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• Do socioeconomic conditions reflect a high exposure to air pollution or more sensitive health condit
  Laurent Filleul
  Published on: 27 April 2016

• Published on: 27 April 2016

  Do socioeconomic conditions reflect a high exposure to air pollution or more sensitive health condit

  • Laurent Filleul, PhD
  • Other Contributors:
    • Imed Harrabi

  Dear Editor,

  We read with great interest the recent paper by Martins et al.[1] concerning the influence of socioeconomic conditions on air pollution adverse health effects in elderly people in Sao Paulo, Brazil. These results are very interesting and may promote understandings of which social category of persons are most sensitive to air pollution. The authors suggest that socioeconomic deprivation represents a...

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  Dear Editor,

  We read with great interest the recent paper by Martins et al.[1] concerning the influence of socioeconomic conditions on air pollution adverse health effects in elderly people in Sao Paulo, Brazil. These results are very interesting and may promote understandings of which social category of persons are most sensitive to air pollution. The authors suggest that socioeconomic deprivation represents an effect modifier of the association between air pollution and respiratory deaths in elderly people for an increase of 10 µg/m3. They conclude that poverty represents an important risk factor that should be taken into account when determining the health consequences of environmental contamination. We agree with these conclusions nevertheless, the question is to know if poor people died because they are more illness or inaccessibility (geographic and economic considerations) to health care system or because they were more exposed to air pollution ? We know that people with lower socioeconomic status are more sensitive to a large number of risk factors according to different life habits, or to addictive conducts as smoking habits [2]. When air pollution is considered, socioeconomic characteristics as an effect modifier can take two aspects. First, people with low socioeconomic status may be more sensitive in term of health effect because they have associated pathologies and individuals with certain diseases had a greater risk of dying during an episode of increased of air pollution than did members of the general population [3]. Furthermore, people living in underprivileged sectors would have both more limited access to healthcare [4] and greater exposure to air pollution. Exposure conditions is the second aspect of the interpretation of the effect modifier. Jerrett et al.[5] argue, low socioeconomic conditions may be associated with manufacturing and so with a higher workplace exposures, but also with a lower mobility. In addition, persons with lower socioeconomic characteristics may be exposed to a complex mix of pollution from indoor sources, as well as outdoor pollution due to traffic, industry, and waste burning in developing countries. It seems necessary to explore the link between individual exposure and socioeconomic characteristics because these two factors are strongly correlated. More studies are need to investigate this effect modifier and particularly the signification of this effect. To understand this effect we will need individual data on risk factor but also data on individual exposure to have a good interpretation of the results and to have policy implications.

  References
  (1) Martins MC, Fatigati FL, Vespoli TC et al. Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in Sao Paulo, Brazil. J Epidemiol Community Health 2004;58:41-6.
  (2) Prescott E, Godtfredsen N, Vestbo J, Osler M. Social position and mortality from respiratory diseases in males and females. Eur Resp J 2003;21:821-6.
  (3) Goldberg MS, Burnett RT, Bailar JC et al. Identification of persons with cardiorespiratory conditions who are at risks of dying from the acute effects of ambient air particles. Environ Health Perspect 2001;109:487-94.
  (4) Chen Y, Dales R, Krewski D. Asthma and the risk of hospitalization in Canada : the role of socioeconomic and demographic factors. Chest 2001;119:708-13.
  (5) Jerrett M, Burnett RT, Brook J et al. Do socioeconomic characteristics modify the short term association between air pollution and mortality ? Evidence from a zonal time series in Hamilton , Canada. J Epidemiol Community Health 2004;58:31-40.

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  Conflict of Interest:
  None declared.

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