Association between ambient air pollutants and upper respiratory tract infection and pneumonia disease burden in Thailand from 2000 to 2022: a high frequency ecological analysis

Abstract

Background A pertinent risk factor of upper respiratory tract infections (URTIs) and pneumonia is the exposure to major ambient air pollutants, with short term exposures to different air pollutants being shown to exacerbate several respiratory conditions. Methods Here, using disease surveillance data comprising of reported disease case counts at the province level, high frequency ambient air pollutant and climate data in Thailand, we delineated the association between ambient air pollution and URTI/Pneumonia burden in Thailand from 2000 – 2022. We developed mixed-data sampling methods and estimation strategies to account for the high frequency nature of ambient air pollutant concentration data. This was used to evaluate the effects past concentrations of fine particulate matter (PM2.5), sulphur dioxide (SO2), and carbon monoxide (CO) and the number of disease case count, after controlling for the confounding meteorological and disease factors. Results Across provinces, we found that past increases in CO, SO2, and PM2.5 concentration were associated to changes in URTI and pneumonia case counts, but the direction of their association mixed. The contributive burden of past ambient air pollutants on contemporaneous disease burden was also found to be larger than meteorological factors, and comparable to that of disease related factors. Conclusions By developing a novel statistical methodology, we prevented subjective variable selection and discretization bias to detect associations, and provided a robust estimate on the effect of ambient air pollutants on URTI and pneumonia burden over a large spatial scale.