Joint effect of heat and air pollution on mortality in 620 cities of 36 countries.

Stafoggia, M; Michelozzi, P; Schneider, A; Armstrong, BORCID logo; Scortichini, M; Rai, M; Achilleos, S; Alahmad, B; Analitis, A; Åström, C; +53 more...Bell, ML; Calleja, N; Krage Carlsen, H; Carrasco, G; Paul Cauchi, J; Dszs Coelho, M; Correa, PM; Diaz, MH; Entezari, A; Forsberg, B; Garland, RM; Leon Guo, Y; Guo, Y; Hashizume, M; Holobaca, IH; Íñiguez, C; Jaakkola, JJ; Kan, H; Katsouyanni, K; Kim, H; Kyselý, J; Lavigne, E; Lee, W; Li, S; Maasikmets, M; Madureira, J; Mayvaneh, F; Fook Sheng Ng, C; Nunes, B; Orru, H; V Ortega, N; Osorio, S; Palomares, AD; Pan, S; Pascal, M; Ragettli, MS; Rao, S; Raz, R; Roye, D; Ryti, N; Hn Saldiva, P; Samoli, E; Schwartz, J; Scovronick, N; Sera, F; Tobias, A; Tong, S; Dlc Valencia, C; Maria Vicedo-Cabrera, A; Urban, A; Gasparrini, AORCID logo; Breitner, S; De' Donato, FK and (2023) Joint effect of heat and air pollution on mortality in 620 cities of 36 countries. Environment international, 181. 108258-. ISSN 0160-4120 DOI: 10.1016/j.envint.2023.108258
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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.


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