Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year period

BACKGROUND: Ambient air pollution, including particulate matter (PM) with diameters ≤10 µm (PM10) or ≤2·5 µm (PM2·5) and nitrogen dioxide (NO2), has been linked to mortality. It is unclear whether populations’ vulnerability to these pollutants has changed over time, and studies lack multi-country analyses. We therefore evaluated whether changes in exposure were associated with changes in mortality effect estimates over time. METHODS: We examined over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries between 1995 and 2016. We applied a two-stage approach to analyze the short-term effects of NO2, PM10, and PM2·5 on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models. FINDINGS: All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM10, PM2·5, or NO2 and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95%CI: -0·05% to 0·80%) in 1998 to 0·85% (95%CI: 0·55% to 1·16%) in 2012 with a 10 µg/m3 increase in PM2·5. Two-pollutant models generally showed comparable results for PM fractions and indicated temporal differences for NO2. INTERPRETATION: Although air pollution levels have decreased, the effect sizes per unit increase have not changed. This might be due to the composition and toxicity, air pollution sources, but also other factors, such as socioeconomic determinants, or changes in population distribution and susceptibility

Rainfall events and daily mortality across 645 global locations: two stage time series analysis.

OBJECTIVE: To examine the associations between characteristics of daily rainfall (intensity, duration, and frequency) and all cause, cardiovascular, and respiratory mortality. DESIGN: Two stage time series analysis. SETTING: 645 locations across 34 countries or regions. POPULATION: Daily mortality data, comprising a total of 109 954 744 all cause, 31 164 161 cardiovascular, and 11 817 278 respiratory deaths from 1980 to 2020. MAIN OUTCOME MEASURE: Association between daily mortality and rainfall events with return periods (the expected average time between occurrences of an extreme event of a certain magnitude) of one year, two years, and five years, with a 14 day lag period. A continuous relative intensity index was used to generate intensity-response curves to estimate mortality risks at a global scale. RESULTS: During the study period, a total of 50 913 rainfall events with a one year return period, 8362 events with a two year return period, and 3301 events with a five year return period were identified. A day of extreme rainfall with a five year return period was significantly associated with increased daily all cause, cardiovascular, and respiratory mortality, with cumulative relative risks across 0-14 lag days of 1.08 (95% confidence interval 1.05 to 1.11), 1.05 (1.02 to 1.08), and 1.29 (1.19 to 1.39), respectively. Rainfall events with a two year return period were associated with respiratory mortality only, whereas no significant associations were found for events with a one year return period. Non-linear analysis revealed protective effects (relative risk 1) with extreme intensities. Additionally, mortality risks from extreme rainfall events appeared to be modified by climate type, baseline variability in rainfall, and vegetation coverage, whereas the moderating effects of population density and income level were not significant. Locations with lower variability of baseline rainfall or scarce vegetation coverage showed higher risks. CONCLUSION: Daily rainfall intensity is associated with varying health effects, with extreme events linked to an increasing relative risk for all cause, cardiovascular, and respiratory mortality. The observed associations varied with local climate and urban infrastructure

The Multi-Country Multi-City Collaborative Research Network An international research consortium investigating environment, climate, and health

Research on the health risks of environmental factors and climate change requires epidemiological evidence on associated health risks at a global scale. Multi-center studies offer an excellent framework for this purpose, but they present various methodological and logistical problems. This contribution illustrates the experience of the Multi-Country Multi-City Collaborative Research Network, an international collaboration working on a global research program on the associations between environmental stressors, climate, and health in a multi-center setting. The article illustrates the collaborative scheme based on mutual contribution and data and method sharing, describes the collection of a huge multi-location database, summarizes published research findings and future plans, and discusses advantages and limitations. The Multi-Country Multi-City represents an example of a collaborative research framework that has greatly contributed to advance knowledge on the health impacts of climate change and other environmental factors and can be replicated to address other research questions across various research fields.The MCC Collaborative Research Network: Antonio Gasparrini, London School of Hygiene & Tropical Medicine, London, UK; Michelle Bell, Yale University, New Haven CT, USA; Yuming Guo, Monash University, Melbourne, Australia; Yasushi Honda, National Institute for Environmental Studies, Tsukuba, Japan; Veronika Huber, LMU Munich, Munich, Germany; Jouni J. K. Jaakkola, University of Oulu, Oulu, Finland; Aleš Urban, Czech Academy of Sciences, Prague, Czech Republic; Ana Maria Vicedo-Cabrera, University of Bern, Bern, Switzerland; Pierre Masselot, London School of Hygiene & Tropical Medicine, London, UK; Francesco Sera, University of Florence, Florence, Italy; Rosana Abrutzky, Universidad de Buenos Aires, Buenos Aires, Argentina; Shilu Tong, Chinese Center for Disease Control and Prevention, Beijing, China; Micheline de Sousa Zanotti Stagliorio Coelho, University of São Paulo, São Paulo, Brazil; Paulo Hilario Nascimento Saldiva, NSPER, São Paulo, Brazil; Eric Lavigne, University of Ottawa, Ottawa, Canada; Patricia Matus Correa, Universidad de los Andes, Santiago, Chile; Nicolás Valdés Ortega, Universidad Católica de Chile, Santiago, Chile; Haidong Kan, Fudan University, Shanghai, China; Samuel Osorio, University of São Paulo, São Paulo, Brazil; Dominic Roye, Climate Research Foundation, Madrid, Spain; Souzana Achilleos, University of Nicosia Medical School, Nicosia, Cyprus; Jan Kyselý, Czech Academy of Sciences, Prague, Czech Republic; Hans Orru, University of Tartu, Tartu, Estonia; Ene Indermitte, University of Tartu, Tartu, Estonia; Marek Maasikmets, Estonian Environmental Research Centre, Tallinn, Estonia; Niilo Ryti, University of Oulu, Oulu, Finland; Mathilde Pascal, Santé Publique France, Saint Maurice, France; Alexandra Schneider, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany; Susanne Breitner, LMU Munich, Munich, Germany; Klea Katsouyanni, National and Kapodistrian University of Athens, Greece, and Imperial College, London; Antonis Analitis, National and Kapodistrian University of Athens, Greece; Evangelia Samoli, National and Kapodistrian University of Athens, Greece; Hanne Krage Carlsen, University of Gothenburg, Gothenburg, Sweden; Fatemeh Mayvaneh, University of Münster, Münster, Germany; Alireza Entezari, Hakim Sabzevari University, Khorasan Razavi, Iran; Patrick Goodman, Technological University Dublin, Ireland; Ariana Zeka, UK Health Security Agency, London, UK; Raanan Raz, The Hebrew University of Jerusalem, Israel; Paola Michelozzi, Lazio Regional Health Service, Rome, Italy; Francesca de’Donato, Lazio Regional Health Service, Rome, Italy; Matteo Scortichini, Lazio Regional Health Service, Rome, Italy; Massimo Stafoggia, Lazio Regional Health Service, Rome, Italy; Masahiro Hashizume, The University of Tokyo, Tokyo, Japan; Yoonhee Kim, University of Tokyo, Tokyo, Japan; Chris Fook Sheng Ng, The University of Tokyo, Tokyo, Japan; Barrak Alahmad, Harvard University, Boston, MA, USA; John Paul Cauchy, Malta; Magali Hurtado Diaz, National Institute of Public Health, Cuernavaca, Mexico; Eunice Elizabeth Félix Arellano, National Institute of Public Health, Cuernavaca, Mexico; Ala Overcenco, National Agency for Public Health of the Ministry of Health, Labour and Social Protection of the Republic of Moldova, Moldova; Jochem Klompmaker, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Shilpa Rao, Norwegian Institute of Public Health, Oslo, Norway; Gabriel Carrasco, Universidad Peruana Cayetano Heredia, Lima, Peru; Xerxes Seposo, Hokkaido University, Sapporo, Japan; Paul Lester Carlos Chua, The University of Tokyo, Tokyo, Japan; Susana das Neves Pereira da Silva, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal; Joana Madureira, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal; Iulian-Horia Holobaca, Babes-Bolay University, Cluj-Napoca, Romania; Ivana Cvijanovic, Barcelona Institute for Global Health, Barcelona, Spain; Malcolm Mistry, London School of Hygiene & Tropical Medicine, London, UK; Noah Scovronick, Emory University, Atlanta, USA; Fiorella Acquaotta, University of Torino, Italy; Rebecca M. Garland, University of Pretoria, Pretoria, South Africa; Ho Kim, Seoul National University, Seoul, South Korea; Whanhee Lee, Pusan National University, Yangsan, South Korea; Aurelio Tobias, Spanish Council for Scientific Research, Barcelona, Spain; Carmen Íñiguez, Universitat de València, Spain; Bertil Forsberg, Umeå University, Umeå, Sweden; Martina S. Ragettli, Swiss Tropical and Public Health Institute, Allschwill, Switzerland; Yue Leon Guo, National Taiwan University College of Medicine, Taipei, Taiwan; Shih-Chun Pan, National Health Research Institutes, Zhunan, Taiwan; Shanshan Li, Monash University, Melbourne, Australia; Ben Armstrong, London School of Hygiene & Tropical Medicine, London, United Kingdom; Valentina Colistro, University of the Republic, Montevideo, Uruguay; Antonella Zanobetti, Harvard University, Boston, MA, USA; Joel Schwartz, Harvard University, Boston, MA, USA; Tran Ngoc Dang, Duy Tan University, Da Nang, Vietnam; Do Van Dung, University of Medicine and Pharmacy, Ho Chi Minh City, VietNam). Past members: Simona Fratianni, University of Torino, Italy; Julio Cesar Cruz, National Institute of Public Health, Cuernavaca, Mexico; Caroline Ameling, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Daniel Oudin Åström, Umeå University, Umeå, Sweden.Peer reviewe

Health and Economic Impacts Assessment of O3 Exposure in Mexico

Health effects related to exposure to air pollution such as ozone (O3) have been documented. The World Health Organization has recommended the use of the Sum of O3 Means Over 35 ppb (SOMO35) to perform Health Impact Assessments (HIA) for long-term exposure to O3. We estimated the avoidable mortality associated with long-term exposure to tropospheric O3 in 14 cities in Mexico using information for 2015. The economic valuation of avoidable deaths related to SOMO35 exposure was performed using the willingness to pay (WTP) and human capital (HC) approaches. We estimated that 627 deaths (95% uncertainty interval (UI): 227–1051) from respiratory diseases associated with the exposure to O3 would have been avoided in people over 30 years in the study area, which confirms the public health impacts of ambient air pollution. The avoidable deaths account for almost 1400 million USD under the WTP approach, whilst the HC method yielded a lost productivity estimate of 29.7 million USD due to premature deaths. Our findings represent the first evidence of the health impacts of O3 exposure in Mexico, using SOMO35 metrics

Global, regional, and national burden of mortality associated with cold spells during 2000–19 : a three-stage modelling study

Background: Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells. Methods: A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000–19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world. Findings: Globally, 205 932 (95% empirical CI [eCI] 162 692–250 337) excess deaths, representing 3·81 (95% eCI 2·93–4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33–3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016–19 increased by 0·12 percentage points and the excess death rate in 2016–19 increased by 0·18 percentage points, compared with those in 2000–03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones. Interpretation: Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells. Funding: Australian Research Council, Australian National Health and Medical Research Council, EU's Horizon 2020 Project Exhaustion.Peer reviewe