Maayan Yitshak-Sade1, Jennifer F Bobb2, Joel D Schwartz1, Itai Kloog3, Antonella Zanobetti4. 1. Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 2. Biostatistics Unit, Kaiser Permanent Washington Health Research Institute, Seattle, WA, USA. 3. Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel. 4. Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: azanobet@hsph.harvard.edu.
Abstract
BACKGROUND: Particulate matter < 2.5 μm in diameter (PM2.5) and heat are strong predictors of morbidity, yet few studies have examined the effects of long-term exposures on non-fatal events, or assessed the short and long-term effect on health simultaneously. OBJECTIVE: We jointly investigated the association of short and long-term exposures to PM2.5 and temperature with hospital admissions, and explored the modification of the associations with the short-term exposures by one another and by temperature variability. METHODS: Daily ZIP code counts of respiratory, cardiac and stroke admissions of adults ≥65 (N = 2,015,660) were constructed across New-England (2001-2011). Daily PM2.5 and temperature exposure estimates were obtained from satellite-based spatio-temporally resolved models. For each admission cause, a Poisson regression was fit on short and long-term exposures, with a random intercept for ZIP code. Modifications of the short-term effects were tested by adding interaction terms with temperature, PM2.5 and temperature variability. RESULTS: Associations between short and long-term exposures were observed for all of the outcomes, with stronger effects of long-term exposures to PM2.5. For respiratory admissions, the short-term PM2.5 effect (percent increase per IQR) was larger on warmer days (1.12% versus -0.53%) and in months of higher temperature variability (1.63% versus -0.45%). The short-term temperature effect was higher in months of higher temperature variability as well. For cardiac admissions, the PM2.5 effect was larger on colder days (0.56% versus -0.30%) and in months of higher temperature variability (0.99% versus -0.56%). CONCLUSIONS: We observed synergistic effects of short-term exposures to PM2.5, temperature and temperature variability. Long-term exposures to PM2.5 were associated with larger effects compared to short-term exposures.
BACKGROUND: Particulate matter < 2.5 μm in diameter (PM2.5) and heat are strong predictors of morbidity, yet few studies have examined the effects of long-term exposures on non-fatal events, or assessed the short and long-term effect on health simultaneously. OBJECTIVE: We jointly investigated the association of short and long-term exposures to PM2.5 and temperature with hospital admissions, and explored the modification of the associations with the short-term exposures by one another and by temperature variability. METHODS: Daily ZIP code counts of respiratory, cardiac and stroke admissions of adults ≥65 (N = 2,015,660) were constructed across New-England (2001-2011). Daily PM2.5 and temperature exposure estimates were obtained from satellite-based spatio-temporally resolved models. For each admission cause, a Poisson regression was fit on short and long-term exposures, with a random intercept for ZIP code. Modifications of the short-term effects were tested by adding interaction terms with temperature, PM2.5 and temperature variability. RESULTS: Associations between short and long-term exposures were observed for all of the outcomes, with stronger effects of long-term exposures to PM2.5. For respiratory admissions, the short-term PM2.5 effect (percent increase per IQR) was larger on warmer days (1.12% versus -0.53%) and in months of higher temperature variability (1.63% versus -0.45%). The short-term temperature effect was higher in months of higher temperature variability as well. For cardiac admissions, the PM2.5 effect was larger on colder days (0.56% versus -0.30%) and in months of higher temperature variability (0.99% versus -0.56%). CONCLUSIONS: We observed synergistic effects of short-term exposures to PM2.5, temperature and temperature variability. Long-term exposures to PM2.5 were associated with larger effects compared to short-term exposures.
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