Shengzhi Sun1, Linwei Tian2, Wangnan Cao3, Poh-Chin Lai4, Paulina Pui Yun Wong5, Ruby Siu-Yin Lee6, Tonya G Mason7, Alexander Krämer8, Chit-Ming Wong7. 1. School of Public Health, The University of Hong Kong, Hong Kong SAR, China; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA. 2. School of Public Health, The University of Hong Kong, Hong Kong SAR, China. Electronic address: linweit@hku.hk. 3. Public Health and Healthy Ageing Research Group, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China. 4. Department of Geography, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China. 5. Science Unit, Lingnan University, Hong Kong. 6. Elderly Health Service, Department of Health, Hong Kong Special Administrative Region, China. 7. School of Public Health, The University of Hong Kong, Hong Kong SAR, China. 8. Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany.
Abstract
BACKGROUND: City is becoming warmer, especially in the process of urbanization and climate change. However, it is largely unknown whether this warming urban climate may modify the short-term effects of air pollution. OBJECTIVES: To test whether warmer urban climates intensify the acute mortality effects of air pollution on pneumonia in Hong Kong. METHODS: Participants who died of pneumonia from a prospective Chinese elderly cohort between 1998 and 2011 were selected as cases. Urban climatic (UC) classes of cases were determined by an established Urban Climatic Map according to their residential addresses. UC classes were first dichotomized into cool and warm climates and case-crossover analysis was used to estimate the short-term association of pneumonia mortality with air pollution. We further classified UC classes into climate quartiles and used case-only analysis to test the trend of urban climate modification on the short-term association of pneumonia mortality with air pollution. RESULTS: Among 66,820 elders (≥65 years), 2208 pneumonia deaths (cases) were identified during the 11-14 years of follow-up. The effects of air pollution for cases residing in the warm climate were statistically significant (p < 0.05) higher than those living in the cool climate. There was an increasing linear trend of urban climate modification on the association of pneumonia mortality with NO2 (nitrogen dioxide) (p for trend = 0.035). Compared to climate Quartile 1 (the lowest), deaths resided in climate Quartile 2, 3, and 4 (the highest) were associated with an additional percent change of 9.07% (0.52%, 17.62%), 12.89% (4.34%, 21.43%), and 8.45% (-0.10%, 17.00%), respectively. CONCLUSIONS: Warmer urban climate worsened the acute mortality effects of pneumonia associated with air pollutants in Hong Kong. Our findings suggest that warmer urban climate introduced by climate change and urbanization may increase the risks of air pollution-related pneumonia.
BACKGROUND: City is becoming warmer, especially in the process of urbanization and climate change. However, it is largely unknown whether this warming urban climate may modify the short-term effects of air pollution. OBJECTIVES: To test whether warmer urban climates intensify the acute mortality effects of air pollution on pneumonia in Hong Kong. METHODS:Participants who died of pneumonia from a prospective Chinese elderly cohort between 1998 and 2011 were selected as cases. Urban climatic (UC) classes of cases were determined by an established Urban Climatic Map according to their residential addresses. UC classes were first dichotomized into cool and warm climates and case-crossover analysis was used to estimate the short-term association of pneumonia mortality with air pollution. We further classified UC classes into climate quartiles and used case-only analysis to test the trend of urban climate modification on the short-term association of pneumonia mortality with air pollution. RESULTS: Among 66,820 elders (≥65 years), 2208 pneumonia deaths (cases) were identified during the 11-14 years of follow-up. The effects of air pollution for cases residing in the warm climate were statistically significant (p < 0.05) higher than those living in the cool climate. There was an increasing linear trend of urban climate modification on the association of pneumonia mortality with NO2 (nitrogen dioxide) (p for trend = 0.035). Compared to climate Quartile 1 (the lowest), deaths resided in climate Quartile 2, 3, and 4 (the highest) were associated with an additional percent change of 9.07% (0.52%, 17.62%), 12.89% (4.34%, 21.43%), and 8.45% (-0.10%, 17.00%), respectively. CONCLUSIONS: Warmer urban climate worsened the acute mortality effects of pneumonia associated with air pollutants in Hong Kong. Our findings suggest that warmer urban climate introduced by climate change and urbanization may increase the risks of air pollution-related pneumonia.