From Mass to Molecules: PM_2.5 Constituents and Cardiopulmonary Admissions in Makkah

Fine particulate matter (PM_2.5) composition, rather than mass alone, plays a critical role in determining toxicity and health impact. This study examined short-term associations between daily PM_2.5 constituents—black carbon (BC), nitrate (NO₃⁻), ammonium (NH₄⁺), and trace elements—and cardiopulmonary hospital admissions in Makkah, Saudi Arabia. Twelve months of constituent data from the Alharam monitoring site were linked to Herra hospital admissions for cardiovascular (CVD) and pulmonary diseases, stratified by visit type, age, and sex. Negative-binomial generalized linear models estimated adjusted relative risks (aRRs) per interquartile range increase in each constituent, controlling for meteorology, seasonality, and temporal trends. Mean PM_2.5 was 113.6 µg/m³; BC, sulfur, NO₃⁻, and NH₄⁺ dominated the fine fraction. Crustal elements were strongly intercorrelated (r > 0.9), while BC, lead (Pb), and nickel (Ni) showed moderate correlations (r ≈ 0.4–0.6), suggesting shared anthropogenic origins. BC increased CVD emergency/outpatient visits by 18% (aRR = 1.18; 95% CI: 1.08–1.29) and inpatient admissions by 25% (aRR = 1.25; 95% CI: 1.07–1.46). Ni and sulfur were also significant predictors; crustal elements were not. Multi-pollutant models confirmed BC and Pb as independent predictors (aRR = 1.19; 95% CI: 1.02–1.38). Effects were strongest among older adults aged 45–65 at lag 0–2 days. These findings highlight the need for emission controls targeting traffic and industrial combustion sources.