Respiratory Health Impacts of Outdoor Air Pollution and the Efficacy of Local Risk Communication in Quito, Ecuador.

Relatively few studies on the adverse health impacts of outdoor air pollution have been conducted in Latin American cities, whose pollutant mixtures and baseline health risks are distinct from North America, Europe, and Asia. This study evaluates respiratory morbidity risk associated with ambient air pollution in Quito, Ecuador, and specifically evaluates if the local air quality index accurately reflects population-level health risks. Poisson generalized linear models using air pollution, meteorological, and hospital admission data from 2014 to 2015 were run to quantify the associations of air pollutants and index values with respiratory outcomes in single- and multi-pollutant models. Significant associations were observed for increased respiratory hospital admissions and ambient concentrations of fine particulate matter (PM), ozone (O), nitrogen dioxide (NO), and sulfur dioxide (SO), although some of these associations were attenuated in two-pollutant models. Significant associations were also observed for index values, but these values were driven almost entirely by daily O concentrations. Modifications to index formulation to more fully incorporate the health risks of multiple pollutants, particularly for NO, have the potential to greatly improve risk communication in Quito. This work also increases the equity of the existing global epidemiological literature by adding new air pollution health risk values from a highly understudied region of the world.