Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: Multilocation analysis in 398 cities

Xia Meng, Cong Liu, Renjie Chen, Francesco Sera, Ana Maria Vicedo-Cabrera, Ai Milojevic, Yuming Guo, Shilu Tong, Micheline De Sousa Zanotti Stagliorio Coelho, Paulo Hilario Nascimento Saldiva, Eric Lavigne, Patricia Matus Correa, Nicolas Valdes Ortega, Samuel Osorio, Garcia, Jan Kyselý, Aleš Urban, Hans Orru, Marek Maasikmets, Jouni J.K. JaakkolaNiilo Ryti, Veronika Huber, Alexandra Schneider, Klea Katsouyanni, Antonis Analitis, Masahiro Hashizume, Yasushi Honda, Chris Fook Sheng Ng, Baltazar Nunes, João Paulo Teixeira, Iulian Horia Holobaca, Simona Fratianni, Ho Kim, Aurelio Tobias, Carmen Íñiguez, Bertil Forsberg, Christofer Åström, Martina S. Ragettli, Yue-Liang Leon Guo, Shih Chun Pan, Shanshan Li, Michelle L. Bell, Antonella Zanobetti, Joel Schwartz, Tangchun Wu, Antonio Gasparrini, Haidong Kan

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Objective To evaluate the short term associations between nitrogen dioxide (NO 2) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol. Design Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis. Setting 398 cities in 22 low to high income countries/regions. Main outcome measures Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018. Results On average, a 10 μg/m 3 increase in NO 2 concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 μm or ≤2.5 μm (PM 10 and PM 2.5, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO 2 concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities. Conclusions This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO 2 and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO 2.

Original languageEnglish
Article numbern534
Number of pages9
Publication statusPublished - 24 Mar 2021

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