Kai Chen1, Kathrin Wolf2, Susanne Breitner2, Antonio Gasparrini3, Massimo Stafoggia4, Evangelia Samoli5, Zorana Jovanovic Andersen6, Getahun Bero-Bedada7, Tom Bellander8, Frauke Hennig9, Bénédicte Jacquemin10, Juha Pekkanen11, Regina Hampel2, Josef Cyrys2, Annette Peters2, Alexandra Schneider2. 1. Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. Electronic address: kai.chen@helmholtz-muenchen.de. 2. Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany. 3. Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK. 4. Lazio Region Health Service, Department of Epidemiology, Italy. 5. Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece. 6. Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark. 7. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 8. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Centre for Occupational and Environmental Medicine, Stockholm, Sweden. 9. Institute for Occupational, Social and Environmental Medicine, Center for health and Society, University of Düsseldorf, Düsseldorf, Germany. 10. INSERM-Aging and Chronic Diseases, Epidemiological and Public Health Approaches (VIMA), Villejuif, France; Barcelona Institute for Global Health - Campus MAR (ISGlobal), Barcelona, Spain. 11. Department of Public Health, University of Helsinki, Helsinki, Finland; Environment and Health Unit, National Institute for Health and Welfare (THL), Kuopio, Finland.
Abstract
BACKGROUND: Although epidemiological studies have reported associations between mortality and both ambient air pollution and air temperature, it remains uncertain whether the mortality effects of air pollution are modified by temperature and vice versa. Moreover, little is known on the interactions between ultrafine particles (diameter ≤ 100 nm, UFP) and temperature. OBJECTIVE: We investigated whether the short-term associations of particle number concentration (PNC in the ultrafine range (≤100 nm) or total PNC ≤ 3000 nm, as a proxy for UFP), particulate matter ≤ 2.5 μm (PM2.5) and ≤ 10 μm (PM10), and ozone with daily total natural and cardiovascular mortality were modified by air temperature and whether air pollution levels affected the temperature-mortality associations in eight European urban areas during 1999-2013. METHODS: We first analyzed air temperature-stratified associations between air pollution and total natural (nonaccidental) and cardiovascular mortality as well as air pollution-stratified temperature-mortality associations using city-specific over-dispersed Poisson additive models with a distributed lag nonlinear temperature term in each city. All models were adjusted for long-term and seasonal trend, day of the week, influenza epidemics, and population dynamics due to summer vacation and holidays. City-specific effect estimates were then pooled using random-effects meta-analysis. RESULTS: Pooled associations between air pollutants and total and cardiovascular mortality were overall positive and generally stronger at high relatively compared to low air temperatures. For example, on days with high air temperatures (>75th percentile), an increase of 10,000 particles/cm3 in PNC corresponded to a 2.51% (95% CI: 0.39%, 4.67%) increase in cardiovascular mortality, which was significantly higher than that on days with low air temperatures (<25th percentile) [-0.18% (95% CI: -0.97%, 0.62%)]. On days with high air pollution (>50th percentile), both heat- and cold-related mortality risks increased. CONCLUSION: Our findings showed that high temperature could modify the effects of air pollution on daily mortality and high air pollution might enhance the air temperature effects.
BACKGROUND: Although epidemiological studies have reported associations between mortality and both ambient air pollution and air temperature, it remains uncertain whether the mortality effects of air pollution are modified by temperature and vice versa. Moreover, little is known on the interactions between ultrafine particles (diameter ≤ 100 nm, UFP) and temperature. OBJECTIVE: We investigated whether the short-term associations of particle number concentration (PNC in the ultrafine range (≤100 nm) or total PNC ≤ 3000 nm, as a proxy for UFP), particulate matter ≤ 2.5 μm (PM2.5) and ≤ 10 μm (PM10), and ozone with daily total natural and cardiovascular mortality were modified by air temperature and whether air pollution levels affected the temperature-mortality associations in eight European urban areas during 1999-2013. METHODS: We first analyzed air temperature-stratified associations between air pollution and total natural (nonaccidental) and cardiovascular mortality as well as air pollution-stratified temperature-mortality associations using city-specific over-dispersed Poisson additive models with a distributed lag nonlinear temperature term in each city. All models were adjusted for long-term and seasonal trend, day of the week, influenza epidemics, and population dynamics due to summer vacation and holidays. City-specific effect estimates were then pooled using random-effects meta-analysis. RESULTS: Pooled associations between air pollutants and total and cardiovascular mortality were overall positive and generally stronger at high relatively compared to low air temperatures. For example, on days with high air temperatures (>75th percentile), an increase of 10,000 particles/cm3 in PNC corresponded to a 2.51% (95% CI: 0.39%, 4.67%) increase in cardiovascular mortality, which was significantly higher than that on days with low air temperatures (<25th percentile) [-0.18% (95% CI: -0.97%, 0.62%)]. On days with high air pollution (>50th percentile), both heat- and cold-related mortality risks increased. CONCLUSION: Our findings showed that high temperature could modify the effects of air pollution on daily mortality and high air pollution might enhance the air temperature effects.
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