Evaluation of interventions to reduce air pollution from biomass smoke on mortality in Launceston, Australia: Retrospective analysis of daily mortality, 1994-2007
Johnston, FH and Hanigan, IC and Henderson, SB and Morgan, GG, Evaluation of interventions to reduce air pollution from biomass smoke on mortality in Launceston, Australia: Retrospective analysis of daily mortality, 1994-2007, BMJ, 346, (7890) Article e8446. ISSN 1756-1833 (2013) [Refereed Article]
Objective: To assess the effect of reductions in air pollution from biomass smoke on daily mortality. Design: Age stratified time series analysis of daily mortality with Poisson regression models adjusted for the effects of temperature, humidity, day of week, respiratory epidemics, and secular mortality trends, applied to an intervention and control community. Setting: Central Launceston, Australia, a town in which coordinated strategies were implemented to reduce pollution from wood smoke and central Hobart, a comparable city in which there were no specific air quality interventions. Participants: 67 000 residents of central Launceston and 148 000 residents of central Hobart (at 2001 census). Interventions: Community education campaigns, enforcement of environmental regulations, and a wood heater replacement programme to reduce ambient pollution from residential wood stoves started in the winter of 2001. Main outcome measures: Changes in daily all cause, cardiovascular, and respiratory mortality during the 6.5 year periods before and after June 2001 in Launceston and Hobart. Results: Mean daily wintertime concentration of PM10 (particulate matter with particle size <10 μm diameter) fell from 44 μg/m3 during 1994-2000 to 27 μg/m3 during 2001-07 in Launceston. The period of improved air quality was associated with small non-significant reductions in annual mortality. In males the observed reductions in annual mortality were larger and significant for all cause (-11.4%, 95% confidence interval -19.2% to -2.9%; P=0.01), cardiovascular (-17.9%, -30.6% to -2.8%; P=0.02), and respiratory (-22.8%, -40.6% to 0.3%; P=0.05) mortality. In wintertime reductions in cardiovascular (-19.6%, -36.3% to 1.5%; P=0.06) and respiratory (-27.9%, -49.5% to 3.1%; P=0.07) mortality were of borderline significance (males and females combined). There were no significant changes in mortality in the control city of Hobart. Conclusions Decreased air pollution from ambient biomass smoke was associated with reduced annual mortality in males and with reduced cardiovascular and respiratory mortality during winter months.