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RefWorks
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Zotero
EndNote
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Effect Modification of Heat-Related Mortality Risk by Air Pollutants in Shandong, China
Zhonghui Zhao
Zhonghui Zhao
Shandong Public Health Clinical Center, Shandong University, Jinan, China;
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China;
Shandong University Climate Change and Health Center, Jinan, China;
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Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China;
Shandong University Climate Change and Health Center, Jinan, China;
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Jie Chu
Jie Chu
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
Academy of Preventive Medicine, Shandong University, Jinan, China;
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Academy of Preventive Medicine, Shandong University, Jinan, China;
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Jie Ren
Jie Ren
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
Academy of Preventive Medicine, Shandong University, Jinan, China;
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Academy of Preventive Medicine, Shandong University, Jinan, China;
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Chunxiao Xu
Chunxiao Xu
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
Academy of Preventive Medicine, Shandong University, Jinan, China;
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Academy of Preventive Medicine, Shandong University, Jinan, China;
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Xiaohui Xu
Xiaohui Xu
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
Academy of Preventive Medicine, Shandong University, Jinan, China;
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Academy of Preventive Medicine, Shandong University, Jinan, China;
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Yanwen Cao
Yanwen Cao
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China;
Shandong University Climate Change and Health Center, Jinan, China;
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Shandong University Climate Change and Health Center, Jinan, China;
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Tamara Schikowski
Tamara Schikowski
Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany;
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Qi Zhao
Qi Zhao
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China;
Shandong University Climate Change and Health Center, Jinan, China;
Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany;
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Qiyong Liu
Qiyong Liu
Chinese Center for Disease Control and Prevention, Beijing, China;
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Gongbo Chen
Gongbo Chen
Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Zilong Lu
Zilong Lu
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
Academy of Preventive Medicine, Shandong University, Jinan, China;
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Xiaolei Guo
Xiaolei Guo
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
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Wei Ma
Wei Ma
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Haitao Wang
Haitao Wang
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China;
Shandong University Climate Change and Health Center, Jinan, China;
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Shandong University Climate Change and Health Center, Jinan, China;
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Jixiang Ma
Jixiang Ma
Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China;
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ABSTRACT.
Although studies have reported the modification effect of air pollutants on heat-related health risk, little is known on the modification effect among various particulate matter with different particle size on mortality. We aimed to investigate whether the associations of hot temperatures with daily mortality were modified by different air pollutant levels in Shandong Province, China. Daily data of air pollutants, meteorological factors, and mortality of 1,822 subdistricts in Shandong province from 2013 to 2018 were collected. We used a time-stratified case-crossover model with an interaction term between the cross-basis term for ambient temperature and the linear function of particulate matter ≤1 µm (PM1), PM2.5, nitrogen dioxide (NO2), and ozone to obtain heat-mortality associations during the hot season. Results showed that the cumulative odds ratio of extreme heat on mortality over 0 to 10 days was 3.66 (95% CI: 3.10–4.31). The mortality risk during hot seasons was stronger at high air pollutant levels. The modification effect of particulate matters on heat-related mortality decreased by its aerodynamic diameter. Females and older adults over 75 years were more vulnerable to the modification effect of air pollutants, and significant differences were detected in the association between temperatures and mortality stratified by PM1 and PM2.5. Higher heat-related mortality risks were observed at high NO2 levels, especially for cardiorespiratory disease. The findings suggest that more consideration should be given to the combined effect of very fine particles and NO2 with ambient heat when developing healthcare strategies, and women and older adults should be given priority in health-related settings.
- Supplemental Materials (PDF 368.61 KB)
Author Notes
Financial support: This study was supported by the
Disclosure: Ethical approval for analysis of this deidentified data was granted by the Ethics Review Committee, School of Public Health, Shandong University (20120501). All the patient records involved were anonymized and de-identified before receiving.
Current contact information: Zhonghui Zhao, Shandong Public Health Clinical Center, Shandong University, Jinan, China, E-mail: zhao_zhonghui@126.com. Yanwen Cao, Qi Zhao, Wei Ma, and Haitao Wang, Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China, and Shandong University Climate Change and Health Center, Jinan, China, E-mails: cywsdu@126.com, qi.zhao@sdu.edu.cn, weima@sdu.edu.cn, and wanghaitao@sdu.edu.cn. Jie Chu, Jie Ren, Chunxiao Xu, Xiaohui Xu, Zilong Lu, Xiaolei Guo, and Jixiang Ma, Shandong Center for Disease Control and Prevention, Jinan, China, and Academy of Preventive Medicine, Shandong University, Jinan, China, E-mails: sdjn_chj@163.com, qdcdcrenjie@126.com, xuchunxiao919@163.com, lyynxxh@126.com, lzllzl22@163.com, guoxiaolei@126.com, and majix@163.com. Tamara Schikowski, Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany, E-mail: tamara.schikowski@iuf-duesseldorf.de. Qiyong Liu, Chinese Center for Disease Control and Prevention, Beijing, China, E-mail: liuqiyong@icdc.cn. Gongbo Chen, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China, E-mail: chengb36@mail.sysu.edu.cn.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Patz JA , Frumkin H , Holloway T , Vimont DJ , Haines A , 2014. Climate change: Challenges and opportunities for global health. JAMA 312: 1565–1580.
-
2.
Alahmad B et al., 2023. Associations between extreme temperatures and cardiovascular cause-specific mortality: Results from 27 countries. Circulation 147: 35–46.
-
3.
Chen Y , Qin X , 2022. The impact of extreme temperature shocks on the health status of the elderly in China. Int J Environ Res Public Health 19: 15729.
-
4.
Robinson WA , 2021. Climate change and extreme weather: A review focusing on the continental United States. J Air Waste Manag Assoc 71: 1186–1209.
-
5.
Dutta P , Sathish L , Mavankar D , Ganguly PS , Saunik S , 2020. Extreme heat kills even in very hot cities: Evidence from Nagpur, India. Int J Occup Environ Med 11: 188–195.
-
6.
Fatima SH , Rothmore P , Giles LC , Varghese BM , Bi P , 2021. Extreme heat and occupational injuries in different climate zones: A systematic review and meta-analysis of epidemiological evidence. Environ Int 148: 106384.
-
7.
Wilk P , Gunz A , Maltby A , Ravichakaravarthy T , Clemens KK , Lavigne É , Lim R , Vicedo-Cabrera AM , 2021. Extreme heat and paediatric emergency department visits in Southwestern Ontario. Paediatr Child Health 26: 305–309.
-
8.
Ebi KL et al., 2021. Hot weather and heat extremes: Health risks. Lancet 398: 698–708.
-
9.
Verhoeven JI , Allach Y , Vaartjes I , Klijn C , de Leeuw FE , 2021. Ambient air pollution and the risk of ischaemic and haemorrhagic stroke. Lancet Planet Health 5: e542–e552.
-
10.
Yin P et al., 2020. The effect of air pollution on deaths, disease burden, and life expectancy across China and its provinces, 1990–2017: An analysis for the Global Burden of Disease Study 2017. Lancet Planet Health 4: e386–e398.
-
11.
Sierra-Vargas MP , Teran LM , 2012. Air pollution: Impact and prevention. Respirology 17: 1031–1038.
-
12.
Hu K et al., 2018. Mortality burden attributable to PM1 in Zhejiang province, China. Environ Int 121: 515–522.
-
13.
Analitis A et al., 2018. Synergistic effects of ambient temperature and air pollution on health in Europe: Results from the PHASE project. Int J Environ Res Public Health 15: 1856.
-
14.
Analitis A et al., 2014. Effects of heat waves on mortality: Effect modification and confounding by air pollutants. Epidemiology 25: 15–22.
-
15.
Watts N et al., 2021. The 2020 report of The Lancet Countdown on health and climate change: Responding to converging crises. Lancet 397: 129–170.
-
16.
Chen G et al., 2018. Estimating spatiotemporal distribution of PM1 concentrations in China with satellite remote sensing, meteorology, and land use information. Environ Pollut 233: 1086–1094.
-
17.
Chen G , Li S , Knibbs LD , Hamm NAS , Cao W , Li T , Guo J , Ren H , Abramson MJ , Guo Y , 2018. A machine learning method to estimate PM2.5 concentrations across China with remote sensing, meteorological and land use information. Sci Total Environ 636: 52–60.
-
18.
Gasparrini A et al., 2016. Changes in susceptibility to heat during the summer: A multicountry analysis. Am J Epidemiol 183: 1027–1036.
-
19.
Zhao Q , Li S , Coelho MSZS , Saldiva PHN , Hu K , Abramson MJ , Huxley RR , Guo Y , 2019. Assessment of intraseasonal variation in hospitalization associated with heat exposure in Brazil. JAMA Netw Open 2: e187901.
-
20.
Li Z , Li Y , Wang X , Liu G , Hao Y , 2022. Extreme temperature exposure and urolithiasis: A time series analysis in Ganzhou, China. Front Public Health 10: 1075428.
-
21.
Chen K et al., 2018. Two-way effect modifications of air pollution and air temperature on total natural and cardiovascular mortality in eight European urban areas. Environ Int 116: 186–196.
-
22.
Luo K , Li R , Wang Z , Zhang R , Xu Q , 2017. Effect modification of the association between temperature variability and daily cardiovascular mortality by air pollutants in three Chinese cities. Environ Pollut 230: 989–999.
-
23.
Chen PC , Mou CH , Chen CW , Hsieh DPH , Tsai SP , Wei CC , Sung FC , 2022. Roles of ambient temperature and PM2.5 on childhood acute bronchitis and bronchiolitis from viral infection. Viruses 14: 1932.
-
24.
Lee W , Choi HM , Kim D , Honda Y , Leon Guo YL , Kim H , 2019. Synergic effect between high temperature and air pollution on mortality in northeast Asia. Environ Res 178: 108735.
-
25.
Yitshak-Sade M , Bobb JF , Schwartz JD , Kloog I , Zanobetti A , 2018. The association between short and long-term exposure to PM2.5 and temperature and hospital admissions in New England and the synergistic effect of the short-term exposures. Sci Total Environ 639: 868–875.
-
26.
Pascal M , Wagner V , Alari A , Corso M , Tertre AL , 2021. Extreme heat and acute air pollution episodes: A need for joint public health warnings? Atmos Environ 249: 118249.
-
27.
Liu C et al., 2019. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med 381: 705–715.
-
28.
Wang G , Xu Y , Huang L , Wang K , Shen H , Li Z , 2021. Pollution characteristics and toxic effects of PM1.0 and PM2.5 in Harbin, China. Environ Sci Pollut Res Int 28: 13229–13242.
-
29.
Zhu C , Maharajan K , Liu K , Zhang Y , 2021. Role of atmospheric particulate matter exposure in COVID-19 and other health risks in human: A review. Environ Res 198: 111281.
-
30.
Guo Y et al., 2017. Heat wave and mortality: A multicountry, multicommunity study. Environ Health Perspect 125: 87006.
-
31.
Vallianou NG , Geladari EV , Kounatidis D , Geladari CV , Stratigou T , Dourakis SP , Andreadis EA , Dalamaga M , 2021. Diabetes mellitus in the era of climate change. Diabetes Metab 47: 101205.
-
32.
Gostimirovic M , Novakovic R , Rajkovic J , Djokic V , Terzic D , Putnik S , Gojkovic-Bukarica L , 2020. The influence of climate change on human cardiovascular function. Arch Environ Occup Health 75: 406–414.
-
33.
Sirotkin AV , Parkanyi V , Pivko J , 2021. High temperature impairs rabbit viability, feed consumption, growth and fecundity: Examination of endocrine mechanisms. Domest Anim Endocrinol 74: 106478.
-
34.
Arias-Perez RD , Taborda NA , Gómez DM , Narvaez JF , Porras J , Hernandez JC , 2020. Inflammatory effects of particulate matter air pollution. Environ Sci Pollut Res Int 27: 42390–42404.
-
35.
Filep A , Fodor GH , Kun-Szabó F , Tiszlavicz L , Rázga Z , Bozsó G , Bozóki Z , Szabó G , Peták F , 2016. Exposure to urban PM1 in rats: Development of bronchial inflammation and airway hyperresponsiveness. Respir Res 17: 26.
-
36.
Eum KD , Kazemiparkouhi F , Wang B , Manjourides J , Pun V , Pavlu V , Suh H , 2019. Long-term NO2 exposures and cause-specific mortality in American older adults. Environ Int 124: 10–15.
-
37.
Kim H et al., 2017. Cardiovascular effects of long-term exposure to air pollution: A population-based study with 900 845 person-years of follow-up. J Am Heart Assoc 6: e007170.
-
38.
Yorifuji T , Kashima S , Tsuda T , Ishikawa-Takata K , Ohta T , Tsuruta K , Doi H , 2013. Long-term exposure to traffic-related air pollution and the risk of death from hemorrhagic stroke and lung cancer in Shizuoka, Japan. Sci Total Environ 443: 397–402.
-
39.
Meng X et al., 2021. Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: Multilocation analysis in 398 cities. BMJ 372: n534.
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