Atmospheric Pollutants
Numerical simulations using the atmospheric pollutants concentrations were exploiting meteorological data for the period from 2005 to 2009, physical characteristics of the environment (topography and type of land use), and the pollutant sources (information from the physical characteristics of the sources and their emissions), correlating this data with the research done in 2003 to 2005.
For the simulations, we used the AERMOD, it is a dispersion model developed by the American Meteorological Society (AMS) and the US Environmental Protection Agency (EPA) (United States Environmental Protection Agency (US EPA) 2008) and made available for public use. We evaluated the CPC atmospheric emissions area of influence with the combination of the AERMOD dispersion model with the Weather Research Forecast (WRF) meteorological model (American Meteorological Society/Environmental Protection Agency Regulatory Model 2016) (Kumar et al. 2016).
The concentration maps for each pollutant were used to evaluate the hot spots where the population has high exposure.
The only documentation on the building downwash algorithm in AERMOD referred to as PRIME (Plume Rise Model Enhancements), new field and wind tunnel studies have shown that AERMOD can overpredict concentrations by factors of 2-8 for specific building configurations. While a wind tunnel, Equivalent Building Dimension (EBD) analysis can be conducted to approximately correct the overprediction bias, past field, and wind tunnel studies indicate that there are notable flaws in the PRIME building downwash theory.
Although AERMOD/PRIME may provide accurate and unbiased estimates (within a factor of 2) for some building configurations, a significant review and update are needed. Thus, accurate estimates can be obtained for other building configurations, where significant over predictions or underpredictions are common due to downwash effects (Petersen et al. 2017). Due to the impact on health, VOCs' dispersion curves were also analyzed, even though the Brazilian legislation does not regulate VOC concentrations.
Study Population and Data Collection
This study was a cohort, and we have evaluated residents living in the Capuava Petrochemical Complex (CPC) influence area in the Greater ABC region (Fig.1), from July 2003 through June 2005.
The residents were divided into two groups (A and B), based on their proximity to the industrial areas and those considered non-exposed (but do not include ambient air pollution) living in the surroundings of a different industrial area, mainly steel industries with no petroleum byproducts manufactured.
The research population was defined after the explanation about this study. Previously to data collection, free consent was signed by the father, mother, or responsible person, and authorization to this realization was obtained from the residents.
The data collected consisted of obtaining information of the residents, and a home-based questionnaire was applied in 2004 residents of both sexes aged 8-72 years old.
Group A: comprised of 1002 residents, males, and females, living in the surroundings of the CPC. This industrial area was named Region 1 and is occupied by 14 industries producing polyethylene and polypropylene from naphtha distillation and various intermediary substances used as raw materials for manufacturing other products. The area is located on the boundaries of Santo André, Mauá, and São Paulo, State of São Paulo (SP), Brazil (0.5 km, 1.0 km, and 2.0 km away from CPC, respectively).
Group B comprises 1002 residents, males, and females, living in the surroundings of a different industrial area, mainly steel industries with no petroleum byproducts manufactured. The site is located on the boundaries of Santo André, São Bernardo do Campo, and São Caetano do Sul, SP, Brazil (7.5 km, 8.0 km, and 8.5 km away from Region 1, respectively). This industrial area was named Region 2 and was treated as the control group.
The city's population density followed the Brazilian Institute of Geography and Statistics (IBGE) (IBGE 2016). Regions 1 and 2 were divided into five cities; 334 residents were evaluated according to the distance from the CPC.
Each resident had lived in either Region, 1 or 2, for more than ten years in the same home, and the controls were matched for similar social and economic situations. The socio-economic conditions were evaluated through the questionnaire. According to the subjects themselves, the residents were selected when they had similar salaries and social habits (these residents do not have the economic needs to move far from the polluted areas).
The residents were considered adults if they were over or equal to 18 years of age, and children and adolescents were under the age of 18. When the residents were children or adolescents, the questions were presented to the parents or responsible persons.
The visits occurred once in each house, and to guarantee the maximal participation, we included weekends.
During the study time (2003-2005), there was no pre-selection of residents for Regions 1 and 2, and only spontaneous answers were considered. The inclusion criteria for data analysis included ages between 8-72 years and each resident had lived in either Region 1 or 2 for more than ten years in the same home. Residents who worked at the CPC and that lived in the Region 1 and 2 were excluded.
The survey was formulated and applied by the authors of this study.
Written questionnaires (WQ) have been widely used in epidemiologic studies. The International Study of Asthma and Allergies in Childhood (ISAAC) WQ has been previously validated by a comprehensive study (Vanna et al. 2001).
The international ISSAC was an important milestone between the epidemiological studies on the prevalence of asthma and allergic illnesses in children and adolescents. ISSAC was designed to evaluate the prevalence of asthma and allergic problems in children in different parts of the world using the standard method (written questionnaire self-applicable and or video questionnaire (Asher et al. 1995; ISAAC 1998).
The written questionnaire (WQ) self-applicate of ISAAC was the more utilized instrument due to its being easy to understand, low cost, and independent from applying a trained interviewer (Asher et al. 1995; ISAAC 1998).
The questionnaire of "The International Study of Asthma and Allergies in Childhood (ISAAC)" is a program important of an epidemiological survey established in 1991 to investigate asthma, rhinitis, and eczema in children adolescents. ISAAC for nasal symptoms was chosen for the epidemiological diagnosis of rhinitis in children and adolescents, using questions including sneeze, coryza, watery eyes, and itchy eyes (Vanna et al. 2001).
The European Community Respiratory Health Survey II (ECRHS II) was chosen for the epidemiological diagnosis of asthma and consists of questions as the prevalence of wheezing, cough, panting, the previous diagnosis, and use of medication for the treatment of asthma. It is also used to determine the incidence of allergic diseases, asthma, and reduced pulmonary function and the risk of ambient factors associated with allergic diseases and low pulmonary function (Jarvis and Burney 2002).
The questions asked on the survey were about: Identification-name (initials), age (years), sex (male, female), address and time at local residency, profession and education (adults), education (children and adolescents), and social and economic situation (adults); medical history - rhinitis was investigated through questions based on the same questionnaire: symptoms of a sneeze, coryza, watery eyes and itchy eyes, nasal itch, rhinorrhea, blocked nose, cough, sputum production, shortness of breath and rhinitis. All the symptoms were evaluated in children, adolescents, and adults; sinusitis with frontal headache symptoms or pain in the jaw region, posterior secretion, watery eyes, and itchy eyes and sinusitis; pharyngitis was investigated for symptoms of oropharyngeal pain, scratchiness in the throat, and difficulty to swallow and OPD, as asthma and COPD were investigated through questions based on the questionnaire. OPD was based on both person reports of symptoms like cough, sputum production and shortness of breath, chest wheeze, and asthma or COPD.
The response for rhinitis, sinusitis, pharyngitis, and OPD as asthma and COPD were only considered positive when the diagnosis and treatment were done by a doctor and took medication for these pathologies.
We selected only residents presenting with OPD as asthma and COPD and took medications to these pulmonary pathologies. Individuals taking medication that could interfere in this study, including treatments for other otorhinolaryngological and pulmonary pathologies, were excluded. Individuals with a history of smoking, other otorhinolaryngological pathologies emphysema, bronchiectasis, lung surgery, other lung diseases also were excluded.
Conjunctivitis was based on both person reports of signs and symptoms like pink or red color in the white of the eyes, watery eyes, itchiness, a gritty feeling, irritation and or burning eyes, painful eye, and photophobia.
The response to conjunctivitis was only considered positive when the residents' information about the diagnosis and treatment of sick people was made for a physician. We selected only residents presenting with conjunctivitis and who were taking medications to this pathology.
Individuals taking medication to treatments to other eye diseases, history of smoking, eye surgery, viral conjunctivitis, or bacterial, were excluded.
Dermatitis was based on both person reports of symptoms like redness, swelling, intense itching, skin lesions, such as red bumps, blisters, and pustules. The response to dermatitis was only considered positive when the residents' information about the diagnosis and treatment of sick people was made for a physician. We selected only residents presenting with dermatitis and who were taking medications to this skin pathology.
PH was evaluated through a questionnaire; we selected only residents presenting with PH and using thyroid hormone.
SARS-CoV-2 database
The number of SARS-CoV-2 cases was collected from each city of the Greater ABC Region, a traditionally industrial region of the São Paulo State, Brazil, part of the São Paulo Metropolitan Region. Five cities were chosen: Santo André, Mauá, the eastern Region of the São Paulo City, São Bernardo do Campo, and São Caetano do Sul. All information about SARS-CoV-2 cases was based on the five ABC Paulista prefectures, the São Paulo State Health Secretariat, and the Brazilian Ministry of Health (Johns Hopkins 2020; Brazil Ministry of Health 2020).
Two air pollutants categories were analyzed in this study to determine the influence of climatic factors, such as atmospheric pollution, on the rhinitis, sinusitis, pharyngitis, OPD as asthma and COPD, conjunctivitis, dermatitis, and PH, and the higher risk of complications in the case of SARS-CoV-2.
1) Volatile organic compounds (VOCs) which have its primary source on the evaporation and leakage of the storage tanks; and
2) Criteria air pollutants, those that are controlled by the São Paulo State legislation (NO2, CO, PM10, and SO2) which are emitted by a chimney after processing. Due to the impact on health, VOCs' dispersion curves were also analyzed, even though the Brazilian legislation does not regulate VOC concentrations.
The average concentrations of each pollutant, for the Greater ABC region and east of the city of São Paulo, part of the Metropolitan Region of São Paulo, state of São Paulo, Brazil, were calculated using the simulated plumes, where the questionnaires were performed: Region 1- Location: Santo André, Mauá, São Paulo. Region 2: Santo André, São Bernardo do Campo, and São Caetano do Sul.
Ethical Statement
This research was approved by the Committee of Ethics in Research of the ABC School of Medicine, SP, Brazil, and registered under number 087/2002.
Statistical Analysis
The odds of rhinitis, sinusitis, pharyngitis, obstructive pulmonary diseases as asthma and chronic obstructive pulmonary diseases, conjunctivitis, dermatitis, and primary hypothyroidism in each city were computed for each combination and compared through Wald tests with Bonferroni correction for multiple comparisons.
The association between both regions (Region 1 and Region 2) and diseases (rhinitis, sinusitis, pharyngitis, obstructive pulmonary diseases as asthma and chronic obstructive pulmonary diseases, conjunctivitis, dermatitis, and primary hypothyroidism) was compared by Chi-Square test.
The different incidence and relative complication risk of SARS-CoV-2 in association with the diseases as rhinitis, sinusitis, pharyngitis, obstructive pulmonary diseases, conjunctivitis, dermatitis, and primary hypothyroidism was compared by Chi-Square test.
A polynomial regression having the logarithm of the odds of diseases as response and pollutant concentration up to the third degree, along with their interactions, was fitted to the pollutant, which exhibited a consistent trend of increase in concentration with increasing distance from the Capuava Petrochemical Complex (CPC).