The interactive effects between high temperature and air pollution on mortality: A time-series analysis in Hefei, China.

Recent evidence suggests that there may be an interaction between air pollution and heat on mortality, which is pertinent in the context of global climate change. We sought to examine this interaction in Hefei, a hot and polluted Chinese city. We conducted time-series analyses using daily mortality, air pollutant concentration (including particulate matter with aerodynamic diameter <10μm (PM), sulphur dioxide (SO) and nitrogen dioxide (NO)), and temperature data from 2008 to 2014. We applied quasi-Poisson regression models with natural cubic splines and examined the interactive effects using temperature-stratified models. Subgroup analyses were conducted by age, gender, and educational levels. We observed consistently stronger associations between air pollutants and mortality at high temperatures than at medium temperatures. These differences were statistically significant for the associations between PM and non-accidental mortality and between all pollutants studied and respiratory mortality. Mean percentage increases in non-accidental mortality per 10μg/m at high temperatures were 2.40% (95% confidence interval: 0.64 to 4.20) for PM, 7.77% (0.60 to 15.00) for SO, and 6.83% (-1.37 to 15.08) for NO. The estimates for PM were 3.40% (0.96 to 5.90) in females and 4.21% (1.44 to 7.05) in the illiterate, marking them as more vulnerable. No clear trend was identified by age. We observed an interaction between air pollutants and high temperature on mortality in Hefei, which was stronger in females and the illiterate. This may be due to differences in behaviours affecting personal exposure to high temperatures and has potential policy implications.