Investigating the effects of dust storms on morbidity and mortality due to cardiovascular and respiratory diseases: A systematic review
Ali Sadeghimoghaddam1, Hamidreza Khankeh2, Mehdi Norozi3, Shahrokh Fateh4, Mehrdad Farrokhi4
1 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran; Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
2 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
3 Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
|Date of Submission||19-Sep-2020|
|Date of Acceptance||11-Oct-2020|
|Date of Web Publication||31-May-2021|
Dr. Mehrdad Farrokhi
Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran
Source of Support: None, Conflict of Interest: None
New epidemiological studies acknowledge the detrimental effects of dust storms on health. The aim of this study was to systematically review the effects of dust storms on the morbidity and mortality rates of cardiovascular and respiratory diseases. The results of this study were obtained based on articles published in English-language journals. For the purpose of this study, all articles published until the end of 2020 based on the search in the “Scopus,” “Web of Science,” and “PubMed” databases were selected. Articles were searched independently by two trained researchers. Dust storms are the cause of many diseases and health-related complications, of which cardiovascular and respiratory diseases are common. It is necessary to recognize and investigate the harmful effects of dust storms to prevent serious harms to human societies. In the reviewed articles, the impact of dust storms on several diseases, including cardiovascular and respiratory diseases,has been analyzed. Most of these articles acknowledge the effect of dust storms on increasing the incidence and mortality rate of these diseases, although in some articles this effect is not statistically significant. Many studies conducted around the world confirm the harmful effects of dust storms on cardiovascular and respiratory diseases, including increase in the number and duration of hospitalizations, as well as increase in mortality and exacerbation of these diseases. However, some studies do not consider the harmful effects of dust storms on the above diseases to be statistically significant.
Keywords: Cardiovascular disease, climate change, morbidity, sand storm whit dust
|How to cite this article:|
Sadeghimoghaddam A, Khankeh H, Norozi M, Fateh S, Farrokhi M. Investigating the effects of dust storms on morbidity and mortality due to cardiovascular and respiratory diseases: A systematic review. J Edu Health Promot 2021;10:191
|How to cite this URL:|
Sadeghimoghaddam A, Khankeh H, Norozi M, Fateh S, Farrokhi M. Investigating the effects of dust storms on morbidity and mortality due to cardiovascular and respiratory diseases: A systematic review. J Edu Health Promot [serial online] 2021 [cited 2022 May 27];10:191. Available from: https://www.jehp.net/text.asp?2021/10/1/191/317150
| Introduction|| |
Dust storms affect many parts of the world, encompassing the coasts of North Africa, southern Europe, the Middle East, and East Asia. According to the agreement of the World Meteorological Organization, whenever the wind speed at a station exceeds 15 m per second and the horizontal visibility reaches <1 km, a dust storm is reported. Sandstorms are winds that can move particles 15–30 μ in diameter to a height of 15 m. While dust storms are made up of very fine particles, 1–5 μ in diameter, they move at a much higher altitude and travel very long distances that can cover cities in a country or even countries on a continent. The world's two major dust storms transport millions of tons of minerals to remote areas each year. African dust storms, which often originate in the Sahara region, regularly cover the Mediterranean region, Europe, and even the United States at different times of the year. Asian dust storms, which occur mainly in the spring, originate in the deserts of Mongolia and western China, and can affect eastern China, Korea, Japan, Taiwan, and even North America. Although Asian dust is a known natural phenomenon, new epidemiological studies acknowledge its detrimental effects on health. Dust mixes with other pollutants in urban air as it passes through the atmosphere, making its effects more harmful. This dust also contains germs and biological substances that can cause or aggravate respiratory diseases. It also causes cardiovascular disease (CVD) by inflammation in the respiratory system or by the penetration of very fine dust particles into the circulatory system. Dust particles in the atmosphere are generally of particulate matter (PM) 2.5 to PM10. Numerous studies in recent years have shown their impact on health and mortality. Research has shown that people, who are exposed to dust, even if it is short lived, still increase hospitalization rates and mortality. There have been many studies on the health effects of dust and mortality and morbidity rates that have yielded conflicting results. Studies by Chen et al. and Schwartz et al. have not found a significant association between the effects of dust and health. In contrast, in the study carried out by Spokin, dust mortality increased during storm days. Findings of many studies indicate the relationship between the presence of dust and respiratory diseases, while less attention has been paid to the role of dust in CVD. In the studies of Chen and Yang ., the effect of dust on CVD has been emphasized. Due to these contradictory results and the increasing number of this phenomenon, we intended to conduct a systematic review of the studies on the effects of dust storms on morbidity and mortality due to CVD and respiratory diseases. The results of this study explore the challenges associated with morbidity and mortality caused by dust storms and examine the existing experiences.
| Materials and Methods|| |
The present study is a systematic review on the health effects of dust on mortality and morbidity due to CVD and respiratory diseases. The results of this study were obtained based on articles published in English-language journals without limiting the time of publication of articles. In this study, all articles published until the end of 2020 based on the search in the “Science Direct,” “Scopus,” “Web of Science,” “PubMed,” “Google Scholar,” “Irandoc,” “Magiran,” and “SID” databases were selected. Search for articles was carried out using the keywords of “Dust Storm.” “Cardiovascular disease,” “Cardiovascular mortality,” “Cardiovascular morbidity,” “Cardiovascular incidence,” “Cardiovascular prevalence,” “COPD” “Respiratory disease,” “Respiratory mortality,” “Respiratory incidence,” “Respiratory prevalence,” “Pulmonary disease,” “Pulmonary mortality,” “Pulmonary morbidity,” “Pulmonary incidence,” “Pulmonary prevalence,” “Myocardial infarction,” “(MI),” “Congestive heart failure,” “CHF,” and “Asthma” twice in isolation and in combination with AND and OR. Accordingly, first, all articles related to the study of the health effects of dust on mortality and morbidity due to CVD and respiratory diseases were collected and after the search, a list of abstracts was prepared. After concealing the details of the articles such as the author's name and the name of the journal, the full text of the articles was given to two trained and skilled researchers to review the articles. Each article was reviewed by two reviewers independently and in case of rejection of the articles by the two reviewers, the reason was mentioned and in case of disagreement between them, the article was judged by a third person. In order to evaluate the quality of the articles, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, which has 22 parts, was used. Scoring based on the importance of each part is in accordance with the present study. The final score of the checklist was 33 and the minimum score was 20. All available English-language articles on the health effects of dust on morbidity and mortality from CVD and respiratory diseases, which were of good quality based on the STROBE checklist, were included in this study. Studies that did not consider the health effects of dust on CVD and respiratory diseases were excluded from the study. Such as studies about other risk factors effect of CVD .
A total of 258 articles related to the health effects of dust on morbidity and mortality due to CVD and respiratory diseases were found, of which 39 articles were excluded from the study due to duplication and 112 articles were excluded due to irrelevance to our study. Of these, 107 articles dealt with the various effects of dust on health except cardiovascular and respiratory effects. Among them, 56 articles focused on the health effects of dust on the incidence and mortality of CVD and respiratory diseases. After reviewing the abstracts, 23 articles that lacked the required information were also excluded from further assessment. Finally, 33 articles met the inclusion criteria and were included in the study [Figure 1].
| Findings|| |
The extracted articles are categorized in [Table 1] based on the year of publication, the study population, the intended outcome, and the tools and the design of the study.
|Table 1: General specifications of articles eligible for systematic review|
Click here to view
| Discussion|| |
Daily, monthly, seasonal, or annual dust concentrations at stations in four West African countries are reported to be well above the air quality standards set by the European Union, the United States, and the WHO. These results are the first quantitative assessment of the significance of PM10 concentrations in West Africa, and these findings suggest that desert dust has adverse health effects on the Sudanese population. All the current evidence suggests that the effects will intensify in the coming years, with the greatest impact on the most vulnerable African populations.
A systematic review study probes the relationship between the occurrence of dust and the health effects of dust in the world and highlights West Africa as an area of interest for study. These studies show that the decline in air quality has significant negative effects on human health. Although some results appear to have a lesser impact, there is no significant discrepancy. While few studies on desert dust have been published, the available evidence indicates that desert dust has a significant impact on human health. Many studies are not close to the sources of the dust; however, the effects of this desert dust on the increase in disease incidence and disease mortality have clearly reached alarming levels. Although dust events are more common and severe in West Africa than anywhere else, their health effects have not been fully evaluated.
A study conducted in Taipei shows that in a day with moderate pollution, daily mortality is associated with the amount of pollution. The mortality rate was 68 on a day, when the mean PM10 particle level was 125.94/m3. This rate was very close to 68 for other pollutants (CO, NO, and SO2). However, this amount was more significant for O3 compared to other days. Temperature and humidity during the dust storm were lower than normal. Overall, the average number of nonaccidental deaths in the city was 27. The effects of dust storms on the total mortality due to CVD 2 days after the occurrence of these storms were prominent and significant. For respiratory illness mortality, dust was highest 1 day after the event and then declining. An average of 67 CVD patients were admitted on dust storm days. The average number of daily admissions of patients with CVD was higher compared to the same days. The effects of dust storm on CVD were detected after 1 day and then decreased. The effects of dust storm on CVD admission were significantly reduced 3 days after dust events. An average of 58 RDS patients were admitted on dust storm days. The average number of daily admissions of patients with RDS was slightly higher compared to that of the same days. The association between the dust storm and the highest significant acceptance of pneumonia was 1 day after the event. The results were evaluated. After removing 1%, 5%, and 10% of consecutive days with the lowest PM10 concentrations, there were small changes in the estimation of pneumonia risk on dusty days. With a maximum delay of 3 days, for all 47 hospitals in Taipei, there were an average of 21 admissions of chronic obstructive pulmonary disease (COPD) patients in the dust storm, with an average age of 71.78 years. The average number of daily admissions of patients with COPD was slightly higher compared to that of the same days. The highest number of hospital admissions for COPD patients was at a maximum of 3 days after the dust accident. However, these values were not statistically significant. The results of the model were examined. After removing 1%, 5%, and 10% of consecutive days with the lowest PM10 concentration, there were small changes in the estimation of COPD risk on dusty days.
The 3-day return routes show that air trains arrived in Seoul, mostly through desert areas in China and Mongolia during the Asian Dust Storm (ADS) event. The levels of fine particles in these three cities may reflect the common origin of ADS and appear to be related. The concentration of pollutants seems to have been maintained in Beijing for the past few days, and a few days later with a lower concentration in Seoul. We divided the particles into PM2.5 and PM10 groups. The proportion of natural metal compounds attached to the particles was much higher than that of anthropogenic pollutants. In particular, the proportion of natural metals was higher in Alashan, which was close to the source of ADS, while the proportion of human-made metal pollutants was higher in Beijing. In this research, 56 male and 54 female students at an elementary school in Seoul were studied. The mean age of the participants was 3.9 years and some of them had a history of asthma and exposure to second-hand smoke by the age of 18 (16.8%) and 20 years (18.7%). This result indicates that exposure of bonded metals to dust particles during the ADS period reduces children's lung function, but there is no power difference in statistical tests to reduce lung function between natural and human-made metal parts.
In a study conducted in Madrid, out of a total of 1096 days examined during the study period, the infiltration of desert dust in Madrid was 219, which accounts for 20% of the days analyzed. The percentage of days with the presence of African dust in 2003 was 4.27%, 9.18% in 2004, and 7.13% in 2005. The total mortality due to the underlying causes in the study population is as follows: 8617 days for desert dust events (1550 due to respiratory diseases and 3071 due to CVD) and 35,397 days without dust event (6838 due to respiratory diseases and 12,716 due to CVD). Among people over 75 years of age, the average daily mortality due to each of the three causes studied was similar for days with and without the infiltration of desert dust.
In Rome, during the warm seasons of the year, about 19% of the days of the year between 2001 and 2004 are affected by desert dust. The average particle concentration during the day was higher than that of dust-free days and the concentration of coarse particles was higher than that of fine particles. The air temperature and apparent temperature were higher during the days with the dust event than on the days without dust. The findings of this study show the relationship between mortality and coarse particles. The components of this dust include bacteria, fungi, viruses, and 11 types of human contaminants that cause various levels of strong inflammatory effects on the cell surface. A recent study on cardiovascular mortality in Madrid, Spain, indirectly shows the effects of dust particles on morbidity and mortality from these diseases. The authors obtained different effects from both organic and inorganic compounds in the dust and showed the destructive effect of human pollutants and their synergy on days with the dust event. We do not have complete information about the PM components in Rome. In addition, the small number of dusty days prevents accurate analysis of personal factors such as age and gender. In conclusion, our study showed a positive effect of PM2.5–10 on the increase in respiratory disease and PM10 on the incidence of cerebrovascular disease during the days affected by the desert dust event. This finding indicates that a certain proportion of the compounds in desert dust are PM2.5–10 and PM10. It is recommended to pay more attention to the particle type and size in deserts in order to conduct similar studies in future.
In Japan, 21 participating institutions across Kumamoto that are capable of performing coronary interventions were included in the study. Data from Asian dust events were measured at the Kumamoto Meteorological Center. Data were analyzed from 3713 patients with acute MI (AMI) from April 1, 2010, to March 31, 2015. The incidence of AMI, 1 day after the occurrence of Asian dust events, had significantly correlated, and this significance was clearly higher for patients with non-ST-elevation MI. There was a significant relationship between AMI and Asian dust in male patients with chronic kidney disease, diabetes, and nonsmokers aged 75 years. However, Asian dust events had a significant impact on the onset of AMI in patients with CKD (P < 0.01). Analysis of research data showed that Asian dust events may lead to AMI and have a significant effect on its onset in patients with CKD.
CVD is affected by variouse resurese, such as sress and other risk factor such as in this time for pandemic COVID-19. this interfernings might by effect in mortality or morbidity of patient.
In various articles, the incidence and mortality of CVD and respiratory diseases have been mentioned in general, but the incidence and mortality of CVD and respiratory diseases were not mentioned in detail. Although in this study only English-language articles were reviewed, it is possible that non-English-language articles that are in line with the objectives of the present study were not reviewed.
| Conclusion|| |
According to previous studies, the trend of creating dust storms around the world is increasing. In the field of health, the effects of these storms on various diseases, especially the increase in the hospitalization process on days with the occurrence of dust events, have been emphasized in many articles. The cause of these hospitalizations is mostly respiratory and heart diseases and, of course, the mortality rate in relation to these diseases is clear in studies. However, some studies do not mention the statistically significant cases, and the certainty of the results is questionable. The type and size of particles in the dust have been studied in some studies and the effect of these parameters in causing disease or prolongation of diseases has been highlighted, which often indicate contradictory results in this field. The synergistic effects of human-made pollutants and particles in dust storms have also been considered in some studies. Considering all the aspects and studies done, it seems that there is still a need for further studies in this field to clarify the many hidden angles that are still uncovered.
This article is part of the PhD thesis that has been approved by the University of Social Welfare and Rehabilitation Sciences (Ethical code: IR. USWR. REC.1399.075). The authors would like to thank all researchers who have already done research in this field and whose results were used in this study. Special thanks from Dr. Mohsen Poursadeghiyan for assist to write and published this paper.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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