TY - JOUR
T1 - Heat-related cardiorespiratory mortality
T2 - Effect modification by air pollution across 482 cities from 24 countries
AU - Rai, Masna
AU - Stafoggia, Massimo
AU - de'Donato, Francesca
AU - Scortichini, Matteo
AU - Zafeiratou, Sofia
AU - Vazquez Fernandez, Liliana
AU - Zhang, Siqi
AU - Katsouyanni, Klea
AU - Samoli, Evangelia
AU - Rao, Shilpa
AU - Lavigne, Eric
AU - Guo, Yuming
AU - Kan, Haidong
AU - Osorio, Samuel
AU - Kyselý, Jan
AU - Urban, Aleš
AU - Orru, Hans
AU - Maasikmets, Marek
AU - Jaakkola, Jouni J.K.
AU - Ryti, Niilo
AU - Pascal, Mathilde
AU - Hashizume, Masahiro
AU - Fook Sheng Ng, Chris
AU - Alahmad, Barrak
AU - Hurtado Diaz, Magali
AU - De la Cruz Valencia, César
AU - Nunes, Baltazar
AU - Madureira, Joana
AU - Scovronick, Noah
AU - Garland, Rebecca M.
AU - Kim, Ho
AU - Lee, Whanhee
AU - Tobias, Aurelio
AU - Íñiguez, Carmen
AU - Forsberg, Bertil
AU - Åström, Christofer
AU - Maria Vicedo-Cabrera, Ana
AU - Ragettli, Martina S.
AU - Leon Guo, Yue Liang
AU - Pan, Shih Chun
AU - Li, Shanshan
AU - Gasparrini, Antonio
AU - Sera, Francesco
AU - Masselot, Pierre
AU - Schwartz, Joel
AU - Zanobetti, Antonella
AU - Bell, Michelle L.
AU - Schneider, Alexandra
AU - Breitner, Susanne
N1 - Funding Information:
Masna Rai, Massimo Stafoggia, Francesca K. de’ Donato, Sofia Zafeiratou, Liliana Vazquez Fernandez, Siqi Zhang, Klea Katsouyanni, Evangelia Samoli, Shilpa Rao, Antonio Gasparrini, Pierre Masselot, and Alexandra Schneider were supported by the European Union's Horizon 2020 Project Exhaustion (Grant ID: 820655). Joana Madureira was supported by the Fundação para a Ciência e a Tecnologia (FCT) (Grant SFRH/BPD/115112/2016). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. SB, AS, FD, and MS designed the study and developed the statistical methods. MR performed the statistical analysis for the MCC dataset and Germany MR. MS, SZ, and LV performed the analysis for Italy, Greece, and Norway, respectively. SB verified the analysis. MR coordinated the work and took the lead in drafting the manuscript and interpreting the results. SB, AS, FD and MS provided substantial scientific input in interpreting the results and drafting the manuscript. All other authors provided data and reviewed the manuscript.
Funding Information:
Masna Rai, Massimo Stafoggia, Francesca K. de’ Donato, Sofia Zafeiratou, Liliana Vazquez Fernandez, Siqi Zhang, Klea Katsouyanni, Evangelia Samoli, Shilpa Rao, Antonio Gasparrini, Pierre Masselot, and Alexandra Schneider were supported by the European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655). Joana Madureira was supported by the Fundação para a Ciência e a Tecnologia (FCT) (Grant SFRH/BPD/115112/2016).
Publisher Copyright:
© 2023
PY - 2023/4
Y1 - 2023/4
N2 - Background: Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations. Objectives: We investigated the effects of heat on cardiovascular and respiratory mortality and its modification by air pollution during summer months (six consecutive hottest months) in 482 locations across 24 countries. Methods: Location-specific daily death counts and exposure data (e.g., particulate matter with diameters ≤ 2.5 µm [PM2.5]) were obtained from 2000 to 2018. We used location-specific confounder-adjusted Quasi-Poisson regression with a tensor product between air temperature and the air pollutant. We extracted heat effects at low, medium, and high levels of pollutants, defined as the 5th, 50th, and 95th percentile of the location-specific pollutant concentrations. Country-specific and overall estimates were derived using a random-effects multilevel meta-analytical model. Results: Heat was associated with increased cardiorespiratory mortality. Moreover, the heat effects were modified by elevated levels of all air pollutants in most locations, with stronger effects for respiratory than cardiovascular mortality. For example, the percent increase in respiratory mortality per increase in the 2-day average summer temperature from the 75th to the 99th percentile was 7.7% (95% Confidence Interval [CI] 7.6–7.7), 11.3% (95%CI 11.2–11.3), and 14.3% (95% CI 14.1–14.5) at low, medium, and high levels of PM2.5, respectively. Similarly, cardiovascular mortality increased by 1.6 (95%CI 1.5–1.6), 5.1 (95%CI 5.1–5.2), and 8.7 (95%CI 8.7–8.8) at low, medium, and high levels of O3, respectively. Discussion: We observed considerable modification of the heat effects on cardiovascular and respiratory mortality by elevated levels of air pollutants. Therefore, mitigation measures following the new WHO Air Quality Guidelines are crucial to enhance better health and promote sustainable development.
AB - Background: Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations. Objectives: We investigated the effects of heat on cardiovascular and respiratory mortality and its modification by air pollution during summer months (six consecutive hottest months) in 482 locations across 24 countries. Methods: Location-specific daily death counts and exposure data (e.g., particulate matter with diameters ≤ 2.5 µm [PM2.5]) were obtained from 2000 to 2018. We used location-specific confounder-adjusted Quasi-Poisson regression with a tensor product between air temperature and the air pollutant. We extracted heat effects at low, medium, and high levels of pollutants, defined as the 5th, 50th, and 95th percentile of the location-specific pollutant concentrations. Country-specific and overall estimates were derived using a random-effects multilevel meta-analytical model. Results: Heat was associated with increased cardiorespiratory mortality. Moreover, the heat effects were modified by elevated levels of all air pollutants in most locations, with stronger effects for respiratory than cardiovascular mortality. For example, the percent increase in respiratory mortality per increase in the 2-day average summer temperature from the 75th to the 99th percentile was 7.7% (95% Confidence Interval [CI] 7.6–7.7), 11.3% (95%CI 11.2–11.3), and 14.3% (95% CI 14.1–14.5) at low, medium, and high levels of PM2.5, respectively. Similarly, cardiovascular mortality increased by 1.6 (95%CI 1.5–1.6), 5.1 (95%CI 5.1–5.2), and 8.7 (95%CI 8.7–8.8) at low, medium, and high levels of O3, respectively. Discussion: We observed considerable modification of the heat effects on cardiovascular and respiratory mortality by elevated levels of air pollutants. Therefore, mitigation measures following the new WHO Air Quality Guidelines are crucial to enhance better health and promote sustainable development.
KW - Air pollution
KW - Air temperature
KW - Cardiovascular mortality
KW - Effect modification
KW - Heat
KW - Respiratory mortality
UR - http://www.scopus.com/inward/record.url?scp=85150267738&partnerID=8YFLogxK
U2 - 10.1016/j.envint.2023.107825
DO - 10.1016/j.envint.2023.107825
M3 - Article
C2 - 36934570
AN - SCOPUS:85150267738
SN - 0160-4120
VL - 174
JO - Environment International
JF - Environment International
M1 - 107825
ER -
