A characteristics of atmospheric air pollution during the period from 1980 till 1992 in the town of Beloslav, a settlement located in the immediate proximity of Devnya industrial complex was prepared. The following parameters were examined: dust, sulphur dioxide, sulphuric acid, hydrogen sulphide, nitric oxides, ammonia, chlorine, and hydrogen fluoride. Annual indexes of pollution presented according to the Canadian Indexing System exceeded considerably the hygienic standards concerning most atmospheric air pollutants. During the whole period of observation the total index varied between 3,22 and 8,28 one unit being the standard. The morbidity rate of the population according to the registration files for children and adults was analyzed, too. Multiple correlation and step regression analyses were applied to follow-up the influence of the atmospheric air pollution on the morbidity. There were statistically reliable correlation dependences between the atmospheric air pollution and the diseases of the respiratory, nervous, alimentary and other systems

Chuturkova, R.

Popova, S.

English

Varna Medical University Press: Journals

Scripta Scientifica Medica, vol. 29 (1996), pp.81-89 Copyright © Medical University, Varna M U L T I P L E C O R R E L A T I O N M O D E L F O R E S T A B L I S H I N G T H E A S S O C I A T I O N B E T W E E N A T M O S P H E R I C A I R P O L L U T I O N AND M O R B I D I T Y R. Chuturkova, S. Popova* National Centre of Hygiene, Medical Ecology and Nutrition, Sofia, Varna Branch and ^Department of Social Medicine and Biostatistics, Medical University of Varna, Varna A characteristics of atmospheric air pollution during the period from 1980 till 1992 in the town of Beloslav, a settlement located in the immediate proximity of Devnya industrial complex was prepared. The following parameters were examined: dust, sulphur dioxide, sulphuric acid, hydrogen sulphide, nitric oxides, ammonia, chlorine, and hydrogen fluoride. Annual indexes of pollution presented according to the Canadian Indexing System exceeded considerably the hygienic standards concerning most atmospheric air pollutants. During the whole period of observation the total index varied between 3,22 and 8,28 one unit being the standard. The morbidity rate of the population according to the registration files for children and adults was analyzed, too. Multiple correlation and step regression analyses were applied to follow-up the influence of the atmospheric air pollution on the morbidity. There were statistically reliable correlation dependences between the atmospheric air pollution and the diseases of the respiratory, nervous, alimentary and other systems. Key-words: Atmospheric air pollution, indexes of pollution, morbidity, children, adults, multiple correlation analysis, step regression analysis The effect of atmosheric pollution on the morbidity of exposed population is currently studied in the whole world. There exist numerous convincing data about the changed resistance of the organism under the influence of the atmospheric air pollution manifesting with a consi-derable reduction of both specific and Address for correspondence: R. Chuturkova, Centre of Hygiene, Varna Branch, 3 Bregalnitsa St, BG-9010 Varna, BULGARIA non-specific defense forces, the factors of cellular and humoral immunity, etc. (3,4,14,16). An increased morbidity rate of the population concerning the respiratory tract diseases such as acute bronchitis, asthma, and emphysema was registered and an association with the atmospheric air pollution with sulphur dioxide, nitric dioxide, fine-fraction dust, and aerosols of sulphuric acid was proved (7,8,12-15). An elevated morbidity rate of ischemic heart disease was also observed (11). R. Chuturkova, S. Popova The purpose of this study was to assess the atmospheric air pollution in the town of Beloslav located in the immediate proximity of a region with developed chemical industry and then to analyze the correlation with the morbidity of the population. M A T E R I A L AND METHODS A characteristics of the atmospheric air poluution in the town of Beloslav located 10 km far from the Devnya industrial complex presenting with well-developed chemical industry was prepared. The examination covered the period from 1980 till 1992. The following parameters were assessed: dust, sulphur dioxide, sulphuric acid, hydrogen sulphide, nitric oxides, ammonia, chlorine, and hydrogen fluoride. Canadian Indexing System was used to evaluate these parameters as the indexes of pollution were calculated in their independent and combined action (1,2,6,10). The morbidity rates of the population according to registration files in the town of Beloslav during the ,same period were analyzed as data were elaborated for both age groups -children and adults. A total of 34 nosological units according to the International Classification of Diseases were selected. In order to clarify the influence of atmospheric air polution on the morbidity of population multiple correlation and step regression analyses were applied. RESULTS AND DISCUSSION The results concerning the atmospheric air pollution with dust revealed that annual indexes remained within the limits of 1,33 to 4,84 one unit being the standard during the 13-year period and indicated a relatively constant level of dustiness in the settlement near to the industrial region (Fig. 1). Hydrogen fluoride values were rather variable. Annual indexes were very high in the beginning of the period - between 8,11 for 1981 and 5,39 for 1983. Then they decreased down to 2,77 and 3,47 for 1984 and for 1989, respectively, and even under the standard in the middle and the end of the period of observation - between 0,2 and 0,55 during 1986-1988 and between 0,4 and 0,64 during 1991-1992. Annual indexes of ammonia demonstrated a slightly elevated pollution over the standard in the early years (up to 1985) followed by gradual increase up to 2,24 in 1987 and reaching the maximum of 4,07 in 1990. The reduced values in the end of the period remained over the standard -between 2,43 for 1991 and 1,89 for 1992. 82 Multiple correlation model for establishing the association. 10 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 • DUST * H F »NH 3 Fig. 1. Atmospheric air pollution indexes of dust, hydrogen fluoride and ammonia 7 I •v x s q • H t S Q , mHjs Fig. 2. Atmospheric air pollution indexes of sulphur dioxide, sulphuric acid, and hydrogen sulphide 83 R. Chuturkova, S. Popova Concerning the pollution with sulphur dioxide it was established that abnormally high indexes were found out during the first half of the period only - between 1,57 for 1980 and 3,58 for 1985 (Fig. 2). During the second half of the period the indexes varied about the standard or even consi-derably below it - down to 0,28 for 1992 and 0,10 for 1991. The pollution indexes of hydrogen sulphide were abnormally high for almost all the years - e. g., 1,77 for 1984 and 1,85 for 1985. In the early years and then in 1987-1990 these indexes were low - between 0,29 and 0,92. The indexes of hydrogen sulphide were considerably higher reaching their maximum in the beginning of the period (5,97 for 1980 and 6,31 for 1984).They decreased but remained abnormal in the rest years - up to 3,64 for 1986 but down to 0,50 and 0,83 for 1987 and 1990, respectively. Annual indexes of nitrogen oxides (nitric oxide and nitric dioxide) and chlorine were significantly lower than the standard and testified to a low pollution level. The simultaneous presence of different atmospheric air pollutants necessitated the elaboration of a complex assessment of the atmospheric air using a total pollution index ( I 0 ) . It was demonstrated that independently of the registered low concentrations of some atmospheric pollutants during the whole period of observation the total index significantly exceeded the hygienic standard and varied between 3,22 and 8,28. It represented an important parameter providing a real idea of the atmopheric air pollution and thus it was currently used by numerous investigators (2,5). These results testified to a rather high level of atmospheric air pollution in the town of Beloslav located in the immediate proximity of the region with intensively developed chemical industry. This location in a territory complicated by physico-geographic peculiarities contributed to this pollution level, too. The town of Beloslav is at sea-level and surrounded by plateaus high up to 300 m which is sufficient for the harmful emissions of the chemical works of Devnya industril complex to hold at the ground layer. Prevailing breeze circulation and comparatively frequent Western and North-western winds exert their influence as they transport the chemical pollutants to the town of Beloslav. It was evident that there existed a tendency towards reduction of the atmospheric air pollution concerning the following indexes: sulphur dioxide, hydrogen sulphide, sulphuric acid, and hydrogen fluoride. The reasons could be looked for in the decreased exploitation of the production capacities of Devnya industrial complex and in the realized 84 Multiple correlation model for establishing the association. ADULTS g S Q M H g Q EaHfi HNQ BNQ M N H 3 B H F (MCl2EaDUST ffllo 1. NEOPLASMS 7. HYPERTENSION 13. CHRONIC BRONHITIS 2. DISEASES OF THE ENDOCRINE SYSTEM 8. ISCHEMIC HEART DISEASE 14.ASTHMA 3. DIABETES 9. CEREBRO-VASCULAR DISEASE 15.GASTROINTESTINAL 4. DISEASES OF THE BLOOD CIRCULATION 10.ACUTE UPPER RESPIRATORY DISEASES 5. NEUROSES TRACT INFECTIONS 16.DISEASES OF SKIN AND 6. DISEASES OF THE NEVROUS 11. ACUTE BRONCHITIS SUBCUTANEOUS TISSUE SYSTEM 12. PNEUMONIA 12. TOTAL Fig. 3. Multiple correlation between atmospheric air pollution and morbidity rate in adults reconstructions and improvements in the chemical works. The results from the multiple correlation and regression models demonstrated that there existed statistically significant correlation dependences (r = 0,7 + 0,9 at 0,001 < p < 0,01) between the atmospheric air pollution with nitric oxides, sulphur dioxide, sulphuric acid, dust, chlorine, hydrogen fluoride, on the one hand, and the chronic bronchitis, asthma, pneumoniae, acute upper respiratory tract infections, diseases of the nervous and alimentary systems, hypertension, ischemic heart disease, thyroid gland disease, skin diseases, and neoplasms (Figs. 3 and 4). These correlations were more outlined in the adult population than in the children. Some equations of regression in both age groups were presented. 1. Adults Thyroid gland diseases'. Y = 27,7 - l , 4 8 . X d u s t - 1,1 l . X N 0 + l ,34.X I O + 0 , 8 . X c l 2 + 0 , 6 8 . X S O 2 -0 , 9 2 . X H 2 S O 4 - 0 , 3 7 . X N H 3 85 R. Chuturkova, S. Popova H1S02 HHSQ ИН23 HNQ DNO B N H , B H F ШС1 HDUST ffllo 1. NEOPLASMS 2. DISEASES OF THE NEVROUS SYSTEM 3. ACUTE UPPER RESPIRATORY TRACT INFECTIONS 4. ACUTE BRONCHITIS 5. PNEUMONIA 6. CHRONIC BRONCHITIS 7. ASTHMA 8. GASTROINTESTINAL DISEASES 9. DISEASES OF SKIN AND SUBCUTANEOUS TISSUE 10. TOTAL Fig. 4. Multiple correlation between atmospheric air pollution and morbidity rate in children Hypertension: Y = 438,31 - 1,13.X N 0 + 0 , 4 2 . X H 2 S O 4 + 0 ,26 .X H 2 S + 0,1 l . X I O + 2 , 9 4 . X N H 3 - 3 , 1 9 . X d u s t - 2 , 1 6 . X S 0 2 Chronic bronchitis: Y = 58,88 + 1 ,28 .X H 2 S 04" 0 ,69 .X H F -1 , 2 . X N 0 2 - 0 , 37 .X S O 2 + 0 ,82 .X d u s t + 0 ,38 .X C L 2 + 0 , 3 9 . X N H 3 + 0,35.X l 0 Alimentary tract diseases: Y = 537,64 - 0 , 9 . X N O 2 + 0 ,32 .X S O 2 + 0,41 . X N H 3 - 0 ,23 .X H F + 0 ,44 .X d u s t - 0 ,21 .X N O + ° > , 2 . X H 2 S 0 4 -0 ,36 .X H 2 S 2. Children Acute bronchitis: Y = 765,58 + 2 , 7 8 . X N 0 2 - l , 7 3 . X d u s t - 1 , 2 9 . X N H 3 - 0 , 7 3 . X N O + 0 , 6 5 . X H 2 S O 4 - 0 , 7 1 . X I o Pneumonia: Y = 340,39 + 2 , 7 6 . X N 0 2 - 1 ,54.X N H 3 - 0 , 9 4 . X c l 2 - 0 , 5 9 . X S O 2 - l , 0 5 . X l 0 -0 ,98 .X d u s t 86 Multiple correlation model for establishing the association. Asthma: Y = 56,02 - 1 ,14.X N H 3 - 1,02.X H 2 S + 0 , 8 5 . X N O 2 - 0 ,92 .X H F Single linear correlation (9) was used in order to clarify the effect of the atmospheric air pollution on the morbidity in some investigations. However, the method of multiple correlation and step regression analysis enabled the study of the combined action of the atmospheric pollutants on the morbidity rate of the population exposed. These results indicated the presence of an enhanced risk for the population in the town of Beloslav. There exists an obvious necessity for more profound investi­gations in this field. The awareness of the health status of single population groups could serve as a basis for the adequate organization of the medical aid, appropriate decision making and in the last reckoning for the achievement of a stable human health. CONCLUSIONS 1. Annual pollution indexes for most pollutants exceeded signi­ficantly the hygienic standards in the town of Beloslav. 2. There was a tendency to­wards improvement of the atmo­spheric air pollution in the town of Beloslav of the following parameters: sulphur dioxide, sulphuric acid, hydrogen sulphide, and hydrogen fluoride. This was determined by the lower exploitation of the production capacities of Devnya industrial comp­lex and by the already performed reconstructions and modernizations in the chemical works. 3. Multiple correlation and re­gression models revealed statistically significant correlation dependences between the atmospheric air pollution and the diseases of the respiratory, nervous, and alimentary systems, the haemopoietic organs, the skin and the neoplasms as well. 4. These correlations were more outlined for the adults than for the children. R E F E R E N C E S 1. А р г и р о в а , M . , X . С т о й ч е в а . Хиг. и здравеоп., 1982, № 3, 283-290.- 2. Д е л и р а д е в а, Р . Хиг. и здравеоп., 1995, № 1, 18-20.- 3. Д е н и с о в , В . Л . , Б . В . Г о р о д с к и й , Г . Г . Ю ш к о в . Методология, организация и итоги массовых иммунологических обследований. Москва, Ангарск, 1987,9-10.-4. К о в а л е в а , Е . П . , А . Я . Л ы с е н к о , Д . П. Н и к и т и н . Урбанизацияи проблемы эпидемиологии. Москва, 1982.- 5. 87 R. Chuturkova, S. Popova П о п о в а , Т . Л . , Л . С . К а р п о в а , Л . М . Ц ы б а л о в а , В . А . И с а к о в а . Педиатрия {Москва), 1994, № 5, 7 - 1 6 . С т о й ч е в а , X . , М . Т о ш е в а , Е . М у т а ф о в а , Р . Ч у т у р к о в а . - В: Състояние на изследванията, рационалното усвояване и защита на природните ресурси на Варненския регион. Науч.-практ. конф. Варна, 1989 г. Сб. доклади. Варна, 1989, 287-297.- 7. В a t е s , D . V . Environ. Health Perspect., 103, 1995, No 6, 24-247.- 8. B r u n e k r e e f , В . , D . W . D o c k e r y , M . К r z у z a n о w s k i . Environ. Health Perspect., 103, 1995, No 2, 3-13.- 9. С h u t u r k о v a , R . , M . T o s h e v a , S . P o p o v a , H . S t o y c h e v a . Annu. Proc. Internat. Med. Assoc. Bulg., 2, 1996, No 2, 366-369.- 10. C h u t u r k o v a , R . , M . T o s h e v a , I . Z l a t a r o v , S . P o p o v a , H . S t o y c h e v a . Annu. Proc. Internat. Med. Assoc. Bulg., 3, 1997 (in press).- 11. C i c c o n e , G . , F . F a g g i a n o , P . F a l a s c a . Epidemiol. Prevenz., 19, 1995, 99-104.- 12. Health effects of outdoor air pllution. Amer. J. Respir. Crit. Care Med., 153, 1996, No 1, 3-50.-13. S c h w a r t z , J . Thorax, 50, 1995, No 5, 531-538.- 14. W a g n e r o v a , M . , V . W a g n e , J . K r i z . G. Hyg., 31, 1986, No 5, 271-281.- 15. W a l t e r s , S . , R . К . C r i f f i t h s , J . G . А у r е s . Thorax, 49, 1994, No 2, 133-140.-16. Z h e n h u a , Z . , M . Z o n g g i n g , Y . Z h e n k a i , D . Y o n g h u n . J. West. China Univ. Med. Sci., 18, 1987, No 2, 157-159. Множествен корелационен модел за установяване на връзката между замърсяването на атмосферния въздух и заболяемостта Р. Чутуркова, С. Попова* Национален център по хигиена, медицинска екология и хранене - София, Филиал Варна и ^Катедра по социална медицина и биостатистика, Медицински университет - Варна Резюме: Изготвена е характеристика на замърсяването на атмосферния въздух за периода от 1980 до 1992 г. в гр. Белослав - селище, разположено в непосредствена близост до Девненския промишлен комплекс. Изследвани са следните показатели: прах, серен двуокис, сярна киселина, сероводород, азотни окиси, амоняк, хлор и флуороводород. Годишните индекси на замърсяване, представени по канадската индексова система, значително превишават хигиенните хорми за по-голямата част от атмосферните замърсители. Сумарният индекс варира от 3,2 до 8,28 при норма единица за целия период на наблюдение. Проучена е и заболяемостта по обръщаемост на населението за медицинска помощ при деца и възрастни. За проследяване на влиянието на атмосферното замърсяване върху заболяемостта са използвани множествен корелационен и стъпков регресионен анализи. Установени са статистически достоверни корелационни зависимости между замърсяването на 88 Multiple correlation model for establishing the association... атмосферния въздух и болестите на дихателната, нервната, храносмилателната и други системи. 89 

MULTIPLE CORRELATION MODEL FOR ESTABLISHING THE ASSOCIATION BETWEEN ATMOSPHERIC AIR POLLUTION AND MORBIDITY

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MULTIPLE CORRELATION MODEL FOR ESTABLISHING THE ASSOCIATION BETWEEN ATMOSPHERIC AIR POLLUTION AND MORBIDITY

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