The association of daily diabetes mortality and outdoor air pollution in Shanghai, China

The objective of the study reported here was to assess the association between air pollution and daily diabetes mortality in Shanghai. Death records were collected for all individuals who lived in the Zhabei district of Shanghai and died from diabetes from January 1, 2001, to December 31, 2002. The authors used a time-series approach to study the acute effects of air pollution on diabetes mortality after controlling for long-term trends, weather variables, and day of the week. Each increase of 10 microg/m3 in PM10, SO2, or NO2 was found to correspond, respectively, to a 1.006 (95 percent CI: 1.000-1.012), 1.011 (95 percent CI: 0.990-1.032), or 1.013 (95 percent CI: 1.000-1.026) relative risk of diabetes mortality in Shanghai. The air pollutants also were observed to have a greater effect on diabetics than on nondiabetics. These findings provide new evidence for the association between air pollution and diabetes mortality risk, and suggest that diabetics are more susceptible to air pollution than are nondiabetics.     

上海市闵行区日均气温对居民日死亡的影响

目的 研究上海市闵行区日均气温与居民死亡的关系.方法 应用广义相加模型(GAM)分析时间序列资料,在控制了与时间有关的中长期趋势、星期效应、大气污染等混杂因素的基础上,拟合二次函数分析了上海市日均气温与闵行区居民死亡的关系.结果　2002-2004年闵行区总死亡人数为13 919人,平均每日死亡12.70人.从各年代数据来看,日死亡人数及其他多数相关指标年平均值在3年间变化不大或多呈波动变化.只有SO2的年平均值从2002年到2004年连续增高.根据各温度点对应的气温每改变1℃居民死亡的相对危险度(RR)及95%CI,求得适温段为11.67℃～20.71℃.随着气温的升高和降低而偏离适温段时,每日居民死亡增加.结论 目前上海市日均气温偏离最适温度段时,气温变化对居民死亡有影响.     

A case-crossover analysis of air pollution and daily mortality in Shanghai

We used a case-crossover approach to assess the association between air pollution and daily mortality in Shanghai from June 2000 to December 2001. By design, this method can avoid some common concerns about the time-series approach, which was most frequently used to assess the short-term effects of air pollution. Different control periods (unidirectional and bi-directional control samplings) were used for the analysis. With a bi-directional six control sampling approach, the results from a conditional logistic regression model controlling for weather conditions showed that each 10 microg/m3 increase over a 48-h moving average of PM10, SO2 and NO2 corresponds to 1.003 (95%CI 1.001-1.005), 1.016 (95%CI 1.011-1.021), and 1.020 (95%CI 1.012-1.027) relative risk of non-accident mortality, respectively. The association between air pollution and mortality for chronic obstructive pulmonary diseases (COPD) and cardiovascular causes was found to be closer than that for all causes. The results confirmed the deleterious role of the current air pollution level on human health in Shanghai, and provided information on the applicability of case-crossover design in studying the acute health effects of air pollution.     

气候变化国家评估报告(I): 中国气候变化的历史和未来趋势

  目的  探讨成都市气温与人群死亡的关系,为降低敏感人群死亡风险提供依据。  方法  收集2013年1月1日 — 2018年12月31日四川省成都市逐日气象、大气污染物及全死因死亡数据并进行描述分析,将 ≤ 第2.5个百分位数的气温定义为低温,≥ 第97.5个百分位数定义为高温。采用分布滞后非线性模型（DLNM）,分析气温与死亡的暴露–滞后–反应关系,求得最适宜温度,并将其作为参考水平,计算气温归因死亡人数与分值。  结果  2013 — 2018年,成都市日均气温范围为 – 1.9 ℃～29.8 ℃,P₅₀为17.5 ℃,死亡总人数484 736人,日死亡人数范围为137～375人/d,P₅₀为214人/d,日均气压、日均相对湿度、PM₁₀、和O_{3 – 8}的P₅₀分别为950.8 kPa、80 %、88.3 μg/m³和79.3 μg/m³;日均气温和死亡人数存在统计学关联（P < 0.05）,暴露 – 反应关系呈近似L型,最适宜温度为25 ℃。高温效应在暴露当日出现,最长持续5 d;低温效应在暴露后1～2 d出现,最长持续13 d,高温和低温暴露0～21 d的累积死亡相对危险度分别为1.142（95 % CI = 1.087～1.199）、1.405（95 % CI = 1.244～1.587）;以最适宜温度作为基线暴露水平,累积滞后0～21 d情况下,气温归因死亡人数为60 280人（95 % CI = 30 875～85 953）,归因分值为12.4 %（95 % CI = 6.5 %～17.6 %）,其中低温归因死亡人数为56 794人,归因分值为11.7 %,高温归因死亡人数为3 493人,归因分值为0.72 %。  结论  成都市日均气温和人群死亡的暴露 – 反应关系呈近似L型,低温风险大于高温风险,表现在相对危险度大、效应滞后时间长,归因死亡人数多和分值高。     

Diurnal temperature range and daily mortality in Shanghai, China

Although the relationship between temperature level and mortality outcomes has been well established, it is still unknown whether within-day variation in temperature, e.g. diurnal temperature range (DTR), is a risk factor for death independent of the corresponding temperature. Moreover, DTR is a meteorological indicator associated with global climate change which may be related to a variety of health outcomes. We hypothesized that large diurnal temperature change might be a source of additional environmental stress and therefore a risk factor for death. We used daily weather and mortality data from Shanghai, China to test this hypothesis. We conducted a time-series study to examine the association between DTR and mortality outcomes from 2001 to 2004. A semi-parametric generalized additive model (GAM) was used to assess the acute effect of DTR on mortality after controlling for covariates including time trend, day of the week (DOW), temperature, humidity, and outdoor air pollution. We found a strong association between DTR and daily mortality after adjustment for those potential confounders. A 1 degrees C increment of the 3-day moving average of DTR corresponded to a 1.37% (95% CI 1.08-1.65%) increase in total non-accidental mortality, a 1.86% (95% CI 1.40-2.32%) increase in cardiovascular mortality, and a 1.29% (95% CI 0.49-2.09%) increase in respiratory mortality. The effects of DTR on total non-accidental and cardiovascular mortality were significant on both "cold" (below 23 degrees C) and "warm" (at least 23 degrees C) days, although respiratory mortality was only significantly associated with DTR on "cold" days. This study suggests within-day variation in temperature may be a novel risk factor for death.     

Effect of air pollution on daily mortality in Hong Kong

In different weather conditions, constituents and concentrations of pollutants, personal exposure, and biologic responses to air pollution may vary. In this study we assessed the effects of four air pollutants on mortality in both cool and warm seasons in Hong Kong, a subtropical city. Daily counts of mortality, due to all nonaccidental causes, and cardiovascular and respiratory diseases were modeled with daily pollutant concentrations [24-hr means for nitrogen dioxide, sulfur dioxide, and particulate matter < 10 microm in aerodynamic diameter (PM(10)); 8-hr mean for ozone]. using Poisson regression. We controlled for confounding factors by fitting the terms in models, in line with those recommended by the APHEA (Air Pollution and Health: a European Approach) protocol. Exposure-response relationships in warm and cool seasons were examined using generalized additive modeling. During the cool season, for a linear extrapolation of 10th-90th percentiles in the pollutant concentrations of all oxidant pollutants, NO(2), SO(2), and O(3), we found significant effects on all the mortality outcomes under study, with relative risks (RR) of 1.04-1.10 (p < 0.038, except p = 0.079 for SO(2) on respiratory mortality). We observed consistent positive exposure-response relationships during the cool season but not during the warm season. The effects of PM(10) were marginally significant (RR = 1.06; p = 0.054) for respiratory mortality but not for the other outcomes (p > 0.135). In this subtropical city, local air quality objectives should take into account that air pollution has stronger health effects during the cool rather than warm season and that oxidant pollutants are more important indicators of health effects than particulates.     

上海市大气污染与居民每日死亡关系的病例交叉研究

目的 以病例交叉的研究方法，估计大气污染急性暴露对上海市居民每日死亡的影响，并探讨该设计用于大气污染急性健康效应研究的可行性。方法 采用病例交叉设计的方法分析上海市2000年6月1日至2001年12月31日大气污染与居民每日总死亡和分疾病别死亡的关系，同时比较双向对照设计和单向回顾性对照设计研究结果的差异。结果 采用不同的对照选择方案，病例交叉设计的研究结果变化较大；采用双向1：6的对照设计，大气可吸入颗粒物(PMl0)、二氧化硫(SO2)、二氧化氮(NO2)48h平均浓度每增加10μg／m^3，上海市城区居民总死亡发生的相对危险度分别为1．003(95％CI：1．001～1．005)、1．016(95％CI：1．011～1．021)、1．020(95％CI：1．012～1．027)。结论 上海市城区目前的PMl0、SO2、NO2水平对居民死亡确有影响；病例交叉设计是一种研究大气污染急性健康效应的有效工具。     

北京市大气污染与城区居民死亡率关系的时间序列分析

为定量评价北京市大气污染对居民每日疾病死亡率的影响 ,运用时间 -序列分析方法 ,控制了流感、季节等混杂因素的影响后 ,对北京市主要大气污染物CO、SO2 、NOX、TSP、PM10 与居民相应疾病死亡率的相关关系进行了定量评价。以呼吸系统疾病、循环系统疾病、冠心病、慢性阻塞性肺病和消化系统肿瘤疾病死亡人数分别为因变量 ,大气污染物浓度和平均温度、湿度为自变量 ,进行了泊松回归分析。单变量分析结果表明 ,除TSP对冠心病死亡率的影响无显著意义外 ,大气中CO、SO2 、NOX 、TSP浓度与呼吸系统、心脑血管疾病、慢性阻塞性肺病和冠心病死亡率之间的正相关关系均有显著意义 ,而多因素泊松回归得到的暴露 -反应关系模型显示 ,SO2 浓度每提高 10 0 μg m3,呼吸系统、循环系统、冠心病和慢性阻塞性肺病疾病死亡率分别增加 4 2 1%、3 97%、10 68%和 19 2 2 % ;总悬浮颗粒物每增加 10 0 μg m3 ,呼吸系统疾病死亡率增加 3 19% ,循环系统死亡率增加 0 62 %。提示大气污染物浓度的升高会引起相应疾病死亡率的增加     

Interactions between particulate air pollution and temperature in air pollution mortality time series studies

In many community time series studies on the effect of particulate air pollution on mortality, particulate air pollution is modeled additively. In this study, we investigated the interaction between daily particulate air pollution and daily mean temperature in Cook County, Illinois and Allegheny County, Pennsylvania, using data for the period 1987-1994. This was done through the use of joint particulate air pollution-temperature response surfaces and by stratifying the effect of particulate air pollution on mortality by temperature. Evidence that the effect of particulate air pollution on mortality may depend on temperature is found. However, the results were sensitive to the number of degrees of freedom used in the confounder adjustments, the particulate air pollution exposure measure, and how the effects of temperature on mortality are modeled. The results were less sensitive to the estimation method used--generalized linear models and natural cubic splines or generalized additive models and smoothing splines. The results of this study suggest that in community particulate air pollution mortality time series studies the possibility of an interaction between daily particulate air pollution and daily mean temperature should be considered.     

Ozone air pollution and daily mortality in Genoa, Italy between 1993 and 1996

The association between ozone (O3) and daily mortality was investigated in Genoa, an Italian city characterized by a Mediterranean climate and a high prevalence of elderly inhabitants. The O3 effect, adjusted for long time trend, seasonality and weather, was assessed using Poisson regression modelling, allowing for overdispersion and autocorrelation, and expressed as mean variation percent of daily mortality per 50 microg/m3 increase (MV). Significant MVs for overall (+4.0%) and cardiovascular (+7.2%) mortality were detected at 1-day lag. The effects were stronger in the warmer season (May-October). Similar estimates were found after restricting the analyses to the elderly (>or=75 years). Furthermore, in this group, higher MVs were observed for total mortality at 2-day lag. A statistically significant synergistic effect between O3 and temperature was observed for cardiovascular mortality, particularly in elderly people, with an evident increase in mortality risk above 26 degrees C (MV +30.0% for the whole population and +40.0% for the elderly, respectively). This investigation highlights the importance of taking local climatic and demographic features into account when comparing different time-series studies, and substantiates the influence of photochemical pollution on mortality trends in small urban areas.     

上海市卢湾区居民日死亡数与大气污染关系的时间序列研究

[目的]分析上海市卢湾区大气污染急性暴露对居民每日死亡数的影响。[方法]分别采用时间序列的半参数广义相加模型(GAM)和广义线性模型(GLM),在控制死亡的长期趋势、气象因素、“星期几效应”等混杂因素的基础上,分析上海市卢湾区2001年1月1日~2004年12月31日大气污染与居民每日死亡数的关系。[结果]在GAM中大气可吸入颗粒物(PM10),SO2和NO2,48h平均浓度每增加10μg/m3,居民死亡的相对危险度分别为1.0003(95%CI1.0000~1.0007)、1.0009(95%CI0.9998~1.0019)和1.0012(95%CI1.0003~1.0021);在GLM中大气PM10,SO2和NO2,48h平均浓度每增加10μg/m3,居民死亡的相对危险度分别为1.0004(95%CI1.0001~1.0008)、1.0008(95%CI0.9998~1.0019)和1.0012(95%CI1.0002~1.0022)。[结论]GAM、GLM拟和结果相似,上海市卢湾区目前的PM10和NO2水平对居民日死亡数有影响。     

Ozone and daily mortality in Shanghai, China

BACKGROUND: Controversy remains regarding the relationship between ambient ozone and mortality worldwide. In mainland China, the largest developing country, there has been no prior study investigating the acute effect of O3 on death risk. Given the changes in types of air pollution from conventional coal combustion to the mixed coal combustion/motor vehicle emissions in China's large cities, it is worthwhile to investigate the acute effect of O3 on mortality outcomes in the country. OBJECTIVES: We conducted a time-series study to investigate the relation between O3 and daily mortality in Shanghai using 4 years of daily data (2001-2004). METHODS: We used the generalized additive model with penalized splines to analyze mortality, O3 pollution, and covariate data in warm and cold seasons. We considered daily counts of all-cause mortality and several cause-specific subcategories (respiratory and cardiovascular). We also examined these associations among several subpopulations based on age and sex. RESULTS: O3 was significantly associated with total and cardiovascular mortality in the cold season but not in the warm season. In the whole-year analysis, an increase of 10 microg/m3 of 2-day average (lag01) O3 corresponds to 0.45% [95% confidence interval (CI) , 0.16-0.73%], 0.53% (95% CI, 0.10-0.96%), and 0.35% (95% CI, -0.40 to 1.09%) increase of total nonaccidental, cardiovascular, and respiratory mortality, respectively. In the cold season, the estimates increased to 1.38% (95% CI, 0.68-2.07%), 1.53% (95% CI, 0.54-2.52%), and 0.95% (95% CI, -0.71 to 2.60%), respectively. In the warm season, we did not observe significant associations for both total and cause-specific mortality. The results were generally insensitive to model specifications such as lag structure of O3 concentrations and degree of freedom for time trend. Multipollutant models indicate that the effect of O3 was not confounded by particulate matter相似文献   

Short-term associations between outdoor air pollution and mortality in London 1992-4

OBJECTIVES: A previous study of the short term effects of air pollution in London from April 1987 to March 1992 found associations between all cause mortality and black smoke and ozone, but no clear evidence of specificity for cardiorespiratory deaths. London data from 1992 to 1994 were analysed to examine the consistency of results over time and to include particles with a mean aerodynamic diameter of 10 microns (PM10) and carbon monoxide. METHODS: Poisson regression was used of daily mortality counts grouped by age and diagnosis, adjusting for trend, seasonality, calendar effects, deaths from influenza, meteorology, and serial correlation. The pollutants examined were particles (PM10 and black smoke), nitrogen dioxide, ozone, sulphur dioxide, and carbon monoxide with single and cumulative lags up to 3 days. RESULTS: No significant associations were found between any pollutant and all cause mortality, but, with the exception of ozone, all estimates were positive. Each pollutant apart from ozone was significantly associated with respiratory mortality; PM10 showed the largest effect (4% increase in deaths of all ages for a 10th-90th percentile increment). The pollutants significantly associated with cardiovascular deaths were nitrogen dioxide, ozone, and black smoke but there was no evidence of an association with PM10. In two pollutant models of respiratory deaths, the effect of black smoke, which in London indicates fine particles of diesel origin, was independent of that of PM10, but not vice versa. CONCLUSION: These results from a new data set confirm a previous report that there are associations between various air pollutants and daily mortality in London. This new study found greater specificity for associations with respiratory and cardiovascular deaths, and this increases the plausibility of a causal explanation. However, the effects of ozone found in the earlier study were not replicated. The fraction of PM10 which comprises black smoke accounted for much of the effect of PM10.

 

     

Association of daily cause-specific mortality with ambient particle air pollution in Wuhan, China

In Asia, limited literature has been published on the association between daily mortality and ambient air pollution. We examined the associations of daily cause-specific mortality with daily mean concentrations of particulate matter (PM) with a mass median aerodynamic diameter less than 10 microm (PM(10)) in Wuhan, China using 4 years of data (2001-2004). There are approximately 4.5 million residents in Wuhan who live in the city core area of 201 km(2) where air pollution levels are higher and pollution ranges are wider than the majority of cities in the published literature. We use quasi-likelihood estimation within the context of the generalized additive models (GAMs) (natural spline (NS) models in R) to model the natural logarithm of the expected daily death counts as a function of the predictor variables. We found consistent PM(10) effects on mortality with the strongest effects on lag 0 day. Every 10 microg/m(3) increase in PM(10) daily concentration at lag 0 day was significantly associated with an increase in non-accidental (0.36%; 95% CI 0.19-0.53%), cardiovascular (0.51%; 95% CI 0.28-0.75%), stroke (0.44%; 95% CI 0.16-0.72%), cardiac (0.49%; 95% CI 0.08-0.89%), respiratory (0.71%; 95% CI 0.20-1.23%), and cardiopulmonary (0.46%; 95% CI 0.23-0.69%). In general, these effects were stronger among the elderly (65 years > or = 45 years) than among the young. The exploration of exposure-response relationships between PM(10) and cause-specific mortality suggests the appropriateness of assuming linear relationships, where the PM(10) concentration in Wuhan ranged from 24.8 to 477.8 microg/m(3). We conclude that there is consistent evidence of acute effects of PM(10) on cardiopulmonary mortality. A linear no threshold exposure-response relationship is suggested between PM(10) and the studied cause-specific mortality.     

Air pollution and daily mortality in Shenyang, China

The authors analyzed daily mortality data in Shenyang, China, for calendar year 1992 to identify possible associations with ambient sulfur dioxide and total suspended particulates. Both total suspended particulate concentrations (mean = 430 microg/m3, maximum = 1,141 microg/m3) and sulfur dioxide concentrations (mean 197 = microg/m3, maximum = 659 microg/m3) far exceeded the World Health Organization's recommended criteria. An average of 45.5 persons died each day. The lagged moving averages of air-pollution levels, calculated as the mean of the nonmissing air-pollution levels of the concurrent and 3 preceding days, were used for all analyses. Locally weighted regression analysis, including temperature, humidity, day of week, and a time variable, showed a positive association between daily mortality and both total suspended particulates and sulfur dioxide. When the authors included total suspended particulates and sulfur dioxide separately in the model, both were highly significant predictors of daily mortality. The risk of all-cause mortality increased by an estimated 1.7% and 2.4% with a 100-microg/m3 concomitant increase in total suspended particulate and sulfur dioxide, respectively. When the authors analyzed mortality separately by cause of death, the association with total suspended particulates was significant for cardiovascular disease (2.1%), but not statistically significant for chronic obstructive pulmonary diseases (2.6%). In contrast, the association with sulfur dioxide was significant for chronic obstructive pulmonary diseases (7.4%), but not for cardiovascular disease (1.8%). The mortality from cancer was not associated significantly with total suspended particles or with sulfur dioxide. The correlation between sulfur dioxide and total suspended particulates was high (correlation coefficient = .66). When the authors included sulfur dioxide and total suspended particulates simultaneously in the model, the association between total suspended particulates and mortality from all causes and cardiovascular diseases remained significant. Sulfur dioxide was associated significantly with increased mortality from chronic obstructive pulmonary diseases and other causes. The results of the current study reveal increased mortality associated with both total suspended particulates and sulfur dioxide.     

Particulate air pollution and daily mortality in Steubenville, Ohio.

Particulate air pollution has been associated with daily mortality in London, England, both in the smog episodes of the 1950s and at the lower pollution levels of the late 1960s and early 1970s. Replicating these findings in the United States has been difficult, because particulates are usually sampled every sixth day. Replication, particularly with a gravimetric measure of particulates, is important in assessing the causality of the relation. Daily measurements of total suspended particulates by high volume gravimetric sampler are available for the Steubenville, Ohio, metropolitan area. These were matched to daily mortality counts from the detail mortality tapes of the National Center for Health Statistics. Deaths of residents which occurred outside the Steubenville Standard Metropolitan Statistical Area were excluded. Because of the much smaller population, the average total number of deaths per day in the Steubenville Standard Metropolitan Statistical Area over the 11-year period 1974-1984 was about 1% of the deaths in a typical London winter. Despite this reduced statistical power, total suspended particulate count was significantly associated with increased daily mortality in Poisson regression analyses controlling for season and temperature. An increase in particulates of 100 micrograms/m3 was associated with a 4% increase in mortality on the succeeding day. Associations with sulfur dioxide were not significant after adjustment for particulates. The relation appeared to continue at levels well below the current National Ambient Air Quality Standard.     

Particulate air pollution and daily mortality in Detroit.

Particulate air pollution has been associated with increased mortality during episodes of high pollution concentrations. The relationship at lower concentrations has been more controversial, as has the relative role of particles and sulfur dioxide. Replication has been difficult because suspended particle concentrations are usually measured only every sixth day in the U.S. This study used concurrent measurements of total suspended particulates (TSP) and airport visibility from every sixth day sampling for 10 years to fit a predictive model for TSP. Predicted daily TSP concentrations were then correlated with daily mortality counts in Poisson regression models controlling for season, weather, time trends, overdispersion, and serial correlation. A significant correlation (P less than 0.0001) was found between predicted TSP and daily mortality. This correlation was independent of sulfur dioxide, but not vice versa. The magnitude of the effect was very similar to results recently reported from Steubenville, Ohio (using actual TSP measurements), with each 100 micrograms/m3 increase in TSP resulting in a 6% increase in mortality. Graphical analysis indicated a dose-response relationship with no evidence of a threshold down to concentrations below half of the National Ambient Air Quality Standards for particulate matter.     

Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

BACKGROUND: Various factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries. OBJECTIVES: We conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004). METHODS: Using a natural spline model to analyze the data, we examined effects of air pollution for the warm season (April-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality. RESULTS: Outdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 mug/m(3) in a 2-day average concentration of PM(10), SO(2), NO(2), and O(3) corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0.58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above). CONCLUSIONS: Season, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.