Estimation of Premature Mortality in Saudi Arabia from Increased Pm10 Levels Associated with the 1991 Gulf War

ISEE-248 Introduction: Events of the 1991 Gulf War resulted in increased levels of airborne particulate matter (PM) in the eastern and central regions of the Kingdom of Saudi Arabia (KSA) during the war and for the year following its conclusion. Extensive fires in the Kuwaiti oil fields released millions of tons of combustion-related PM into the atmosphere during 1991. Further, a large number of diesel-fuel military vehicles were in operation in this area during the conflict, which resulted in substantial emissions of mobile sources pollutants including PM. Finally, military activities in the deserts of KSA, Kuwait and Iraq resulted in disruption of the desert surface and led to resuspension of desert dust via wind erosion. All of these events significantly increased PM exposures for residents of eastern and central KSA for a period of several months. Epidemiologic research has indicated that exposure to elevated levels of PM results in an increased risk of early mortality. Using measures of PM exposure and mortality data from the Saudi Arabia Central Department of Statistics, we estimate the number of premature deaths associated with the increase in PM10 related to Gulf War activities. Methods: Exposure assessment was based on analysis of air pollution monitoring data collected in KSA from 1988 through 1995 supplemented by air quality modeling results for the oil fires. Age- and gender-adjusted mortality rates were calculated using data supplied by the Ministry of Health. A meta-analysis was conducted using the results of 32 peer-reviewed epidemiologic studies addressing total, non-accidental mortality associated with ambient PM10 in order to estimate a weighted average relative risk of mortality. The number of excess premature deaths associated with war-related PM10 was calculated as: Excess deaths = ▵PM10 × (▵Mortality/▵PM10) × (baseline mortality) Results: Analysis showed that eastern and central Saudi Arabia behaves as a single air shed with respect to PM10 and that PM10 levels were 60 to 94 μg/m3 higher in this region during the war and its aftermath than during the 3 years before and after that period (▵PM10). Depending on the weighting methodology employed, the weighted average increase in relative risk percentage for total, non-accidental mortality ranged from 2.8 – 3.4%. Applying these percentage relative risk increases to mortality estimates, between 1,097 to 1,337 excess deaths were estimated to have occurred due to PM exposures associated with the Gulf War. Discussion: This analysis demonstrates that health risk assessment methodology can be applied to estimate war-related mortality due to environmental exposures. A substantial number of excess deaths can be attributed to elevated levels of airborne pollutants associated with war-related sources. Ambient PM10 exposures resulted in increased risk of mortality among the population of Saudi Arabia during the Gulf War and the period following the conflict.