Pol. J. Environ. Stud. Vol. 26, No. 1 (2017), 163-171 DOI: 10.15244/pjoes/64642 Original Research Air Pollution Associated with Sumatran Forest Fires and Mortality on the Malay Peninsula Yu Jie* School of Public Health, Zunyi Medical University, Zunyi, Guizhou, 563000, P.R. of China Received: 14 June 2016 Accepted: 12 August 2016 Abstract Background: The main study objective was to determine the associations between mean daily concentrations of criteria air pollutants and the risks of respiratory and cardiovascular mortality at hospitals in Malaysia’s Klang Valley. Methods: The study period was 1-31 August 2005. Two areas in the valley, Port Klang and Kuala Lumpur, and two areas in northwestern Malaysia, Penang and Langkawi, were selected. The study sample was all respiratory (ICD-10 J00-J99) and cardiovascular (ICD10 I10-I99) disease cases who were discharged as deceased from (for mortality data), the study hospitals during the study period. Air quality data on respirable particulate, nitrogen dioxide, sulphur dioxide, carbon monoxide, and ozone were obtained from continuous air quality monitoring stations located nearest to the hospitals in these four areas. Data on maximum temperature and rainfall were obtained from the four closest meteorological stations. Spearman correlation was then used to model the relationships between daily variations in the five air pollutants with variations in in-patient mortality statistics. Results: Of the five criteria air pollutants, PM10 was the pollutant that exceeded the 24-hour average 3 Malaysian Ambient Air Quality Guidelines (MAAQG) for PM10 of 150 μg/m 6-12 August in both Klang and Kuala Lumpur, and on 13 August in Penang and Langkawi. In Kuala Lumpur, the 24-hour mean temperature (r = 0.586, p<0.005) was directly correlated with PM10 concentration. Conclusions: The variability of respiratory and cardiovascular case mortality in the four areas was not attributed to the change in the concentration of PM10 in ambient air over time. This outcome may be due to several factors such as the limitation in the area of influence of the 2005 haze episode in Malaysia, relatively lower concentrations of PM10 in ambient air, etc. Keywords: air pollutants, PM10, respiratory diseases, cardiovascular diseases, Malaysia Introduction central part of peninsular Malaysia to a standstill and prompted crisis talks with Indonesia [1]. Lingering smoke The 2005 Malaysian haze was a week-long choking from forest fires on the Indonesian island of Sumatra were smog-like haze over Malaysia that almost brought the identified as the primary cause. Farmers regularly burn scrub and forest to clear land during the dry season for agricultural purposes, but this was the worst haze that to *e-mail: [email protected] hit Malaysia since the 1977 haze, when the daily average 164 Jie Y. concentration of total suspended particles was about government had enhanced haze pollution management 297 μg/m3 of air in Kuala Lumpur [2]. and people had raised self-protection consciousness since On 11 August 2005 a state of emergency was the 1997 haze crisis, together with the haze health effect announced for the world’s 12th largest port, Port Klang, on residents. and the district of Kuala Selangor after air pollution As Malaysia becomes more developed, the cost of there reached dangerous levels. The state of emergency medical care (especially in-patient hospital care) escalates in the two affected areas meant the closing of schools, tremendously. This imposes a significant burden on government offices, and the port. the country’s economy. Even though deteriorating air Health authorities said asthma attacks had soared quality may not have a direct causal relationship with and tourists were hiding in their hotels or seeking refuge respiratory and cardiovascular diseases, it may exacerbate in air-conditioned shopping malls. Schools and one these diseases that lead to hospital admissions [6-11]. of Malaysia’s key ports, Northport, were suspended. Deteriorating air quality may also cause premature Shipping in the Malacca Straits was also affected by the mortality [12, 13]. It would be interesting to know whether haze. According to Malaysian Health Minister Chua Soi there exists a correlation between daily concentrations Lek, some government hospitals and clinics saw a 150% of criteria air pollutants and the risks of respiratory and increase in respiratory complaints [3]. A high air pollutant cardiovascular mortality at hospitals in Malaysia’s Klang index (API) reading was announced for the first time Valley. by the Malaysian government since 1997. (Malaysia’s API closely follows the U.S. Environmental Pollution Agency’s pollutant standard index; an API reading of 101- Materials and Methods 200 is considered to be unhealthy, and an API of 301-500 is hazardous; Table 1). The following are API readings Study Design released by the Malaysian government during the onset of haze on 10 August 2005: Port Klang 424, Kuala Selangor A population-based, cross-sectional epidemiological 418, Shah Alam 349, Putrajaya 337, Petaling Jaya 304, survey of respiratory and cardiovascular diseases was Kuala Lumpur (KL) 276, and Malacca 107. conducted in Zunyi. The study was conducted 1-31 August Although previous studies have determined the 2005. relationship between biomass haze and mortality regarding the 1997 Southeast Asian haze episode [4, 5], Study Location the 2005 haze episode was the worst to hit Malaysia since, and there was still a lack of information about the effects The areas affected by the smoke haze from the of haze pollution on human health. To our knowledge, this Indonesian forest fires in August 2005 include the Klang is the first study to investigate the relationship between Valley (Port Klang and Kuala Lumpur areas) and the biomass haze and mortality associated with the August Penang and Langkawi areas in northern Malaysia, which 2005 Southeast Asian haze episode. The objective of were affected more lightly [2]. At 2,832 km2, the Klang this study is to determine the associations between mean Valley is situated within the drainage basins of the Klang daily concentrations of criteria air pollutants and the risks and Gombak rivers. The population in this area was of respiratory and cardiovascular mortality in the Klang more than 4.0 million in 2005. Penang is Malaysia’s Valley. From this study, we can determine whether the second smallest state with a total population of around Table 1. Air pollutant index in Malaysia. API Status Level of pollution Health measure 0-50 Good Low, no ill effects on health No restriction of activities for all groups 51-100 Moderate Moderate pollution no ill effects No restriction of activities for all groups on health 101-200 Unhealthy Mild aggravation of symptoms 1. Restriction of outdoor activities for high risk persons among high risk groups, e.g., 2. General population should reduce vigorous outdoor activity those with heart or lung disease 201-300 Very Significant aggravation of 1. Elderly and persons with known heart or lung disease should stay unhealthy symptoms and decreased indoors and reduce physical activity exercise tolerance in persons 2. General population should avoid vigorous outdoor activity with heart or lung disease 3. Those with any health problems to consult doctor 301-500 Hazardous Severe aggravation of symptoms 1. Elderly and persons with existing heart or lung disease should stay and a danger to health indoors and reduce physical activity 2. General population should avoid vigorous outdoor activity 501+ Emergency Severe aggravation of symptoms 1. General population advised to follow the orders of the National security and a danger to health council and always follow announcements through the mass media Air Pollution Associated with Sumatran... 165 Table 2. ASMA’s continuous air quality monitoring (CAQM) stations in four study areas. Location ID Name Station Location Longitude Latitude CA001 Sek. Men. Perempuan Raja Zarina Klang N03°00.620 E101°24.484 CA0054 Sek. Men. Keb. Sri Permaisuri Kuala Lumpur Cheras N03°06.376 E101°43.072 CA0038 Universiti Sains Malaysia Penang N05°21.528 E100°17.864 CA0032 Komplek Sukan Langkawi Kedah N06°19.903 E099°51.517 1,578,000 in 2005. Langkawi archipelago is a cluster of (Table 2). We obtained mean daily ambient concentrations 99 islands with a much smaller island population of only of particulate matter less than 10 microns (PM10) in 3 62,000. µg/m , sulphur dioxide (SO2) in ppm, nitrogen dioxide (NO2) in ppm, ozone (O3) in ppm, and carbon monoxide Respiratory and Cardiovascular (CO) in ppm. Each CAQM station is an integrated ambient Mortality Data air quality monitoring system designed to monitor ambient air for specific pollutants. These five criteria pollutant Our target population for the present study used all concentrations were recorded per hour in the monitoring respiratory and cardiovascular disease patients admitted to system. Mean daily ambient concentration was calculated hospitals in Penang and Langkawi. The data of respiratory according to the monitored 24-hour concentrations. and cardiovascular mortality were acquired from the three The Malaysian Ambient Air Quality Guidelines areas during the study period based on discharge data (MAAQG) prescribes ambient guidelines for five criteria of patients discharged as deceased. The date of patient air pollutants as shown by Table 3. In this study, five discharge was taken as the date of mortality. A total of criteria pollutants were selected to assess their associations 536 patients were surveyed. Of the 536, 282 and 254 with patient mortality. These five pollutants were selected had been admitted for cardiovascular and respiratory because they tend to have the greatest impacts on human diseases, respectively. The cause of mortality was based health, especially on respiratory and cardiovascular on the patient’s discharge diagnosis, which was classified mortality [14]. These five pollutants are also used in the according to the ICD 10. The records contain a discharge API computation.