Assessment of the Possible Association of Air Pollutants PM10, O3, NO2 With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis

Medicine (Baltimore). 2016 Jan;95(2):e2464. doi: 10.1097/MD.0000000000002464.


In recent years, Panama has experienced a marked economic growth, and this, in turn, has been associated with rapid urban development and degradation of air quality. This study is the first evaluation done in Panama on the association between air pollution and mortality. Our objective was to assess the possible association between monthly levels of PM10, O3, and NO2, and cardiovascular, respiratory, and diabetes mortality, as well as the seasonal variation of mortality in Panama City, Panama.The study was conducted in Panama City, using air pollution data from January 2003 to December 2013. We utilized a Poisson regression model based on generalized linear models, to evaluate the association between PM10, NO2, and O3 exposure and mortality from diabetes, cardiovascular, and respiratory diseases. The sample size for PM10, NO2, and O2 was 132, 132, and 108 monthly averages, respectively.We found that levels of PM10, O3, and NO2 were associated with increases in cardiovascular, respiratory, and diabetes mortality. For PM10 levels ≥ 40 μg/m3, we found an increase in cardiovascular mortality of 9.7% (CI 5.8-13.6%), and an increase of 12.6% (CI 0.2-24.2%) in respiratory mortality. For O3 levels ≥ 20 μg/m3 we found an increase of 32.4% (IC 14.6-52.9) in respiratory mortality, after a 2-month lag period following exposure in the 65 to <74 year-old age group. For NO2 levels ≥20 μg/m3 we found an increase in respiratory mortality of 11.2% (IC 1.9-21.3), after a 2-month lag period following exposure among those aged between 65 and <74 years.There could be an association between the air pollution in Panama City and an increase in cardiovascular, respiratory, and diabetes mortality. This study confirms the urgent need to improve the measurement frequency of air pollutants in Panama.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Air Pollutants / adverse effects*
  • Air Pollutants / chemistry*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality*
  • Confidence Intervals
  • Databases, Factual
  • Diabetes Mellitus / etiology
  • Diabetes Mellitus / mortality*
  • Environmental Exposure / adverse effects
  • Environmental Monitoring / methods
  • Female
  • Humans
  • Incidence
  • Male
  • Maximum Allowable Concentration
  • Middle Aged
  • Nitrogen Dioxide / adverse effects
  • Odds Ratio
  • Ozone / adverse effects
  • Panama
  • Particulate Matter / adverse effects
  • Particulate Matter / chemistry
  • Respiratory Tract Diseases / etiology
  • Respiratory Tract Diseases / mortality*
  • Retrospective Studies
  • Risk Assessment
  • Sulfur Dioxide / adverse effects
  • Survival Analysis


  • Air Pollutants
  • Particulate Matter
  • Sulfur Dioxide
  • Ozone
  • Nitrogen Dioxide