Heat-related cardiorespiratory mortality: effect modification by air pollution across 482 cities from 24 countries

Rai, M. and Stafoggia, M. and de'Donato, F. and Scortichini, M. and Zafeiratou, S. and Vazquez Fernandez, L. and Zhang, S. and Katsouyanni, K. and Samoli, E. and Rao, S. and Lavigne, E. and Guo, Y. and Kan, H. and Osorio, S. and Kyselý, J. and Urban, A. and Orru, H. and Maasikmets, M. and Jaakkola, J. J. K. and Ryti, N. and Pascal, M. and Hashizume, M. and Fook Sheng Ng, C. and Alahmad, B. and Hurtado Diaz, M. and de la Cruz Valencia, C. and Nunes, B. and Madureira, J. and Scovronick, N. and Garland, R. M. and Kim, H. and Lee, W. and Tobias, A. and Íñiguez, C. and Forsberg, B. and ström, C. and Vicedo-Cabrera, A. M. and Ragettli, M. S. and Leon Guo, Y. L. and Pan, S. -C. and Li, S. and Gasparrini, A. and Sera, F. and Masselot, P. and Schwartz, J. and Zanobetti, A. and Bell, M. L. and Schneider, A. and Breitner, S.. (2023) Heat-related cardiorespiratory mortality: effect modification by air pollution across 482 cities from 24 countries. Environment international, 174. p. 107825.

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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.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Environmental Exposures and Health Systems Research > Physical Hazards and Health (Röösli)
UniBasel Contributors:Ragettli, Martina
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:09 May 2023 07:09
Deposited On:09 May 2023 07:09

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