00444 0.00193 1.0066 1.0454 1.0857 2 HRx.3
MCRG2 0.00459 0.00196 1.0075 1.0469 1.0879 3 HRx.3
MCRG3 0.00260 0.00112 1.0040 1.0263 1.0492 2 HRx.3
MCRG3 0.00243 0.00112 1.0024 1.0246 1.0473 3 HRx.3

significant contribution in this regard, being greater than 92%
due to cardiovascular causes and to 96% due to respiratory
causes, concerning the total population of that area. For the
rest of the zones, G3 represents between 75 and 86% of the
population for both causes. These values are also high as a
result of the deterioration suffered by people in the course of
their lives, which indicates that older people are generally
more likely to die from these diseases.
According to Fig. 5, when analyzing the number of hospital
admissions per 100,000 inhabitants, the East Zone is the one

Fig. 6 Relative risks associated with morbidity of cardiovascular causes Fig. 7 Relative risks associated with morbidity of respiratory causes

Fig. 8 Relative risks associated with mortality of cardiovascular causes
that exposes the highest incidence records for morbidity. The
reason is that the East Zone is the one with the highest per-
centage of the population with ISAPRE, which offers better
hospital care services. Besides, the population with higher
incomes and better quality of life live in this zone, so they
prefer to go to the hospital in search of medical attention for
any illness. In the other study zones, since there is a more
significant percentage of the population with FONASA, peo-
ple resist seeking medical assistance (Ewig and Palmucci
2012; Bedregal et al. 2016), showing less interest in-hospital
care although they need it.
No records were found in other investigations of the vari-
ables shown in the last two figures, but these can be used to
compare with other zones that show differences in the amount
of population.
Analysis of morbidity and mortality in health centers
The values of relative risks that were found to be statistically
significant were obtained, according to NNMAPS. The results
of the unit risk coefficient for PM2.5 help to estimate the rel-
ative risk by exposure of the population, before any variation
of the concentration of this pollutant. They bring information
regarding the cost-benefit analysis that would have the
Fig. 9 Relative risks associated with mortality of respiratory causes
Air Qual Atmos Health
application of some measure of mitigation of emissions of
particulate matter, thus helping to decide between the best
alternatives. On the other hand, the values recorded in
Tables 4 and 5 represent current data of relative risk for expo-
sure to fine particulate material in the Metropolitan Region,
demonstrating the difference that exists between the study
zones.
As it is observed in Figs. 6 and 7, a significant result is that
G1 does not present a risk of hospital admission due to acute
PM2.5 exposure. Figure 6 shows that the highest risk by hos-
pital admissions for cardiovascular causes is in the East zone,
both for the total population and for G2 and G3, respectively.
As mentioned above, in this zone, there is more significant
and better access to hospital facilities, so there is a more fab-
ulous record of attention, as shown in Fig. 5. The RR in de-
creasing order is observed both for G2 and for the total pop-
ulation, in the North-Centre zone, West and South,
respectively.
For respiratory reasons (see Fig. 7), in G2, the most signif-
icant risk occurs in the East zone, followed by the West and
North-Centre zones. The same argument explains the highest
risk for the East zone for cardiovascular causes.
In terms of cardiovascular mortality (see Fig. 8), both for
the total population and for G2 and G3, the only risk is found
in the West and North-Centre zones, which are the areas with
the highest exposure to PM2.5. However, due to respiratory
causes, there is only a risk of mortality in the East and West
zones, the risk being higher in the first zone. The only age
group in which risk is present is in G3, influencing the result
when evaluating the total population. Older adults in the East
Zone have a 31.6% higher risk than older adults in the West
zone. The age distribution of the population could explain it.
As can be seen in Fig. 2, the percentage of older people in the
East zone is double that of the West Zone, which translates
into a more susceptible population.
Although in the East Zone there are the highest risks of
hospital admission due to cardiovascular causes in G2 and
G3, and due to respiratory causes in G2, this situation
does not recur in the case of mortality, as shown in
Figs. 8 and 9, where there are no risks for these causes,
which is justified by better quality medical care. Contrary
to this, it is what is observed for the West and North-
Centre Zones, in which the relative risk of both hospital
admission and mortality is presented, these being the
zones of most considerable exposure to PM2.5 and also
the areas of least ULQI.
The results obtained suggested that the level of risk due
to exposure to air pollution is not defined solely by the
level of exposure to the pollutant. Other factors, such as
the age distribution or quality of life of the population,
will define the susceptibility of this, being able to increase
the risk of becoming ill or dying by being exposed to
contamination.
Air Qual Atmos Health
Conclusions
Air pollution by fine particulate material affects the health of
people, especially in highly populated cities such as Santiago
de Chile. This study showed the incidence of this pollutant in
different areas of the Metropolitan Region, showing its effect
in different age groups of the population. On the other hand,
values obtained from the relative risk associated with morbid-
ity and mortality due to respiratory and cardiovascular dis-
eases, respectively, are more specific than other studies previ-
ously conducted. In this way, the exposed results serve as
input data for the realization of studies in this area, regarding
the cost-benefit that would be obtained by reducing pollutant
emissions to the atmosphere, which would provide more reli-
able information to develop correct management policies
about air quality. It is suggested expanding this study to other
areas of the country to increase the health risk information by
fine particulate material.
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