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Impact of outdoor biomass air pollution on hypertension hospital admissions
  1. Marcos Abdo Arbex1,2,
  2. Paulo Hilário Nascimento Saldiva2,
  3. Luiz Alberto Amador Pereira2,3,
  4. Alfésio Luís Ferreira Braga2,3,4
  1. 1Internal Medicine Post-Graduation Program, São Paulo Federal University Medical School, São Paulo, Brazil
  2. 2Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, University of São Paulo Faculty of Medical Sciences, São Paulo, Brazil
  3. 3Group of Environmental Exposure and Risk Analysis, Collective Health Post-Graduation Program, Catholic University of Santos, Santos, Brazil
  4. 4Department of Collective Health, ABC Faculty of Medicine, Santo André, Brazil
  1. Correspondence to Dr Marcos Abdo Arbex, Rua Pedro de Toledo, 980, 11 Andar, Cj. 116, Vila Clementino, 04039-002, São Paulo, SP, Brazil; arbexma{at}


Background This study aimed to evaluate the association between the total suspended particles (TSP) generated from burning sugar cane plantations and the incidence of hospital admissions from hypertension in the city of Araraquara.

Methods The study was an ecological time-series study. Total daily records of hypertension (ICD 10th I10-15) were obtained from admitted patients of all ages in a hospital in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (μg/m3) was obtained using a Handi-Vol sampler placed in downtown Araraquara. The local airport provided daily measures of temperature and humidity. In generalised linear Poisson regression models, the daily number of hospital admissions for hypertension was considered to be the dependent variable and the daily TSP concentration the independent variable.

Results TSP presented a lagged effect on hypertension admissions, which was first observed 1 day after a TSP increase and remained almost unchanged for the following 2 days. A 10 μg/m3 increase in the TSP 3 day moving average lagged in 1 day led to an increase in hypertension-related hospital admissions during the harvest period (12.5%, 95% CI 5.6% to 19.9%) that was almost 30% higher than during non-harvest periods (9.0%, 95% CI 4.0% to 14.3%).

Conclusions Increases in TSP concentrations were associated with hypertension-related hospital admissions. Despite the benefits of reduced air pollution in urban cities achieved by using ethanol produced from sugar cane to power automobiles, areas where the sugar cane is produced and harvested were found to have increased public health risk.

  • Air pollution
  • cardiovascular disease
  • environmental epidemiology
  • health policy
  • hypertension
  • outdoor biomass burning
  • public health epidemiology

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.