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J Educ Health Promot. 2017; 6: 109.
Published online 2017 December 4. doi:  10.4103/jehp.jehp_166_16
PMCID: PMC5747222

Cardiovascular, respiratory, and total mortality ascribed to PM10 and PM2.5 exposure in Isfahan, Iran



Air pollution is an important environmental issue due to its proven serious impacts on human health. The aim of this study was to estimate the attribution of particulate matter with an aerodynamic diameters of ≤ 2.5 and 10 (PM2.5 and PM10) in the prevalence of cardiovascular and respiratory diseases and premature deaths in Isfahan in 2013–2014.


This descriptive, ecological study was conducted to assess health impacts of PM2.5 and PM10 on the population using Air Q2.2.3 software, suggested by the World Health Organization (WHO).


The results showed that the annual mean, winter mean, summer mean, and the 98 percentile of PM10 concentration in Isfahan were 108, 100, 116, and 264 μg/m3, respectively. The number of deaths per year related to PM2.5 was 670 and that for PM10 was 713 cases. The number of annual deaths due to cardiovascular and respiratory diseases attributed to PM10 was 316 and 68 cases, respectively.


The results of this study revealed that about 44.3% of total annual death due to cardiovascular diseases and 9.55% of that due to respiratory diseases were attributed to PM10 exposure. In the other word, residents were exposed to PM2.5 and PM10 concentrations higher than the WHO guidelines which caused a notable increase in the rate of mortality.

Keywords: Air pollution, AirQ software, Isfahan, mortality, PM2.5 and PM10


Air pollution is considered one of the most important environmental issues due to its well-known serious impacts on human health. In the recent years, health concerns of urban air polluted with emerging pollutants such as O3, NO2, and particulate matters (PMs)[1,2] are exist in both developed and developing countries.[3] In the recent two decades, epidemiological studies have shown that air pollution causes cardiovascular and respiratory problems, lung function defect, chronic bronchitis, and death.[1] According to a study carried out by the World Health Organization (WHO) throughout 1100 cities in 91 countries from 2003 to 2010, the greatest concentration of PM10 was reported in Ahvaz and Ulan Bator (Mongolia), respectively, amounting 372 and 279 μg/m3.[4] They have reported that 11 cities in the world had an annual PM10 concentration above 200 μg/m3 and only some of Canadian and American cities had the concentrations <20 μg/m3.[5] Among of air pollutants, PM has particular importance due to its specific characteristics such as composition and size distribution. This pollutant has very high surface area and can adsorb a wide range of organic materials such as polycyclic aromatic hydrocarbons, nitro-polycyclic aromatic hydrocarbons, heavy metals, pathogens, and radioactive materials. It contains very fine particles that penetrate to lower respiratory system, enters into the blood, and immigrate to the other organs even brain.[6] In urban environments, vehicular traffic is the most important source of PM emissions.[7] The WHO has reported that PM10 can cause respiratory and cardiovascular diseases such as asthma, bronchitis, heart attacks, lung function reduction, and can increase mortality rate. Whereas, in some European cities, with increasing 10 μg/m3 in PM10 concentration, mortality rate increases about 6%.[5] PM can contribute in the prevalence of lung cancer and cardiovascular diseases.[8,9] In Europe, PM2.5 concentration in the air of urban areas has been increasing, and some recent cohort studies have approved the relation between PM2.5 long-term exposure and mortality increase. Such studies have confirmed strong correlation between PM concentration and the number of hospital admission due to heart and respiratory problems.[8,10] Similar studies have been carried out worldwide (China, Italy, Mexico, and Iran) to determine the short-term effects of PM using the AirQ model.[1,11,12,13] Primary standards for PM1024-h and the annual average suggested by the WHO are 50 and 20 μg/m3, respectively, and annual average standard of PM2.5 is 10 μg/m3.[14] The presence of numerous vehicles in the city, vast deserts in the surrounding areas, and so many large industries in the suburb of Isfahan city are caused this city accounts for one of Iran's more polluted cities.[15,16] This study aimed to assess the health impacts of ambient PM10 and PM2.5 exposure in Isfahan city and their attribution in the morbidity rate.

Materials and Methods

Study area

Isfahan city, the capital of Isfahan province, with a population of >1.7 million is the third most populous city of Iran located in the center of Iran in the area of 493.8 km2. Isfahan has been situated in longitude 59°39’E and latitude 32°38’N with a height of 1570 m above sea level. In the age pyramid related to the Isfahan, the largest age group is 25–29 years old that is almost 12% of the population of Isfahan representing the young population of the city. The life expectancy for men and women in Isfahan is 82.52 and 79.9 years, respectively. Figure 1 shows the Map of the study area and locations of monitoring stations.

Figure 1
Map of the study area and monitoring stations location (Isfahan, Iran)

AirQ software 2.2.3 (WHO)

This is a descriptive, ecological study which evaluates the health impacts of PM2.5 and PM10 on the population using the Air Q2.2.3 software recommended by the WHO. This software correlates air quality data in various ranges of concentration with epidemiological parameters such as relative risk (RR), baseline incidence (BI), and attributable proportion (AP), and shows its results as mortality. The AP in this software is calculated according to the following formula.

AP = (Σ {[RR (c) −1] × P (c)})/(Σ {[RR (c) × P (c)]})


RR (c) is the RR of health outcome in the target group

P (c) is the population proportion of the target group

By knowing the amount of BI in the target population can calculate attributed value to population contract (IE) by the following formula:

IE = BI × AP

And finally, the number of cases attributable to the exposure (NE) can be estimated by the following equation by knowing the size of population (N).[17,18]

NE = IE × N

One year data of PM2.5 and PM10 concentrations (from April 2013 to March 2014) were collected from four air pollution monitoring stations which are located near to Ahmadabad, Eliaderan, Valiasr, and Azadi Squares. These monitoring stations are operated by Isfahan Department of Environment. The data were processed by Excel software according to the WHO guidelines. From April to September and from October to March were considered as hot and cold seasons, respectively. Then, hot and cold seasonal averages, annual averages, and their maximum, as well as annual 98 percentile for PM2.5 and PM10, were extracted. The BI of the total deaths, deaths attributed to cardiovascular and respiratory diseases were estimated using death and diseases data obtained from health center of Isfahan province. In case of needs for other epidemiological parameters which were not available for the city the WHO calculated values were applied. Finally, these data were entered into Air Q software according to the WHO guideline and parameters such as AP, IE, and NE related to PM10 and PM2.5 were calculated.


Table 1 shows PM2.5 and PM10 concentrations as μg/m3 in monitoring stations located in Ahmadabad, Eliaderan, Valiasr, and Azadi districts in Isfahan city. Total average concentrations of both PM2.5 and PM10 were the highest in Ahmadabad and the lowest in Azadi stations. The PM10 annual average concentration, winter, summer, and 98 percentile in Isfahan city were 108, 100, 116, and 264 μg/m3, respectively.

Table 1
Particulate matter 2.5 and particulate matter 10 concentrations as μg/m3 in the measuring stations

Table 2 shows summary of air pollutants and meteorological variables in Isfahan city. Table 3 shows the BI, RR, AP indexes, and total death numbers attributable to PM2.5 and PM10. According to the Table 3, total death numbers attributable to PM2.5 and PM10 with BI 598.3 in 105 people with moderate RR were 670 and 713 cases, respectively. Table 3 also shows death number and hospital admissions due to respiratory and cardiovascular diseases attributable to PM10 in the range of moderate RR. Death numbers of PM10 attributable cardiovascular and respiratory diseases with BI 247.1 in 105 people and with moderate RR were 316 and 68 cases, respectively. The numbers of hospital admissions due to PM10 attributable respiratory and cardiovascular diseases were 1614 and 623 people, respectively.

Table 2
Summary of air pollutants and meteorological variables in Isfahan city (2013-2014)
Table 3
Estimated baseline incidence of relative risk, total number, and particulate matter 2.5 and particulate matter 10 attributable deaths and hospital admissions

Figure 2 shows the percentage of days that people were exposed to different concentrations of PM10 (A) and PM2.5. According to Figure 2 for instance, each person has exposed 14% of annual days to PM10 concentrations of 100–109 μg/m3. While that the people of Isfahan have exposed in 23% of annual days to PM2.5 concentration of 50–59 μg/m3.

Figure 2
Percentage of days that people were exposed to different concentrations of PM10 (a) and PM2.5(b) in Isfahan


According to Table 1, maximum annual average concentrations of both PM10 and PM2.5 in the Isfahan ambient air were obtained in the Ahmadabad station. This is due to high traffic volume and vehicle transportation in this area which is one of the busiest and big squares in Isfahan. High traffic is considered as a major source of PM emission.[8] Minimum annual averages of the pollutants were attained in the Azadi station. However, the annual average of PM2.5 and PM10 concentration (64 and 108 μg/m3) were 3.2 and 2.7 times greater than the WHO guidelines (20 and 40 μg/m3) and their annual maximum concentration (202 and 491 μg/m3) were 10.1 and 12.27 times greater than the WHO guidelines.[19] Similar studies carried out in India,[20] Italy,[1] Estonia,[21] and in some of Iran's cities such as Ahvaz,[22] Tabriz,[23] Shiraz,[16] and Tehran[17] have reported the amount of this pollutants higher than standard limits. The elevated levels of PM10 and PM2.5 in Isfahan can be attributed to the increased vehicular traffic due to population inflation, high tourism volume, presence of deserts and mines, especially lead and zinc mines, and energy conversion sectors such as power plants and oil refineries around the city.[24] Average PM2.5 and PM10 concentration in the summer were 116, and 100 μg/m3 and those in the winter were lower than summer amounting 68 and 60 μg/m3, respectively. It can be due to seasonally variation of the meteorological condition of the city which lays in the arid and semi-arid region, drought and reduction of vegetation, strong winds, and reduction of relative humidity as well as entry of dust from Western and Southwestern borders among spring and summer. The results of this study are in agreement with the results have been reported for Tehran, Khorramabad, and Ahvaz.[12,17,25]

The results presented in Table 3 indicate that a total number of deaths attributable to PM2.5 and PM10, with a BI 598.3 per 105 people have average RR equal to 670 and 713 cases, respectively. During 2013–2014, total cases of 10537 nonaccidental deaths have been registered in the Isfahan; so, premature deaths caused by PM2.5 and PM10 with average RR were about 6.35% and 6.76% of the total deaths, respectively. More than 800,000 cases of deaths globally are related to PM2.5.[4] In Russia,[26] Estonia,[27] Italy,[1] and Japan,[28] 4%, 5%, 4%, 5%, and 8% of total deaths have been attributed to PM2.5. In Sanandaj, 11.7% of the total recorded deaths were related to PM10.[29] Similar studies conducted in Italy, Milan,[1] Tehran,[17] Tabriz,[23] and Khorramabad,[25] have shown that the number of deaths attributed to PM10 was 1370, 2194, 368, and 320 cases, respectively.

Table 3 also shows the number of deaths due to cardiovascular and respiratory diseases attributed to PM10. The number of deaths caused by cardiovascular diseases with BI 247.1 and average RR was 316 people, and that due to respiratory diseases with BI 37 and average RR was 68 cases. Strukova et al. have estimated that about 46000 premature deaths in Ukraine in 2006 have been attributed to air pollutants, especially PM2.5 and PM10. Within them, about 27,000 deaths were due to heart and respiratory diseases and lung cancer.[30]

In this study, deaths due to PM10 attributable cardiovascular and respiratory diseases accounted for 44.3% and 9.55% of the total deaths due to PM10. The number of deaths due to cardiovascular and respiratory diseases was 1367 and 402 cases in Tehran, 612 and 114 cases in Ahvaz, 120 and 23 cases in Sanandaj, and 28 and 6 cases in Trieste, Italy, respectively.[12,29,17,31] The number of hospital admissions due to cardiovascular and respiratory diseases attributed to PM10 with BI 436 and 1260 was 623 and 1614 cases, respectively.

RR shows that the increased risk caused by contact to a pollutant which is obtained thought time-series studies. It studies the daily relationship among air pollution and health effects, such as mortality due to cardiovascular and respiratory diseases. In Isfahan, with per 10 μg/m3 increase in pollutant values, the value of RR for the increase of total mortality caused PM10 and PM2.5, were 0.8% and 0.5%. Increasing 10 μg/m3 in the PM10 concentration caused an increase in the RR and total mortality by 0.74% and 5.24%, respectively. Recent studies in Europe have shown that 10 μg/m3 increase in the PM10 concentration has led to mortality increase by 6%.[5] In a study conducted in Tehran a mortality increase of 6.4% has been reported.[17] According to the WHO guidelines decreasing of PM10 annual average value from 70 to 20 μg/m3 can reduce mortality rate by 15%.[5]

The highest percentage of exposure days was for the concentration range of 100–109 μg/m3 of PM10. About 48% of total annual days the people have exposed with PM10 concentrations more than 100 μg/m3. Almost in all days of the year, the people have exposed with PM10 concentrations upper than the WHO recommended guideline (20 μg/m3). About 16% and 23% of people exposed to concentrations of 40–49 and 50–59 μg/m3 of PM2.5, respectively. In other words, each person of Isfahan on all days of the year was exposure of PM2.5 concentrations more than the WHO guidelines.

A weakness of the AirQ model is that it is not take into consideration the health effects caused by exposure to mixtures of several pollutants or their synergistic effects, but only the effect of pollutants is investigated individually.


The results of present study showed that almost all days of the year people have exposed with PM2.5 and PM10 concentrations upper than the WHO recommended guidelines in Isfahan. During 2013–2014, premature deaths caused by PM2.5 and PM10 with average RR were about 6.35% and 6.76% of the total deaths, respectively. Deaths due to PM10 attributable cardiovascular and respiratory diseases accounted for 44.3% and 9.55% of the total deaths due to PM10 exposure. Therefore, the best available and applicable controlling strategies should be carried out by authorities to protect the citizen's health and to reduce the health outcome of exposure to this kind of PMs.

Financial support and sponsorship

Nil. There is no sponsorship for this work

Conflicts of interest

There are no conflicts of interest.


The collaboration of the Isfahan Department of Environment and Health Centre of Isfahan province in providing required information is greatly acknowledged.


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