Spatial Association of Environmental and Dietary Factors with COPD Deaths

Selman Aktas,1,2 Begum Tuzuner,3 Mahmut Mergen,4 Ibrahim Sultan-Ali,5 Mehmet Kocak4 1School of Medicine, Health Sciences University, Istanbul, Turkey; 2School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey; 3School of Engineering, Bogazici University, Istanbul, Turkey; 4International School of Medicine, Istanbul Medipol University, Istanbul, Turkey; 5School of Medicine, the University of Tennessee Health Science Center, Memphis, TN, USACorrespondence: Mehmet Kocak, Email mehmetkocak@medipol.edu.trIntroduction: Chronic obstructive pulmonary disease (COPD) remains a significant health concern globally and spatiotemporal investigations on the etiology and progression of COPD are needed to develop more effective and timely preventive measures. To address this continuing need, we explored the association of air-quality and meteorological markers, fruit and vegetable consumption and drinking water source trajectories with COPD death rate.Methods: For 81 provinces of Turkey, we extracted and merged data in four dimensions: provincial COPD deaths, provincial annual meteorological and air-quality markers, drinking water source data covering rivers, dams, wells, and springs, and annual provincial fruits and vegetables consumption. To investigate the association of these markers with COPD deaths, we used a spatial modelling approach accounting for the spatial autocorrelation.Results: Controlling for household expenditure on cigarette and alcohol and elderly population size, our models suggest that provinces with higher consumption of lemon and higher temperature reported lower level of COPD deaths and provinces high in Nitrogen Dioxide concentration reported higher COPD deaths on average.Conclusion: Therefore, provinces with such profiles need to develop closer screening and follow-up of patients with COPD and encourage healthier diets and lifestyles.Keywords: chronic obstructive pulmonary disease, air quality markers, meteorology markers, drinking water sources, fruit and vegetable consumption