Author(s):
Stafoggia, Massimo ; Michelozzi, Paola ; Schneider, Alexandra ; Armstrong, Ben ; Scortichini, Matteo ; Rai, Masna ; Achilleos, Souzana ; Alahmad, Barrak ; Analitis, Antonis ; Åström, Christofer ; Bell, Michelle L. ; Calleja, Neville ; Krage Carlsen, Hanne ; Carrasco, Gabriel ; Paul Cauchi, John ; DSZS Coelho, Micheline ; Correa, Patricia M. ; Diaz, Magali H. ; Entezari, Alireza ; Forsberg, Bertil ; Garland, Rebecca M. ; Leon Guo, Yue ; Guo, Yuming ; Hashizume, Masahiro ; Holobaca, Iulian H. ; Íñiguez, Carmen ; Jaakkola, Jouni J.K. ; Kan, Haidong ; Katsouyanni, Klea ; Kim, Ho ; Kyselý, Jan ; Lavigne, Eric ; Lee, Whanhee ; Li, Shanshan ; Maasikmets, Marek ; Madureira, Joana ; Mayvaneh, Fatemeh ; Fook Sheng Ng, Chris ; Nunes, Baltazar ; Orru, Hans ; V Ortega, Nicolás ; Osorio, Samuel ; Palomares, Alfonso D.L. ; Pan, Shih-Chun ; Pascal, Mathilde ; Ragettli, Martina S ; Rao, Shilpa ; Raz, Raanan ; Roye, Dominic ; Ryti, Niilo ; HN Saldiva, Paulo ; Samoli, Evangelia ; Schwartz, Joel ; Scovronick, Noah ; Sera, Francesco ; Tobias, Aurelio ; Tong, Shilu ; DLC Valencia, César ; Maria Vicedo-Cabrera, Ana ; Urban, Aleš ; Gasparrini, Antonio ; Breitner, Susanne ; de' Donato, Francesca K.
Date: 2023
Persistent ID: http://hdl.handle.net/10400.18/9130
Origin: Repositório Científico do Instituto Nacional de Saúde
Subject(s): Mortality; Air Temperature; Air Pollution; MCC; Effect Modification; Epidemiology; Determinantes da Saúde e da Doença; Avaliação do Impacte em Saúde
Description
Background: The epidemiological evidence on the interaction between heat and ambient air pollution on mortality is still inconsistent. Objectives: To investigate the interaction between heat and ambient air pollution on daily mortality in a large dataset of 620 cities from 36 countries. Methods: We used daily data on all-cause mortality, air temperature, particulate matter ≤ 10 μm (PM10), PM ≤ 2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) from 620 cities in 36 countries in the period 1995-2020. We restricted the analysis to the six consecutive warmest months in each city. City-specific data were analysed with over-dispersed Poisson regression models, followed by a multilevel random-effects meta-analysis. The joint association between air temperature and air pollutants was modelled with product terms between non-linear functions for air temperature and linear functions for air pollutants. Results: We analyzed 22,630,598 deaths. An increase in mean temperature from the 75th to the 99th percentile of city-specific distributions was associated with an average 8.9 % (95 % confidence interval: 7.1 %, 10.7 %) mortality increment, ranging between 5.3 % (3.8 %, 6.9 %) and 12.8 % (8.7 %, 17.0 %), when daily PM10 was equal to 10 or 90 μg/m3, respectively. Corresponding estimates when daily O3 concentrations were 40 or 160 μg/m3 were 2.9 % (1.1 %, 4.7 %) and 12.5 % (6.9 %, 18.5 %), respectively. Similarly, a 10 μg/m3 increment in PM10 was associated with a 0.54 % (0.10 %, 0.98 %) and 1.21 % (0.69 %, 1.72 %) increase in mortality when daily air temperature was set to the 1st and 99th city-specific percentiles, respectively. Corresponding mortality estimate for O3 across these temperature percentiles were 0.00 % (-0.44 %, 0.44 %) and 0.53 % (0.38 %, 0.68 %). Similar effect modification results, although slightly weaker, were found for PM2.5 and NO2. Conclusions: Suggestive evidence of effect modification between air temperature and air pollutants on mortality during the warm period was found in a global dataset of 620 cities.
