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

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.