Environment International (Apr 2023)
Heat-related cardiorespiratory mortality: Effect modification by air pollution across 482 cities from 24 countries
- Masna Rai,
- Massimo Stafoggia,
- Francesca de'Donato,
- Matteo Scortichini,
- Sofia Zafeiratou,
- Liliana Vazquez Fernandez,
- Siqi Zhang,
- Klea Katsouyanni,
- Evangelia Samoli,
- Shilpa Rao,
- Eric Lavigne,
- Yuming Guo,
- Haidong Kan,
- Samuel Osorio,
- Jan Kyselý,
- Aleš Urban,
- Hans Orru,
- Marek Maasikmets,
- Jouni J.K. Jaakkola,
- Niilo Ryti,
- Mathilde Pascal,
- Masahiro Hashizume,
- Chris Fook Sheng Ng,
- Barrak Alahmad,
- Magali Hurtado Diaz,
- César De la Cruz Valencia,
- Baltazar Nunes,
- Joana Madureira,
- Noah Scovronick,
- Rebecca M. Garland,
- Ho Kim,
- Whanhee Lee,
- Aurelio Tobias,
- Carmen Íñiguez,
- Bertil Forsberg,
- Christofer Åström,
- Ana Maria Vicedo-Cabrera,
- Martina S. Ragettli,
- Yue-Liang Leon Guo,
- Shih-Chun Pan,
- Shanshan Li,
- Antonio Gasparrini,
- Francesco Sera,
- Pierre Masselot,
- Joel Schwartz,
- Antonella Zanobetti,
- Michelle L. Bell,
- Alexandra Schneider,
- Susanne Breitner
Affiliations
- Masna Rai
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Pettenkofer School of Public Health, LMU Munich, Munich, Germany; Corresponding author at: Institute of Epidemiology, Helmholtz Munich-German Research Center for Environmental Health, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany.
- Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
- Francesca de'Donato
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
- Matteo Scortichini
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
- Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, Greece
- Liliana Vazquez Fernandez
- Department of Air Pollution and Noise, Norwegian Institute of Public Health, Oslo, Norway
- Siqi Zhang
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany
- Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, Greece
- Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, Greece
- Shilpa Rao
- Department of Air Pollution and Noise, Norwegian Institute of Public Health, Oslo, Norway
- Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada and Environmental Health Science & Research Bureau, Health Canada, Ottawa, Canada
- Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
- Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
- 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
- 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
- Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- Marek Maasikmets
- Estonian Environmental Research Centre, Tallinn, Estonia
- Jouni J.K. Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Niilo Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
- Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Magali Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- César De la Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Baltazar Nunes
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal
- Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal
- Noah Scovronick
- Department of Environmental Health. Rollins School of Public Health, Emory University, Atlanta, USA
- Rebecca M. Garland
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
- Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, South Korea
- Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
- Carmen Íñiguez
- Department of Statistics and Computational Research. Universitat de València, València, Spain
- Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
- Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
- Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Martina S. Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Yue-Liang Leon Guo
- Environmental and Occupational Medicine, and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
- Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
- Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Francesco Sera
- Department of Statistics, Computer Science and Applications “G. Parenti”, University of Florence, Florence, Italy
- Pierre Masselot
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, New Haven CT, USA
- Alexandra Schneider
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany
- Susanne Breitner
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
- Journal volume & issue
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Vol. 174
p. 107825
Abstract
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.
