Burden of fine air pollution on mortality in the desert climate of Kuwait

BACKGROUND: Middle Eastern desert countries like Kuwait are known for intense dust storms and enormous petrochemical industries affecting ambient air pollution. However, local health authorities have not been able to assess the health impacts of air pollution due to limited monitoring networks and a lack of historical exposure data. OBJECTIVE: To assess the burden of PM2.5 on mortality in the understudied dusty environment of Kuwait. METHODS: We analyzed the acute impact of fine particulate matter (PM2.5) on daily mortality in Kuwait between 2001 and 2016 using spatiotemporally resolved PM2.5 estimates. We explored effect modification by cause of death, sex, age, and nationality. We fitted quasi-Poisson time-series regression for lagged PM2.5 adjusted for time trend, seasonality, day of the week, temperature, and relative humidity. RESULTS: Over 16 years, 70,321 deaths occurred. Average urban PM2.5 was 46.2 ± 19.8 µg/m³. A 10 µg/m³ increase in a 3-day moving average of urban PM2.5 was associated with a 1.19% (95% CI: 0.59, 1.80%) increase in all-cause mortality. A 10 µg/m³ reduction in annual PM2.5 could avert 52.3 (95% CI: 25.7, 79.1) deaths per year in Kuwait, including 28.6 (95% CI: 10.3, 47.0) Kuwaitis, 23.9 (95% CI: 6.4, 41.5) non-Kuwaitis, 9.4 (95% CI: 1.2, 17.8) children, and 20.9 (95% CI: 4.3, 37.6) elderly deaths each year. IMPACT STATEMENT: The prevalence of dust storms and petrochemical emissions in the Gulf/Middle East, coupled with sparse monitoring and limited historical exposure data, necessitates novel approaches. Using big data and predictive models, we estimate air pollution across time and space and quantify the mortality burden in this critically impacted but under-studied region.