Total Non-accidental Mortality Research Articles

Independent risk evaluation associated with short-term black carbon exposure on mortality in two megacities of Yangtze River Delta, China

The adverse health effects of PM2.5 have been well demonstrated by many studies. However, as a component of PM2.5, evidence on the mortality risk of black carbon (BC) is still limited. In this study, based on the data of daily mean PM2.5 concentration, BC concentration, meteorological factors, total non-accidental (all-cause) and cardiovascular mortality in Shanghai and Nanjing during 2015–2016, a semi-parameter generalized additive model (GAM) in the time series and the constituent residual approach were employed to explore the exposure-response relationship between BC and human mortality in these two megacities of Yangtze River Delta, China. The main objective was to separate the health effects of BC from total PM2.5, and compare the difference of mortality ER related to BC original concentration and adjusted concentration after controlling PM2.5. Results showed that there were all significantly associated with daily mortality for PM2.5 and BC. The percentage excess risk (ER) increases in all-cause and cardiovascular categories were 1.68 % (95 % s 1.28, 2.08) and 2.16 % (95 % CI: 1.54, 2.79) with 1 μg/m3 increment in original BC concentration in Shanghai. And the ER in Nanjing was smaller than that in Shanghai. After eliminating PM2.5 confounding effects by a constituent residual approach, the BC residual concentration still had a strong significant ER. The ER for BC residual in Shanghai got an obvious increase, and ER of the cardiovascular mortality for all, females and males increased by 0.55 %, 1.46 % and 0.62 %, respectively, while the ER in Nanjing decreased slightly. It also revealed that females were more sensitive to the health risk associated with short-term BC exposure than males. Our findings provide additional important evidence and ER for mortality related to independent BC exposure. Therefore, BC emission reduction should be paid more attention in air pollution control strategies to reduce BC-related health burdens.

Effects of ambient temperature on mortality among elderly residents of Chengdu city in Southwest China, 2016–2020: a distributed-lag non-linear time series analysis

BackgroundWith complex changes in the global climate, it is critical to understand how ambient temperature affects health, especially in China. We aimed to assess the effects of temperature on daily mortality, including total non-accidental, cardiovascular disease (CVD), respiratory disease, cerebrovascular disease, and ischemic heart disease (IHD) mortality between 2016 and 2020 in Chengdu, China.MethodsWe obtained daily temperature and mortality data for the period 2016–2020. A Poisson regression model combined with a distributed-lag nonlinear model was used to examine the association between temperature and daily mortality. We investigated the effects of individual characteristics by sex, age, education level, and marital status.ResultsWe found significant non-linear effects of temperature on total non-accidental, CVD, respiratory, cerebrovascular, and IHD mortality. Heat effects were immediate and lasted for 0–3 days, whereas cold effects persisted for 7–10 days. The relative risks associated with extreme high temperatures (99th percentile of temperature, 28 °C) over lags of 0–3 days were 1.22 (95% confidence interval [CI]: 1.17, 1.28) for total non-accidental mortality, 1.40 (95% CI: 1.30, 1.50) for CVD morality, 1.34 (95% CI: 1.24, 1.46) for respiratory morality, 1.33 (95% CI: 1.20, 1.47) for cerebrovascular mortality, and 1.38 (95% CI: 1.20, 1.58) for IHD mortality. The relative risks associated with extreme cold temperature (1st percentile of temperature, 3.0 °C) over lags of 0–14 days were 1.32 (95% CI: 1.19, 1.46) for total mortality, 1.45 (95% CI: 1.24, 1.68) for CVD morality, 1.28 (95% CI: 1.09, 1.50) for respiratory morality, 1.36 (95% CI: 1.09, 1.70) for cerebrovascular mortality, and 1.26 (95% CI: 0.95, 1.68) for IHD morality. We found that hot and cold affects were greater in those over 85 years of age, and that women, individuals with low education levels, and those who were widowed, divorced, or never married, were more vulnerable.ConclusionsThis study showed that exposure to hot and cold temperatures in Chengdu was associated with increased mortality, with people over 85 years old, women, those with low education levels, and unmarried individuals being more affected by hot and cold temperatures.

Mortality Risk Related to Heatwaves in Dezful City, Southwest of Iran.

We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019. We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days. There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag0-2 was 10.4 and in second heatwave definition, CER values in lag0, 0-2, and 0-6 were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag0 and 0-2 were 1.79 and 4.11 and in the second heatwave definition, CER values in lag0, 0-2, and 0-6 were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults. However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups.

Meta analysis of health effects of ambient air pollution exposure in low- and middle-income countries

It is well established that exposure to ambient air pollution affects human health. A majority of literature concentrated on health effects of air pollution in high income countries. Only fewer studies analyzing health effects of air pollution in Low- and Middle-Income Countries (LMICs) are available. To bridge this gap in literature, this study investigated short term and long-term health impacts of ambient air pollutants focussed in LMICs. We evaluated Total Non-accidental mortality, Respiratory Mortality, Stroke Mortality, Cardio-vascular Mortality, Chronic Obstructive Pulmonary Disease (COPD), Ischemic Heart Disease (IHD) and Lung Cancer Mortality in LMICs particularly. Random Effects Model was utilised to derive overall risk estimate. Relative Risk (RR) estimates per 10 μg/m3 was used as input for model. Subgroup and Sensitivity Analysis by Design and Country was conducted. A total of 152 studies were included for quantitative analysis. We found positive associations between pollutants and Total Non-accidental mortality for PM10 ((RR:1.0043–1.0036), p < 0.0001), NO2 (RR:1.0222 (1.0111–1.0336), p < 0.0001), SO2 (RR:1.0107 – (1.0073–1.0140), p < 0.0001), O3 (RR: 1.0038 (1.0023–1.0053), p < 0.0001) and PM2.5 (RR: 1.0048 (1.0037–1.0059), p < 0.0001) for every 10 μg/m3 increase. We found positive association between Long-term exposure to PM10 and Total Non-accidental mortality (RR: 1.0430 (1.0278–1.0583), p < 0.0001) We also found statistically significant positive associations between pollutants and Cardiorespiratory and Cardiovascular morbidity. The positive associations persisted when analysed amongst sub-groups. However, the high heterogeneity amongst studies persisted even after performing sub-group analysis. The study has found statistically significant positive associations between short-term and long-term exposure to Ambient air pollution with various health-outcome combinations.

Future temperature-related mortality considering physiological and socioeconomic adaptation: a modelling framework

As the climate changes, it is crucial to focus not only on mitigation measures but also on building climate change resilience by developing efficient adaptation strategies. Although population adaptation is a major determinant of future climate-related health burden, it is not well accounted for in studies that project the health impact of climate change. We propose a methodological framework for temperature-related mortality that incorporates two simultaneous adaptation-sensitivity pathways: the physiological pathway, considering both heat adaptation and cold sensitivity, and the socioeconomic pathway, which is influenced by changes in future adaptive capacities. To demonstrate its utility we apply the framework to a case study mortality time-series dataset from Bavaria, Germany. In this modelling framework, we used extrapolated location-specific and age-specific baseline exposure-response functions and propose different future scenarios of cold sensitivity and heat adaptation on the basis of varying slopes of these exposure-response functions. We also incorporated future socioeconomic adaptation in the exposure-response functions using projections of gross domestic product under the respective shared socioeconomic pathways. Future adaptable fractions, representing the deaths avoided under each of the future scenarios, are projected under combinations of two climate change scenarios (shared socioeconomic pathway [SSP]1-2.6 and SSP3-7.0) and the respective plausible population projection scenarios (SSP1 and SSP3), also incorporating the future changes in demographic age structure and mortality. The case study for this framework was done for five districts in Bavaria, for both total non-accidental mortality and cardiovascular disease mortality. The baseline data was obtained for the period 1990-2006, and the future period was defined as 2083-99. In our Bavaria case study, average temperature was projected to increase by 2099 by an average of 1·1°C under SSP1-2.6 and by 4·1°C under SSP3-7.0. We observed the adaptable fraction to be largely influenced by socioeconomic adaptation for both total mortality and cardiovascular disease mortality, and for both climate change scenarios. For example, for total mortality, the highest adaptable fraction of 18·56% (95% empirical CI 10·77-23·67) was observed under the SSP1-2.6 future scenario, in the presence of socioeconomic adaptation and under the highest heat adaptation (10%) provided the cold sensitivity remains 0%. The cold adaptable fraction is lower than the heat adaptable fraction under all scenarios. In the absence of socioeconomic adaptation, population ageing will lead to higher temperature-related mortality. Our developed framework helps to systematically understand the effectiveness of adaptation mechanisms. In the future, socioeconomic adaptation is estimated to play a major role in determining temperature-related excess mortality. Furthermore, cold sensitivity might outweigh heat adaptation in the majority of locations worldwide. Similarly, population ageing is projected to continue to determine future temperature-related mortality. EU Horizon 2020 (EXHAUSTION).

Impacts of air temperature and its extremes on human mortality in Shanghai, China

Global climate change increased air temperature variability and enhanced the frequency and intensity of extreme weather events, such as heat waves and cold spells with adverse impacts on public health. In this study, we examined the relationships of the daily air temperature with mortality in Shanghai in 2003, a record hot year. We found V-shaped associations between cause-specific mortality and daily air temperature. The temperature-mortality relationship well manifests in three temperature measures, but with varied temperature thresholds for different age groups and mortality categories. Two heat waves and one cold spell were identified in 2003 and brought out excess mortality. The first heat wave lasting for 19 days had a significant impact on total non-accidental, cardiovascular and respiratory deaths compared to the corresponding reference period. The second heat wave lasting for 14 days have resulted in excess mortality in three categories of mortality but without statistical significance. The cold spell lasting for 7 days only had a significant impact on total non-accidental and cardiovascular mortality. We also found the elderly are more sensitive to temperature variation. Our results suggest that air temperature is a significant factor influencing human mortality, particularly for the elderly.

Construction and verification of air quality health index in china

Background: Air Quality Health Index (AQHI) was established in several countries and areas, and has showed validity in communicating health risks of air pollution. But there is a lack of unified AQHI in China. Methods: We contructed six indexes: AQHI_99, AQHI_98, AQHI_95, AQHI_log99, AQHI_log_98, and AQHI_log_95, by summing the excess total non-accidental mortality risks associated with PM2.5,O3, NO2, and SO2 and adjusting them to an arbitratry scale (1-10+). To adjust the distribution of the index, we logarithmic convert the sum of health risks. To avoied the maximun interference, we use the 99%, 98%, and 95% percentile of excess total non-accidental mortality risks of all counties in China as normalization factor. To verification the validity of communicating morbality and morbidity risk, we calculated the relationship between the AQHIs and morbality, anount of hospitalization, and outpatient number. According to the results, we chose the best AQHI. To test the ability of the AQHI to indicated a typical contamination event, we plotted the AQHI and air pollution concentration in several typical contamination event. And we also checked the consistency of AQHI and AQI. Results: AQHI_98 and AQHI_99 performed better in validity of communicating morbality and morbidity risk than AQI and other AQHIs. Given the current state of air pollution in China, we tended to opt for stricter standards: AQHI_98. An IQR increase of AQHI_98 was associated with a 1.0% (95% CI: 0.6 to 1.5) increase of non-accidental mortality in China and 2.0% (95% CI:1.8 to 2.1) increase of all causes hospital admissions in Beijing. This AQHI permforms good in indicating typical contamination events and does not conflict with AQI. Conclusions: We recommend AQHI_98 as Chinese AQHI. The AQHI is a more effective tool to communicate the health risk of air pollution in China.

Effect of temperature on accidental human mortality: A time-series analysis in Shenzhen, Guangdong Province in China

Health-risk assessments of temperature are central to determine total non-accidental human mortality; however, few studies have investigated the effect of temperature on accidental human mortality. We performed a time-series study combined with a distributed lag non-linear model (DLNM) to quantify the non-linear and delayed effects of daily mean temperature on accidental human mortality between 2013 and 2017 in Shenzhen, China. The threshold for effects of temperature on accidental human mortality occurred between 5.6 °C and 18.5 °C. Cold exposures, but not hot exposures, were significantly associated with accidental human mortality. All of the observed groups were susceptible to cold effects, with the strongest effects presented in females (relative risk [RR]: 3.14, 95% confidence interval (CI) [1.44–6.84]), followed by poorly educated people (RR: 2.63, 95% CI [1.59–4.36]), males (RR: 1.79, 95% CI [1.10–2.92]), and well-educated people (RR: 1.20, 95% CI [0.58–2.51]). Pooled estimates for cold effects at a lag of 0–21 days (d) were also stronger than hot effects at a lag of 0–2 d. Our results indicate that low temperatures increased the risk of accidental human mortality. Females and poorly educated people were more susceptible to the low temperatures. These findings imply that interventions which target vulnerable populations during cold days should be developed to reduce accidental human mortality risk.

Japanese Nationwide Study on the Association Between Short-term Exposure to Particulate Matter and Mortality.

BackgroundFrom around 2012, the use of automated equipment for fine particulate matter (PM2.5) measurement with equivalence to a reference method has become popular nationwide in Japan. This enabled us to perform a national health effect assessment employing PM2.5 concentrations based on the standardized measurement method. We evaluated the association between non-accidental mortality and short-term exposure to PM2.5 and coarse particulate matter (PM), with the latter estimated as the difference between suspended particulate matter and PM2.5, for the fiscal years 2012–2014.MethodsThis was a time-stratified case-crossover study in 100 highly-populated Japanese cities. Mortality data was obtained from the Ministry of Health, Labour and Welfare. City-specific estimates of PM-mortality association were calculated by applying a conditional logistic regression analysis, and combined with a random-effects meta-analysis.ResultsThe respective averages of daily mean concentration were 14.6 µg/m3 for PM2.5 and 6.4 µg/m3 for coarse PM. A 10 µg/m3 increase in PM2.5 concentrations for the average of the day of death and the previous day was associated with an increase of 1.3% (95% confidence interval (CI), 0.9–1.6%) in total non-accidental mortality. For cause-specific mortality, PM2.5 was positively associated with cardiovascular and respiratory mortality. After adjustment for PM2.5, we observed a 1.4% (95% CI, 0.2–2.6%) increase in total mortality with a 10 µg/m3 increase in coarse PM.ConclusionThe study revealed that short-term exposure to PM2.5 had adverse effects on total non-accidental, cardiovascular, and respiratory mortality in Japan. Coarse PM exposure also increased the risk of total mortality.

Surrounding green, air pollution, traffic noise exposure and non-accidental and cause-specific mortality

BackgroundMost previous studies that investigated associations of surrounding green, air pollution or traffic noise with mortality focused on single exposures. ObjectivesThe aim of this study was to evaluate combined associations of long-term residential exposure to surrounding green, air pollution and traffic noise with total non-accidental and cause-specific mortality. MethodsWe linked a national health survey (Public Health Monitor, PHM) conducted in 2012 to the Dutch longitudinal mortality database. Subjects of the survey who were 30 years or older on 1 January 2013 (n = 339,633) were followed from 1 January 2013 till 31 December 2017. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 m and 1000 m), annual average air pollutant concentrations (including particulate matter (PM10, PM2.5), nitrogen dioxide (NO2)) and traffic noise with non-accidental, circulatory disease, respiratory disease, lung cancer and neurodegenerative disease mortality. ResultsWe observed 26,886 non-accidental deaths over 1.627.365 person-years of follow-up. Surrounding green, air pollution and traffic noise exposure were not significantly associated with non-accidental or cause-specific mortality. For non-accidental mortality, we found a hazard ratio (HR) of 0.99 (0.98, 1.01) per IQR increase in NDVI 300 m, a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in NO2, a HR of 0.98 (0.97, 1.00) per IQR increase in PM2.5 and a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in road-traffic noise. Analyses restricted to non-movers or excluding subjects aged 85+ years did not change the findings. ConclusionWe found no evidence for associations of long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental or cause-specific mortality in a large population based survey in the Netherlands, possibly related to the relatively short follow-up period.

Estimating the health impact of air pollution in Scotland, and the resulting benefits of reducing concentrations in city centres

Air pollution continues to be a key health issue in Scotland, despite recent improvements in concentrations. The Scottish Government published the Cleaner Air For Scotland strategy in 2015, and will introduce Low Emission Zones (LEZs) in the four major cities (Aberdeen, Dundee, Edinburgh and Glasgow) by 2020. However, there is no epidemiological evidence quantifying the current health impact of air pollution in Scotland, which this paper addresses. Additionally, we estimate the health benefits of reducing concentrations in city centres where most LEZs are located. We focus on cardio-respiratory disease and total non-accidental mortality outcomes, linking them to concentrations of both particulate (PM10 and PM2.5) and gaseous (NO2 and NOx) pollutants. Our two main findings are that: (i) all pollutants exhibit significant associations with respiratory disease but not cardiovascular disease; and (ii) reducing concentrations in city centres with low resident populations only provides a small health benefit.

Burden of non-accidental mortality attributable to ambient temperatures: a time series study in a high plateau area of southwest China

ObjectiveTo examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high...

Mitigation impact of roadside trees on fine particle pollution

Fine particulate matter (PM2.5) is an important air pollutant due to its adverse health effects. Vehicle emissions make a large contribution to particle concentrations in urban areas. Exposure to particles especially near roadways increases the risk of public health problems. Planting vegetation might be used to capture the fine particles at the roadside, which can lower the health risks for the urban population. Istanbul is the most populous city in Turkey, where the number of non-electric cars is increasing rapidly, resulting in decreasing air quality, especially at the roadsides. Recent studies show that cardiovascular, respiratory and total non-accidental mortality is increasing with short-term exposure to outdoor air pollution in Istanbul. In this study, roadside trees were investigated for the mitigation effect on vehicle-related PM2.5 and heavy metal (HM). Cupressus sempervirens (Mediterranean Cypress trees) were planted in three different cases (i.e., no trees-C1, trees with gaps-C2 and thick trees with no gaps-C3) at the study site. Location of the site is on a dense-traffic roadside in Istanbul, where thousands of people are living, working and walking through two sides of this road. PM2.5 samples and tree leaves were examined in the performed experiments. C2 and C3 showed the importance of roadside tree plantation by reducing the exposure to significantly low levels. Roadside PM2.5 concentrations were reduced by 17% in C3, equivalent to urban background levels in the city. Maximum removal of HMs is observed in nickel from 26.4 ± 7.8 to 7.5 ± 2.4 μg m−3. Pedestrian exposure is calculated with the measured data in three experiments and exposure is significantly reduced (e.g., >50% for cadmium and lead exposure) in experiment C3. In conclusion, three experiments showed that Mediterranean Cypress trees significantly decreased particle pollution at roadsides in Istanbul.

The Interaction between Ambient PM10 and NO₂ on Mortality in Guangzhou, China.

Air pollution is now a significant environmental issue in China. To better understand the health impacts of ambient air pollution, this study investigated the potential interaction between PM10 and NO2 on mortality in Guangzhou, China. Time series data of daily non-accidental mortality and concentrations of PM10 and NO2 from 2006 to 2010 were collected. Based on generalized additive model, we developed two models (bivariate model and stratified model) to explore the interaction both qualitatively and quantitatively. At lag of 0–2 days, greater interactive effects between PM10 and NO2 were presented in the graphs. Positive modified effects were also found between the two pollutants on total non-accidental death and cardiovascular death. When the NO2 concentration was at a high level (>76.14 μg/m3), PM10 showed the greatest excess relative risk percentage (ERR%) for total non-accidental mortality (0.46, 95% CI: 0.13–0.79) and cardiovascular disease mortality (0.61, 95% CI: 0.06–1.16) for each 10 μg/m3 increase. During the period of high PM10 concentration (>89.82 μg/m3), NO2 demonstrated its strongest effect for total non-accidental mortality (ERR%: 0.92, 95% CI: 0.42–1.42) and cardiovascular disease mortality (ERR%: 1.20, 95% CI: 0.38–2.03). Our results suggest a positive interaction between PM10 and NO2 on non-accidental mortality in Guangzhou.

Time series analysis of ambient air pollution effects on daily mortality.

Although the growths of ambient pollutants have been attracting public concern, the characteristic of the associations between air pollutants and mortality remains elusive. Time series analysis with a generalized additive model was performed to estimate the associations between ambient air pollutants and mortality outcomes in Shenzhen City for the period of 2012-2014. The results showed that nitrogen dioxide (NO2)-induced excess risks (ER) of total non-accidental mortality and cardiovascular mortality were significantly increased (6.05% (95% CI 3.38%, 8.78%); 6.88% (95% CI 2.98%, 10.93%), respectively) in interquartile range (IQR) increase analysis. Also, these associations were strengthened after adjusting for other pollutants. Moreover, similar associations were estimated for sulfur dioxide (SO2), particulate matter with an aerodynamic diameter of <10μm (PM10), and total non-accidental mortality. There were significant higher ERs of associations between PM10 and mortality for men than women; while there were significant higher ERs of associations between PM10/NO2 and mortality for elders (65 or elder) than youngers (64 or younger). Season analyses showed that associations between NO2 and total non-accidental mortality were more pronounced in hot seasons than in warm seasons. Taken together, NO2 was positively associated with total non-accidental mortality and cardiovascular mortality in Shenzhen even when the concentrations were below the ambient air quality standard. Policy measures should aim at reducing residents' exposure to anthropogenic NO2 emissions.

Do factors related to combustion-based sources explain heterogeneity in PM-mortality associations across the United States?

Introduction: Spatial heterogeneity of effect estimates in associations between PM2.5 and total non-accidental mortality (TNA) in the United States (US), is an issue in epidemiology. This study uses rate ratios generated from the Multi- City /Multi- Pollutant study (1999-2005) for 313 core-based statistical areas (CBSA) and their metropolitan divisions (MD) to examine combustion-based sources of heterogeneity. Methods: For CBSA/MDs, area-specific log rate ratios (betas) were derived from a model adjusting for time, an interaction with age-group, day of week, and natural splines of current temperature, current dew point, and unconstrained temperature at lags 1, 2, and 3. We assessed the heterogeneity in the betas by linear regression with inverse variance weights, using average NO2, SO2, and CO, which may act as a combustion source proxy, and these pollutants’ correlations with PM2.5. Results: We found that weighted mean PM2.5 association (0.96 percent increase in total non-accidental mortality for a 10 µg/m3 increment in PM2.5) increased by 0.26 (95% confidence interval 0.08, 0.44) for an interquartile change (0.2) in the correlation of SO2 and PM2.5., but betas showed less dependence on the annual averages of SO2 or NO2. Spline analyses suggest departures from linearity, particularly in a model that examined correlations between PM2.5 and CO. Conclusions: We conclude that correlations between SO2 and PM2.5 as an indicator of combustion sources explains some heterogeneity in PM2.5’s association with mortality in the US. PM2.5 and TNA associations may be modified by proximity to combustion sources. Future research will include point source and roadway data to further elucidate this relationship. This an abstract of a presentation and does not necessarily reflect the policies of the US Environmental Protection Agency.

Nonlinear exposure-response associations between daily mortality and air pollution in Wuhan, China

Introduction: Previous studies learning the short-time effects of air pollution on daily mortality typically reported excess risk associated with each unit increase of air pollutants, assuming a linear exposure-response association. This may be inappropriate due to nonlinearity, especially when the pollutant concentration range is wide. Methods: Daily mortality, air pollution, meteorological data from Jan 2013 to Dec 2014 were collected in Wuhan, China. Generalized additive model was used to evaluate the risk of daily total non-accidental, cardiovascular and respiratory mortality associated with air pollutants. Lag effects were considered. Results: We identified 35,706 non-accidental, 19,141 cardiovascular, and 3,917 respiratory deaths during 2013-2014. The mean daily average concentrations of PM2.5, PM10, SO2, NO2, CO and O3 were 88.5, 118.6, 27.1, 56.8, 1100 and 91.1 µg/m3 respectively. By assuming a linear association, a 10 µg/m3 increase of 2-day average (Lag01) PM2.5, PM10, SO2, NO2 and CO was associated with 0.21% (95% CI: 0.00-0.42%), 0.39% (0.20-0.57%), 0.74% (0.06-1.42%), 1.52% (1.02-2.02%) and 0.03% (0.004-0.057%) increase of non-accidental mortality, respectively. However, we detected significant nonlinear exposure-response associations for these pollutants, which increased at concentrations &lt;~95th percentile and decreased afterwards. After removing days with concentrations &gt;95th percentile, a 10 µg/m3 increase of 2-day average PM2.5, PM10, SO2, NO2 and CO was associated with 0.83% (95% CI: 0.49-1.17%), 0.82% (0.57-1.07%), 2.46% (1.43-3.49%), 2.30% (1.61-2.99%) and 0.088% (0.043-0.133%) increase of non-accidental mortality, respectively. The models for cardiovascular and respiratory mortality gave similar results. Conclusions: Significant nonlinear exposure-response associations exist between daily mortality and air pollution in Wuhan, China. Simply assuming a linear association between daily mortality and air pollution may yield an underestimation.

The Association between Dust Storms and Daily Non-Accidental Mortality in the United States, 1993-2005.

Background:The impact of dust storms on human health has been studied in the context of Asian, Saharan, Arabian, and Australian storms, but there has been no recent population-level epidemiological research on the dust storms in North America. The relevance of dust storms to public health is likely to increase as extreme weather events are predicted to become more frequent with anticipated changes in climate through the 21st century.Objectives:We examined the association between dust storms and county-level non-accidental mortality in the United States from 1993 through 2005.Methods:Dust storm incidence data, including date and approximate location, are taken from the U.S. National Weather Service storm database. County-level mortality data for the years 1993–2005 were acquired from the National Center for Health Statistics. Distributed lag conditional logistic regression models under a time-stratified case-crossover design were used to study the relationship between dust storms and daily mortality counts over the whole United States and in Arizona and California specifically. End points included total non-accidental mortality and three mortality subgroups (cardiovascular, respiratory, and other non-accidental).Results:We estimated that for the United States as a whole, total non-accidental mortality increased by 7.4% (95% CI: 1.6, 13.5; p = 0.011) and 6.7% (95% CI: 1.1, 12.6; p = 0.018) at 2- and 3-day lags, respectively, and by an average of 2.7% (95% CI: 0.4, 5.1; p = 0.023) over lags 0–5 compared with referent days. Significant associations with non-accidental mortality were estimated for California (lag 2 and 0–5 day) and Arizona (lag 3), for cardiovascular mortality in the United States (lag 2) and Arizona (lag 3), and for other non-accidental mortality in California (lags 1–3 and 0–5).Conclusions:Dust storms are associated with increases in lagged non-accidental and cardiovascular mortality.Citation:Crooks JL, Cascio WE, Percy MS, Reyes J, Neas LM, Hilborn ED. 2016. The association between dust storms and daily non-accidental mortality in the United States, 1993–2005. Environ Health Perspect 124:1735–1743; http://dx.doi.org/10.1289/EHP216

Abstract 16822: Dust Storms in the United States are Associated With Increased Cardiovascular Mortality

Introduction: Extreme weather events such as dust storms are predicted to become more frequent as the global climate warms through the 21st century. Studies of Asian, Saharan, Arabian, and Australian dust storms have found associations with cardiovascular and total non-accidental mortality and hospitalizations for stroke. However, the only population-level epidemiological work on dust storms in the United States was focused on a single small metropolitan area (Spokane, WA), and it is uncertain whether its null results are representative of the country as a whole. Hypothesis: Dust storms in the United States are associated with daily cardiovascular mortality. Methods: Dust storm incidence data (N=141), including date and approximate location, as well as meteorological station observations, were taken from the U.S. National Weather Service. County-level mortality data for the years 1993-2005 were acquired from the National Center for Health Statistics. Ambient particulate matter monitor concentrations were obtained from the U.S. Environmental Protection Agency. Inference was performed used conditional logistic regression models under a case-crossover design while accounting for the nonlinear effect of temperature. Results: We found a 9.5% increase in cardiovascular mortality at a two-day lag (95% CI: [0.31%,19.5%], p = 0.042). The results were robust to adjusting for heat waves and ambient particulate matter concentrations. Analysis of storms occurring only on days with &lt;0.1 inches of precipitation strengthened these results and in addition yielded a mean daily increase of 4.0% across lags 0-5 (95% CI: [0.07%,20.8%], p = 0.046). In Arizona, the U.S. state with the largest number of storms, we observed a 13.0% increase at a three-day lag (CI: [0.40%,27.1%], p = 0.043). Conclusions: Dust storms in the U.S. are associated with increases in lagged cardiovascular mortality. This has implications for the development of public health advisories and suggests that further public health interventions may be needed. Disclaimer: This work does not represent official U.S. Environmental Protection Agency policy.

Study on the association between air pollution and mortality in İstanbul, 2007–2012

We examined the associations between the daily variations of air pollutants and mortality in the population of İstanbul, Turkey, using generalized linear models while controlling for time trends and meteorological factors over a 6-year period (2007–2012) at different time lags (0–10 days). Effects of the pollutants (Relative Risk (RR) on current-day (lag 0) mortality to the first ten days (lag 10) were determined. Data on daily mortality, daily mean concentrations of air pollutants of PM10, SO2 and NO2 and daily mean concentrations of temperature and humidity for İstanbul were used in the study. We found significant associations between air pollution and daily mortality from cardiovascular disease, respiratory diseases, and total non-accidental causes in İstanbul. An increase of 10 μg/m3 in concentrations of PM10, SO2 and NO2 over 10 days of lag corresponds to RR = 1.0222 (95% Confidence Interval (CI) = 0.9957–1.0494), RR = 1.1639 (95% CI = 1.0279–1.3177) and RR = 1.0327 (95% CI = 1.0105–1.0554) increase of cardiovascular mortality, respectively. The associations for total non-accidental and respiratory mortality were also positive. Among the three air pollutants, SO2 was associated with the largest RR for deaths from cardiovascular disease, respiratory disease and total mortality. In conclusion, our study showed that short-term exposure to air pollution was associated with increased cardiovascular, respiratory and total non-accidental mortality in the city during 2007–2012. These findings may have implications for local environmental and social policies.