Environment International (Nov 2023)
Joint effect of heat and air pollution on mortality in 620 cities of 36 countries
- Massimo Stafoggia,
- Paola Michelozzi,
- Alexandra Schneider,
- Ben Armstrong,
- Matteo Scortichini,
- Masna Rai,
- Souzana Achilleos,
- Barrak Alahmad,
- Antonis Analitis,
- Christofer Åström,
- Michelle L. Bell,
- Neville Calleja,
- Hanne Krage Carlsen,
- Gabriel Carrasco,
- John Paul Cauchi,
- Micheline DSZS Coelho,
- Patricia M. Correa,
- Magali H. Diaz,
- Alireza Entezari,
- Bertil Forsberg,
- Rebecca M. Garland,
- Yue Leon Guo,
- Yuming Guo,
- Masahiro Hashizume,
- Iulian H. Holobaca,
- Carmen Íñiguez,
- Jouni J.K. Jaakkola,
- Haidong Kan,
- Klea Katsouyanni,
- Ho Kim,
- Jan Kyselý,
- Eric Lavigne,
- Whanhee Lee,
- Shanshan Li,
- Marek Maasikmets,
- Joana Madureira,
- Fatemeh Mayvaneh,
- Chris Fook Sheng Ng,
- Baltazar Nunes,
- Hans Orru,
- Nicolás V Ortega,
- Samuel Osorio,
- Alfonso D.L. Palomares,
- Shih-Chun Pan,
- Mathilde Pascal,
- Martina S Ragettli,
- Shilpa Rao,
- Raanan Raz,
- Dominic Roye,
- Niilo Ryti,
- Paulo HN Saldiva,
- Evangelia Samoli,
- Joel Schwartz,
- Noah Scovronick,
- Francesco Sera,
- Aurelio Tobias,
- Shilu Tong,
- César DLC Valencia,
- Ana Maria Vicedo-Cabrera,
- Aleš Urban,
- Antonio Gasparrini,
- Susanne Breitner,
- Francesca K. de' Donato
Affiliations
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy; Corresponding author at: Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Via Cristoforo Colombo 112, 00147 Rome, Italy.
- Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
- Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Matteo Scortichini
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
- Masna Rai
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
- Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
- Michelle L. Bell
- School of the Environment, Yale University, New Haven CT, USA
- Neville Calleja
- Directorate for Health Information and Research, Malta
- Hanne Krage Carlsen
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
- Gabriel Carrasco
- Institute of Tropical Medicine “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- John Paul Cauchi
- Queen Mary University of London, London, United Kingdom
- Micheline DSZS Coelho
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Patricia M. Correa
- Department of Public Health, Universidad de los Andes, Santiago, Chile
- Magali H. Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Alireza Entezari
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar 9617916487, Khorasan Razavi, Iran
- Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
- Rebecca M. Garland
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
- Yue Leon Guo
- Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
- Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Iulian H. Holobaca
- Faculty of Geography, Babes-Bolay University, Cluj-Napoca, Romania
- Carmen Íñiguez
- Department of Statistics and Computational Research, Universitat de València, València, Spain
- Jouni J.K. Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
- Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
- Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- Whanhee Lee
- School of the Environment, Yale University, New Haven CT, USA
- Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Marek Maasikmets
- Estonian Environmental Research Centre, Tallinn, Estonia
- Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Fatemeh Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar 9617916487, Khorasan Razavi, Iran
- Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
- Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- Nicolás V Ortega
- Department of Public Health, Universidad de los Andes, Santiago, Chile
- Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
- Alfonso D.L. Palomares
- Norwegian Institute of Public Health, Oslo, Norway
- Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
- Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
- Martina S Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Shilpa Rao
- Norwegian Institute of Public Health, Oslo, Norway
- Raanan Raz
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Israel
- Dominic Roye
- Climate Research Foundation, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- Niilo Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Paulo HN Saldiva
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
- Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
- Francesco Sera
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; Department of Statistics, Computer Science and Applications “G. Parenti”, University of Florence, Florence, Italy
- Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
- Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- César DLC Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
- Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
- Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Susanne Breitner
- IBE-Chair of Epidemiology, LMU Munich, Munich, Germany
- Francesca K. de' Donato
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
- Journal volume & issue
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Vol. 181
p. 108258
Abstract
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.
