Research Article

Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program

Number: 1 July 28, 2026

Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program

Abstract

Objective: This study aimed to estimate the excess mortality risk associated with ambient SO₂ exposure in Hakkari province for the year 2023. 
Method: Daily SO2 concentration data for 2023 were obtained from the National Air Quality Monitoring Network. Mortality data were sourced from the Turkish Statistical Institute. The analysis utilized the WHO AirQ+ version 2.2 software, employing a short-term risk ratio (RR) of 1.0059 for a 10 µg/m³ increase in the 24-hour average SO2 concentration to estimate the short-term attributable mortality burden. 
Results: In 2023, the WHO 24-hour air quality guideline (40 µg/m³) was exceeded on 71 days. The AirQ+ model estimated that the short-term attributable proportion of mortality was 9.46% (95% CI: 7.46 - 11.27) for all natural-cause mortality in Hakkari due to SO2 exposure. This burden corresponds to approximately 62 (95% CI: 49 - 73) attributable deaths annually. 
Conclusion: The findings indicate that high SO2  pollution in Hakkari, driven by residential heating and topographical entrapment, is associated with a significant mortality burden. Specifically, the 'double burden' of extreme cold stress and peak pollution levels in winter creates a high-risk window for vulnerable populations. Urgent interventions, including a transition to cleaner energy sources and improved insulation strategies, are required to mitigate this public health crisis.

Keywords

Air Pollution, Health Impact Assessment, AirQ+, Sulfur Dioxide, Hakkari

Supporting Institution

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Ethical Statement

Ethical approval for the study was obtained from the Istanbul University, Istanbul Faculty of Medicine Ethics Committee (date: 23.12.2024, number: 3076043). Data were sourced from publicly available national databases.

Thanks

We wish to express our sincere gratitude to the Turkish Statistical Institute and the Turkish Ministry of Environment, Urbanization and Climate Change. Their cooperation in granting access to the relevant data was invaluable to the completion of this research.

References

  1. Pandey JS, Kumar R, Devotta S. Health risks of NO2, SPM and SO2 in Delhi (India). Atmos Environ. 2005;39:6868-6874.
  2. Jion MMMF, Jannat JN, Mia MY, Ali MA, Islam MS, Ibrahim SM, et al. A critical review and prospect of NO2 and SO2 pollution over Asia: Hotspots, trends, and sources. Sci Total Environ. 2023;876:162851.
  3. Mayda AS, Yılmaz M. Düzce hava kalitesi izleme istasyonu 2007-2011 yılları arası verilerinin değerlendirilmesi. TAF Prev Med Bull. 2013;12:11-8.
  4. Khaniabadi YO, Daryanoosh SM, Hopke PK, Ferrante M, De Marco A, Sicard P, et al. Acute myocardial infarction and COPD attributed to ambient SO2 in Iran. Environ Res. 2017;156:683-7.
  5. Orellano P, Reynoso J, Quaranta N. Short-term exposure to sulphur dioxide (SO2) and all-cause and respiratory mortality: A systematic review and meta-analysis. Environ Int. 2021;150:106434.
  6. Kan H, Wong CM, Vichit-Vadakan N, Qian Z. Short-term association between sulfur dioxide and daily mortality: the Public Health and Air Pollution in Asia (PAPA) study. Environ Res. 2010;110:258-64.
  7. Nascimento AP, Santos JM, Mill JG, de Almeida Albuquerque TT, Júnior NCR, Reisen VA, et al. Association between the incidence of acute respiratory diseases in children and ambient concentrations of SO2, PM10 and chemical elements in fine particles. Environ Res. 2020;188:109619.
  8. Kobayashi Y, Santos JM, Mill JG, Reis Júnior NC, Andreão WL, de A. Albuquerque TT, et al. Mortality risks due to long-term ambient sulphur dioxide exposure: large variability of relative risk in the literature. Environ Sci Pollut Res Int. 2020;27:35908-17.
  9. Lee WJ, Teschke K, Kauppinen T, Andersen A, Jäppinen P, Szadkowska-Stanczyk I, et al. Mortality from lung cancer in workers exposed to sulfur dioxide in the pulp and paper industry. Environ Health Perspect. 2002;110:991-5.
  10. Dockery DW, Rich DQ, Goodman PG, Clancy L, Ohman-Strickland P, George P, et al. Effect of air pollution control on mortality and hospital admissions in Ireland. Res Rep Health Eff Inst. 2013;176:3-109.
APA
Demir, İ., & Ayvaz, Ö. (2026). Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program. Turkish Journal of Public Health, 1. https://doi.org/10.20518/tjph.1869975
AMA
1.Demir İ, Ayvaz Ö. Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program. TJPH. 2026;(1). doi:10.20518/tjph.1869975
Chicago
Demir, İbrahim, and Özkan Ayvaz. 2026. “Estimation of Excess Mortality Associated With Ambient SO2 Exposure in Hakkari Province, Türkiye in 2023 Using the WHO AirQ+ Program”. Turkish Journal of Public Health, no. 1. https://doi.org/10.20518/tjph.1869975.
EndNote
Demir İ, Ayvaz Ö (July 1, 2026) Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program. Turkish Journal of Public Health 1
IEEE
[1]İ. Demir and Ö. Ayvaz, “Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program”, TJPH, no. 1, July 2026, doi: 10.20518/tjph.1869975.
ISNAD
Demir, İbrahim - Ayvaz, Özkan. “Estimation of Excess Mortality Associated With Ambient SO2 Exposure in Hakkari Province, Türkiye in 2023 Using the WHO AirQ+ Program”. Turkish Journal of Public Health. 1 (July 1, 2026). https://doi.org/10.20518/tjph.1869975.
JAMA
1.Demir İ, Ayvaz Ö. Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program. TJPH. 2026. doi:10.20518/tjph.1869975.
MLA
Demir, İbrahim, and Özkan Ayvaz. “Estimation of Excess Mortality Associated With Ambient SO2 Exposure in Hakkari Province, Türkiye in 2023 Using the WHO AirQ+ Program”. Turkish Journal of Public Health, no. 1, July 2026, doi:10.20518/tjph.1869975.
Vancouver
1.İbrahim Demir, Özkan Ayvaz. Estimation of excess mortality associated with ambient SO2 exposure in Hakkari province, Türkiye in 2023 using the WHO AirQ+ program. TJPH. 2026 Jul. 1;(1). doi:10.20518/tjph.1869975