Back to Browse Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 9 » Issue 1

Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality

Authors Kravchenko J, Akushevich I, Abernethy AP, Holman S, Ross Jr WG, Lyerly HK

Received 2 January 2014

Accepted for publication 9 April 2014

Published 16 June 2014 Volume 2014:9(1) Pages 613—627


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Julia Kravchenko,1 Igor Akushevich,2 Amy P Abernethy,3 Sheila Holman,4 William G Ross Jr,5 H Kim Lyerly1,6

1Department of Surgery, 2Center for Population Health and Aging, 3Duke Clinical Research Institute, Duke University Medical Center, Duke University, Durham, 4Division of Air Quality, North Carolina Department of Environment and Natural Resources, Raleigh, 5Nicholas School of the Environment, 6Department of Pathology, Duke University Medical Center, Duke University, Durham, NC, USA

Background: The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations.
Materials and methods: We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matters (PM2.5 and PM10) using monthly data measurements from air-monitoring stations in North Carolina in 1993–2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population) calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths.
Results: Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths–with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths–with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD)-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only the underlying causes of deaths were used, and when mortality and air-quality data were analyzed on the county level. In each case, the results of sensitivity analyses demonstrated stability. The importance of analysis of pneumonia as an underlying cause of death was also highlighted.
Conclusion: Significant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina.

Keywords: chronic obstructive pulmonary disease, sulfur dioxide, carbon monoxide, nitrogen dioxide, particulate matter

Download Article [PDF] View Full Text [HTML] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:

Readers of this article also read:

Major affective disorders in chronic obstructive pulmonary disease compared with other chronic respiratory diseases

Pothirat C, Chaiwong W, Phetsuk N, Pisalthanapuna S, Chetsadaphan N, Inchai J

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1583-1590

Published Date: 7 August 2015

Risk factors for chronic obstructive pulmonary disease among never-smokers in Korea

Lee SJ, Kim SW, Kong KA, Ryu YJ, Lee JH, Chang JH

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:497-506

Published Date: 5 March 2015

Exhaled volatile organic compounds discriminate patients with chronic obstructive pulmonary disease from healthy subjects

Besa V, Teschler H, Kurth I, Khan AM, Zarogoulidis P, Baumbach JI, Sommerwerck U, Freitag L, Darwiche K

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:399-406

Published Date: 23 February 2015

Oxidative stress and antibacterial properties of a graphene oxide-cystamine nanohybrid

Nanda SS, An SS, Yi DK

International Journal of Nanomedicine 2015, 10:549-556

Published Date: 12 January 2015

An evidence-based update on the pharmacological activities and possible molecular targets of Lycium barbarum polysaccharides

Cheng J, Zhou ZW, Sheng HP, He LJ, Fan XW, He ZX, Sun T, Zhang X, Zhao RJ, Gu L, Cao CH, Zhou SF

Drug Design, Development and Therapy 2015, 9:33-78

Published Date: 17 December 2014

Association of genetic polymorphisms with chronic obstructive pulmonary disease in the Hainan population: a case-control study

Ding YP, Yang DL, Xun XJ, Wang ZF, Sun P, Xu DC, He P, Niu H, Jin TB

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:7-13

Published Date: 17 December 2014

Interleukin-6 and interleukin-8 blood levels’ poor association with the severity and clinical profile of ex-smokers with COPD

Moraes MR, da Costa AC, Corrêa KS, Junqueira-Kipnis AP, Rabahi MF

International Journal of Chronic Obstructive Pulmonary Disease 2014, 9:735-743

Published Date: 29 July 2014