Short-term exposure to ambient air pollution and daily atherosclerotic heart disease mortality in a cool climate.

The associations between exposure to short-term ambient air pollution and daily atherosclerotic heart disease (ASHD) mortality in cool climate have not been established. We performed a time-series analysis in Shenyang, the largest city of Northeastern China. We identified 7659 ASHD deaths and obtained deaths, ambient air pollution levels, and meteorological data for Shenyang during 2014-2017. The impact of ambient air pollution on daily ASHD deaths was analyzed using generalized additive models (GAMs). Cumulative lag effects were investigated using distributed lag non-linear models (DLNM). We found ASHD deaths significantly increased during days with higher air pollution. Particulate matter with diameter < 2.5 μm (PM2.5), PM10, and sulfur dioxide (SO2) were positively associated with ASHD deaths among the total population. Both single- and multi-pollutants models indicated that PM2.5, PM10, and sulfur dioxide (SO2) were positively associated with the deaths of women with AHSD, whereas only SO2 was significant in men. This suggests significant gender-based differences in the fatal effects of ambient air pollution. Up to 28 days of single-day lag effects were observed for PM2.5 and PM10 in women. The cumulative lag effects of PM2.5 and PM10 showed increasing trends in both men and women; however, exposure to higher pollutant concentrations did not necessarily translate to greater risks. The ERRs differences between women and men were larger in cold days than in hot days, suggesting that lower temperature may exacerbate the adverse effects of air pollution on vulnerable women.