TY - JOUR
T1 - Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality
T2 - Multilocation analysis in 398 cities
AU - Meng, Xia
AU - Liu, Cong
AU - Chen, Renjie
AU - Sera, Francesco
AU - Vicedo-Cabrera, Ana Maria
AU - Milojevic, Ai
AU - Guo, Yuming
AU - Tong, Shilu
AU - De Sousa Zanotti Stagliorio Coelho, Micheline
AU - Saldiva, Paulo Hilario Nascimento
AU - Lavigne, Eric
AU - Correa, Patricia Matus
AU - Ortega, Nicolas Valdes
AU - Osorio, Samuel
AU - Garcia, null
AU - Kyselý, Jan
AU - Urban, Aleš
AU - Orru, Hans
AU - Maasikmets, Marek
AU - Jaakkola, Jouni J.K.
AU - Ryti, Niilo
AU - Huber, Veronika
AU - Schneider, Alexandra
AU - Katsouyanni, Klea
AU - Analitis, Antonis
AU - Hashizume, Masahiro
AU - Honda, Yasushi
AU - Ng, Chris Fook Sheng
AU - Nunes, Baltazar
AU - Teixeira, João Paulo
AU - Holobaca, Iulian Horia
AU - Fratianni, Simona
AU - Kim, Ho
AU - Tobias, Aurelio
AU - Íñiguez, Carmen
AU - Forsberg, Bertil
AU - Åström, Christofer
AU - Ragettli, Martina S.
AU - Guo, Yue-Liang Leon
AU - Pan, Shih Chun
AU - Li, Shanshan
AU - Bell, Michelle L.
AU - Zanobetti, Antonella
AU - Schwartz, Joel
AU - Wu, Tangchun
AU - Gasparrini, Antonio
AU - Kan, Haidong
PY - 2021/3/24
Y1 - 2021/3/24
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85103370304&partnerID=8YFLogxK
U2 - 10.1136/bmj.n534
DO - 10.1136/bmj.n534
M3 - Article
C2 - 33762259
AN - SCOPUS:85103370304
SN - 0959-535X
VL - 372
JO - The BMJ
JF - The BMJ
M1 - n534
ER -