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Zhang Y, Zhang S, Xin J, Wang S, He X, Zheng C, Li S. Short-term joint effects of ambient PM 2.5 and O 3 on mortality in Beijing, China. Front Public Health 2023; 11:1232715. [PMID: 37608983 PMCID: PMC10441666 DOI: 10.3389/fpubh.2023.1232715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/03/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction In recent years, air pollution caused by co-occurring PM2.5 and O3, named combined air pollution (CAP), has been observed in Beijing, China, although the health effects of CAP on population mortality are unclear. Methods We employed Poisson generalized additive models (GAMs) to evaluate the individual and joint effects of PM2.5 and O3 on mortality (nonaccidental, respiratory, and cardiovascular mortality) in Beijing, China, during the whole period (2014-2016) and the CAP period. Adverse health effects were assessed for percentage increases (%) in the three mortality categories with each 10-μg/m3 increase in PM2.5 and O3. The cumulative risk index (CRI) was adopted as a novel approach to quantify the joint effects. Results The results suggested that both PM2.5 and O3 exhibited the greatest individual effects on the three mortality categories with cumulative lag day 01. Increases in the nonaccidental, cardiovascular, and respiratory mortality categories were 0.32%, 0.36%, and 0.43% for PM2.5 (lag day 01) and 0.22%, 0.37%, and 0.25% for O3 (lag day 01), respectively. There were remarkably synergistic interactions between PM2.5 and O3 on the three mortality categories. The study showed that the combined effects of PM2.5 and O3 on nonaccidental, cardiovascular, and respiratory mortality were 0.34%, 0.43%, and 0.46%, respectively, during the whole period and 0.58%, 0.79%, and 0.75%, respectively, during the CAP period. Our findings suggest that combined exposure to PM2.5 and O3, particularly during CAP periods, could further exacerbate their single-pollutant health risks. Conclusion These findings provide essential scientific evidence for the possible creation and implementation of environmental protection strategies by policymakers.
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Affiliation(s)
- Ying Zhang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, School of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu, China
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China
| | - Shaobo Zhang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, School of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu, China
| | - Jinyuan Xin
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China
| | - Shigong Wang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, School of Atmospheric Sciences, Chengdu University of Information Technology, Chengdu, China
| | - Xiaonan He
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Canjun Zheng
- Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
| | - Shihong Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Zhang X, Maji KJ, Wang Z, Yang FF, Wang G, Cheng C. Associations between Different Ozone Indicators and Cardiovascular Hospital Admission: A Time-Stratified Case-Crossover Analysis in Guangzhou, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2056. [PMID: 36767423 PMCID: PMC9916254 DOI: 10.3390/ijerph20032056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/13/2023] [Indexed: 05/17/2023]
Abstract
Epidemiological studies reported that ozone (O3) is associated with cardiovascular diseases. However, only few of these studies examined the impact of multiple O3 indicators on cardiovascular hospital admissions. This study aimed to explore and compare the impacts of different O3 indicators on cardiovascular hospital admissions in Guangzhou, China. Based upon the data on daily cardiovascular hospital admissions, air pollution, and meteorological factors in Guangzhou from 2014 to 2018, a time-stratified case-crossover design model was used to analyze the associations between different O3 indicators and cardiovascular hospital admissions. Moreover, the sensitivities of different age and gender groups were analyzed for the whole year and different seasons (i.e., warm and cold). During the warm season, for the single-pollutant model, the odds ratio (OR) value of cardiovascular hospital admissions was 1.0067 (95% confidence interval (CI): 1.0037, 1.0098) for every IQR increase in MDA8 O3 at a lag of five days. The effect of O3 on people over 60 year was stronger than that on the 15-60 years age group. Females were more sensitive than males to O3 exposure. These results provided valuable references for further scientific research and environmental improvement in Guangzhou. Given that short-term O3 exposure poses a threat to human health, the government should therefore pay attention to prevention and control policies to reduce and eliminate O3 pollution and protect human health.
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Affiliation(s)
- Xiangxue Zhang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing 100875, China
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, 7514 AE Enschede, The Netherlands
| | - Kamal Jyoti Maji
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Zhuoqing Wang
- Department of Scientific Research & Discipline Development, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
| | - Fiona Fan Yang
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou 510006, China
| | - Guobin Wang
- School of Geography and Planning, Sun Yat-Sen University, Guangzhou 510006, China
| | - Changxiu Cheng
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing 100875, China
- National Tibetan Plateau Data Center, Beijing 100101, China
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Zhang Y, Tian Q, Feng X, Hu W, Ma P, Xin J, Wang S, Zheng C. Modification effects of ambient temperature on ozone-mortality relationships in Chengdu, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:73011-73019. [PMID: 35618998 DOI: 10.1007/s11356-022-20843-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
A multitude of epidemiological studies have demonstrated that both ambient temperatures and air pollution are closely related to health outcomes. However, whether temperature has modification effects on the association between ozone and health outcomes is still debated. In this study, three parallel time-series Poisson generalized additive models (GAMs) were used to examine the effects of modifying ambient temperatures on the association between ozone and mortality (including non-accidental, respiratory, and cardiovascular mortality) in Chengdu, China, from 2014 to 2016. The results confirmed that the ambient high temperatures strongly amplified the adverse effects of ozone on human mortality; specifically, the ozone effects were most pronounced at > 28 °C. Without temperature stratification conditions, a 10-μg/m3 increase in the maximum 8-h average ozone (O3-8hmax) level at lag01 was associated with increases of 0.40% (95% confidence interval [CI] 0.15%, 0.65%), 0.61% (95% CI 0.27%, 0.95%), and 0.69% (95% CI 0.34%, 1.04%) in non-accidental, respiratory, and cardiovascular mortality, respectively. On days during which the temperature exceeded 28 °C, a 10-μg/m3 increase in O3-8hmax led to increases of 2.22% (95% CI 1.21%, 3.23%), 2.67% (95% CI 0.57%, 4.76%), and 4.13% (95% CI 2.34%, 5.92%) in non-accidental, respiratory, and cardiovascular mortality, respectively. Our findings validated that high temperature could further aggravate the health risks of O3-8hmax; thus, mitigating ozone exposure will be brought into the limelight especially under the context of changing climate.
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Affiliation(s)
- Ying Zhang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, Plain Urban Meteorology and Environment Observation and Research Station of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, ChengduChengdu, 610225, Sichuan, China.
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, 100029, China.
| | - Qiqi Tian
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, Plain Urban Meteorology and Environment Observation and Research Station of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, ChengduChengdu, 610225, Sichuan, China
| | - Xinyuan Feng
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, Plain Urban Meteorology and Environment Observation and Research Station of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, ChengduChengdu, 610225, Sichuan, China
| | - Wendong Hu
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, Plain Urban Meteorology and Environment Observation and Research Station of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, ChengduChengdu, 610225, Sichuan, China
| | - Pan Ma
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, Plain Urban Meteorology and Environment Observation and Research Station of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, ChengduChengdu, 610225, Sichuan, China.
| | - Jinyuan Xin
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, 100029, China.
| | - Shigong Wang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, Plain Urban Meteorology and Environment Observation and Research Station of Sichuan Province, College of Atmospheric Sciences, Chengdu University of Information Technology, ChengduChengdu, 610225, Sichuan, China
| | - Canjun Zheng
- Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, 102206, China
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Fann N, Coffman E, Jackson M, Jhun I, Lamichhane A, Nolte CG, Roman H, Sacks JD. The Role of Temperature in Modifying the Risk of Ozone-Attributable Mortality under Future Changes in Climate: A Proof-of-Concept Analysis. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:1202-1210. [PMID: 34965106 PMCID: PMC9359214 DOI: 10.1021/acs.est.1c05975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Air pollution risk assessments typically estimate ozone-attributable mortality counts using concentration-response (C-R) parameters from epidemiologic studies that treat temperature as a potential confounder. However, some recent epidemiologic studies have indicated that temperature can modify the relationship between short-term ozone exposure and mortality, which has potentially important implications when considering the impacts of climate change on public health. This proof-of-concept analysis quantifies counts of temperature-modified ozone-attributable mortality using temperature-stratified C-R parameters from a multicity study in which the pooled ozone-mortality effect coefficients change in concert with daily temperature. Meteorology downscaled from two global climate models is used with a photochemical transport model to simulate ozone concentrations over the 21st century using two emission inventories: one holding air pollutant emissions constant at 2011 levels and another accounting for reduced emissions through the year 2040. The late century climate models project increased summer season temperatures, which in turn yields larger total counts of ozone-attributable deaths in analyses using temperature-stratified C-R parameters compared to the traditional temperature confounder approach. This analysis reveals substantial heterogeneity in the magnitude and distribution of the temperature-stratified ozone-attributable mortality results, which is a function of regional variability in both the C-R relationship and the model-predicted temperature and ozone.
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Affiliation(s)
- Neal Fann
- U.S. EPA Office of Air Quality Planning and Standards,
Research Triangle Park NC 27711 USA
| | - Evan Coffman
- U.S. EPA Office of Research and Development, Research
Triangle Park, NC 27711 USA
| | | | - Iny Jhun
- Stanford Health Care, San Francisco, CA 94305 USA
| | - Archana Lamichhane
- U.S. EPA Office of Air Quality Planning and Standards,
Research Triangle Park NC 27711 USA
| | - Christopher G. Nolte
- U.S. EPA Office of Research and Development, Research
Triangle Park, NC 27711 USA
| | - Henry Roman
- Industrial Economics Inc, Cambridge, MA 02140 USA
| | - Jason D. Sacks
- U.S. EPA Office of Research and Development, Research
Triangle Park, NC 27711 USA
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Huang M, Strickland MJ, Richards M, Holmes HA, Newman AJ, Garn JV, Liu Y, Warren JL, Chang HH, Darrow LA. Acute associations between heatwaves and preterm and early-term birth in 50 US metropolitan areas: a matched case-control study. Environ Health 2021; 20:47. [PMID: 33892728 PMCID: PMC8066488 DOI: 10.1186/s12940-021-00733-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The effect of heatwaves on adverse birth outcomes is not well understood and may vary by how heatwaves are defined. The study aims to examine acute associations between various heatwave definitions and preterm and early-term birth. METHODS Using national vital records from 50 metropolitan statistical areas (MSAs) between 1982 and 1988, singleton preterm (< 37 weeks) and early-term births (37-38 weeks) were matched (1:1) to controls who completed at least 37 weeks or 39 weeks of gestation, respectively. Matching variables were MSA, maternal race, and maternal education. Sixty heatwave definitions including binary indicators for exposure to sustained heat, number of high heat days, and measures of heat intensity (the average degrees over the threshold in the past 7 days) based on the 97.5th percentile of MSA-specific temperature metrics, or the 85th percentile of positive excessive heat factor (EHF) were created. Odds ratios (OR) for heatwave exposures in the week preceding birth (or corresponding gestational week for controls) were estimated using conditional logistic regression adjusting for maternal age, marital status, and seasonality. Effect modification by maternal education, age, race/ethnicity, child sex, and region was assessed. RESULTS There were 615,329 preterm and 1,005,576 early-term case-control pairs in the analyses. For most definitions, exposure to heatwaves in the week before delivery was consistently associated with increased odds of early-term birth. Exposure to more high heat days and more degrees above the threshold yielded higher magnitude ORs. For exposure to 3 or more days over the 97.5th percentile of mean temperature in the past week compared to zero days, the OR was 1.027 for early-term birth (95%CI: 1.014, 1.039). Although we generally found null associations when assessing various heatwave definitions and preterm birth, ORs for both preterm and early-term birth were greater in magnitude among Hispanic and non-Hispanic black mothers. CONCLUSION Although associations varied across metrics and heatwave definitions, heatwaves were more consistently associated with early-term birth than with preterm birth. This study's findings may have implications for prevention programs targeting vulnerable subgroups as climate change progresses.
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Affiliation(s)
- Mengjiao Huang
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA.
| | - Matthew J Strickland
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Megan Richards
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Heather A Holmes
- Department of Chemical Engineering, University of Utah, Salt Lake City, UT, USA
| | | | - Joshua V Garn
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Howard H Chang
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV, 89557, USA
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Anenberg SC, Haines S, Wang E, Nassikas N, Kinney PL. Synergistic health effects of air pollution, temperature, and pollen exposure: a systematic review of epidemiological evidence. Environ Health 2020; 19:130. [PMID: 33287833 PMCID: PMC7720572 DOI: 10.1186/s12940-020-00681-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/30/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Exposure to heat, air pollution, and pollen are associated with health outcomes, including cardiovascular and respiratory disease. Studies assessing the health impacts of climate change have considered increased exposure to these risk factors separately, though they may be increasing simultaneously for some populations and may act synergistically on health. Our objective is to systematically review epidemiological evidence for interactive effects of multiple exposures to heat, air pollution, and pollen on human health. METHODS We systematically searched electronic literature databases (last search, April 29, 2019) for studies reporting quantitative measurements of associations between at least two of the exposures and mortality from any cause and cardiovascular and respiratory morbidity and mortality specifically. Following the Navigation Guide systematic review methodology, we evaluated the risk of bias of individual studies and the overall quality and strength of evidence. RESULTS We found 56 studies that met the inclusion criteria. Of these, six measured air pollution, heat, and pollen; 39 measured air pollution and heat; 10 measured air pollution and pollen; and one measured heat and pollen. Nearly all studies were at risk of bias from exposure assessment error. However, consistent exposure-response across studies led us to conclude that there is overall moderate quality and sufficient evidence for synergistic effects of heat and air pollution. We concluded that there is overall low quality and limited evidence for synergistic effects from simultaneous exposure to (1) air pollution, pollen, and heat; and (2) air pollution and pollen. With only one study, we were unable to assess the evidence for synergistic effects of heat and pollen. CONCLUSIONS If synergistic effects between heat and air pollution are confirmed with additional research, the health impacts from climate change-driven increases in air pollution and heat exposure may be larger than previously estimated in studies that consider these risk factors individually.
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Affiliation(s)
- Susan C. Anenberg
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052 USA
| | - Shannon Haines
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052 USA
- Now at: American Lung Association, Springfield, IL USA
| | - Elizabeth Wang
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052 USA
| | - Nicholas Nassikas
- Department of Pulmonary, Critical Care, and Sleep Medicine, Brown University Alpert Medical School, Providence, RI 02903 USA
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Wang C, Qi Y, Zhu G. Deep learning for predicting the occurrence of cardiopulmonary diseases in Nanjing, China. CHEMOSPHERE 2020; 257:127176. [PMID: 32497840 DOI: 10.1016/j.chemosphere.2020.127176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
The efficiency of disease prevention and medical care service necessitated the prediction of incidence. However, predictive accuracy and power were largely impeded in a complex system including multiple environmental stressors and health outcome of which the occurrence might be episodic and irregular in time. In this study, we established four different deep learning (DL) models to capture inherent long-term dependencies in sequences and potential complex relationships among constituents by initiating with the original input into a representation at a higher abstract level. We collected 504,555 and 786,324 hospital outpatient visits of grouped categories of respiratory (RESD) and circulatory system disease (CCD), respectively, in Nanjing from 2013 through 2018. The matched observations in time-series that might pose risk to cardiopulmonary health involved conventional air pollutants concentrations and metrological conditions. The results showed that a well-trained network architecture built upon long short-term memory block and a working day enhancer achieved optimal performance by three quantitative statistics, i.e., 0.879 and 0.902 of Nash-Sutcliffe efficiency, 0.921% and 0.667% of percent bias, and 0.347 and 0.312 of root mean square error-standard deviation ratio for RESD and CCD hospital visits, respectively. We observed the non-linear association of nitrogen dioxide and ambient air temperature with CCD hospital visits. Furthermore, these two environmental stressors were identified as the most sensitive predictive variables, and exerted synergetic effect for two health outcomes, particular in winter season. Our study indicated that high-quality surveillance data of atmospheric environments could provide novel opportunity for anticipating temporal trend of cardiopulmonary health outcomes based on DL model.
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Affiliation(s)
- Ce Wang
- School of Energy and Environment, Southeast University, Nanjing, 210096, China; State Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, 210096, PR China.
| | - Yi Qi
- School of Architecture and Urban Planning, Nanjing University, No. 22, Hankoulu Road, Nanjing, 210093, PR China.
| | - Guangcan Zhu
- School of Energy and Environment, Southeast University, Nanjing, 210096, China; State Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, 210096, PR China.
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Lee W, Choi HM, Kim D, Honda Y, Leon Guo YL, Kim H. Synergic effect between high temperature and air pollution on mortality in Northeast Asia. ENVIRONMENTAL RESEARCH 2019; 178:108735. [PMID: 31539825 DOI: 10.1016/j.envres.2019.108735] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/09/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
High temperature and air pollutants have been reported as potential risk factors of mortality. Previous studies investigated interaction between the two variables; however, the excess death risk due to the synergic effect (i.e. interaction on the additive scale) between the two variables has not been investigated adequately on a multi-country scale. This study aimed to assess the excess death risk due to the synergism between high temperature and air pollution on mortality using a multicity time-series analysis. We collected time-series data on mortality, weather variables, and four air pollutants (PM10, O3, NO2, and CO) for 16 metropolitan cities of three countries (Japan, Korea, and Taiwan) in Northeast Asia (1979-2015). Quasi-Poisson time-series regression and meta-analysis were used to estimate the additive interaction between high temperature and air pollution. The additive interaction was measured by relative excess risk due to interaction (RERI) index. We calculated RERI with relative risks (RR) of the 99th/10th, 90th/90th, and 99th/90th percentiles of temperature/air pollution metrics, where risk at the 90th/10th percentiles of temperature/air pollution metrics was the reference category. This study showed that there may exist positive and significant excess death risks due to the synergism between high temperature and air pollution in the total population for all pollutants (95% lower confidence intervals of all RERIs>0 or near 0). In final, we measured quantitatively the excess death risks due to synergic effect between high temperature and air pollution, and the synergism should be considered in public health interventions and a composite warning system.
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Affiliation(s)
- Whanhee Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hayon Michelle Choi
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Dahye Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yasushi Honda
- Faculty of Health and Sports Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yue-Liang Leon Guo
- Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
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