Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: multilocation analysis in 398 cities
Author:
Meng Xia, Liu Cong, Chen Renjie, Sera Francesco, Vicedo-Cabrera Ana Maria, Milojevic Ai, Guo Yuming, Tong Shilu, Coelho Micheline de Sousa Zanotti Staglior, Saldiva Paulo Hilario Nascimento, Lavigne Eric, Correa Patricia Matus, Ortega Nicolas Valdes, Osorio Samuel, Garcia , Kyselý Jan, Urban Aleš, Orru Hans, Maasikmets Marek, Jaakkola Jouni J K, Ryti Niilo, Huber Veronika, Schneider Alexandra, Katsouyanni Klea, Analitis Antonis, Hashizume Masahiro, Honda Yasushi, Ng Chris Fook Sheng, Nunes Baltazar, Teixeira João Paulo, Holobaca Iulian Horia, Fratianni Simona, Kim Ho, Tobias Aurelio, Íñiguez Carmen, Forsberg Bertil, Åström Christofer, Ragettli Martina S, Guo Yue-Liang Leon, Pan Shih-Chun, Li Shanshan, Bell Michelle L, Zanobetti Antonella, Schwartz Joel, Wu Tangchun, Gasparrini Antonio, Kan HaidongORCID
Abstract
Abstract
Objective
To evaluate the short term associations between nitrogen dioxide (NO
2
) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol.
Design
Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis.
Setting
398 cities in 22 low to high income countries/regions.
Main outcome measures
Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018.
Results
On average, a 10 μg/m
3
increase in NO
2
concentration on lag 1 day (previous day) was associated with 0.46% (95% confidence interval 0.36% to 0.57%), 0.37% (0.22% to 0.51%), and 0.47% (0.21% to 0.72%) increases in total, cardiovascular, and respiratory mortality, respectively. These associations remained robust after adjusting for co-pollutants (particulate matter with aerodynamic diameter ≤10 μm or ≤2.5 μm (PM
10
and PM
2.5
, respectively), ozone, sulfur dioxide, and carbon monoxide). The pooled concentration-response curves for all three causes were almost linear without discernible thresholds. The proportion of deaths attributable to NO
2
concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities.
Conclusions
This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO
2
and increased risk of total, cardiovascular, and respiratory mortality, suggesting that health benefits would be achieved by tightening the guidelines and regulatory limits of NO
2
.
Subject
General Engineering
Reference27 articles.
1. US EPA. National Ambient Air Quality Standards for six criteria pollutants. 2016. 2. Associations Between Ambient Nitrogen Dioxide and Daily Cause-specific Mortality 3. Nitrogen dioxide and mortality: review and meta-analysis of long-term studies 4. US-EPA. Integrated science assessment for oxides of nitrogen – health criteria (final report). 2008. 5. US-EPA. Integrated science assessment for oxides of nitrogen – health criteria (final report). 2016.
Cited by
109 articles.
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