Harvard T.H. Chan School of Public Health, Boston, MA, United States; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Hanoi University of Public Health, Hanoi, Viet Nam.
Environ Pollut. 2019 Nov;254(Pt B):113121. doi: 10.1016/j.envpol.2019.113121. Epub 2019 Aug 28.
There is limited evidence for short-term association between mortality and ambient air pollution in the Middle East and no study has evaluated exposure windows of about a month prior to death. We investigated all-cause non-accidental daily mortality and its association with fine particulate matter (PM), nitrogen dioxide (NO), and the Air Quality Index (AQI) from March 2011 through March 2014 in the megacity of Tehran, Iran. Generalized additive quasi-Poisson models were used within a distributed lag linear modeling framework to estimate the cumulative effects of PM, NO, and the AQI up to a lag of 45 days. We further conducted multi-pollutant models and also stratified the analyses by sex, age group, and season. The relative risk (95% confidence interval (CI)) for all seasons, both sexes and all ages at lag 0 for PM, NO, and AQI were 1.004 (1.001, 1.007), 1.003 (0.999, 1.007), and 1.004 (1.001, 1.007), respectively, per inter-quartile range (IQR) increment (18.8 μg/m for PM, 12.6 ppb for NO, and 31.5 for AQI). In multi-pollutant models, the PM associations were almost independent from NO. However, the RRs for NO were slightly attenuated after adjustment for PM but they were still largely independent from PM. The cumulative relative risks (95% CI) per IQR increment reached maximum during the cooler months, including: 1.13 (1.06, 1.20) for PM at lag 0-31 (for females, all ages); 1.17 (1.10, 1.25) for NO at lag 0-45 (for males, all ages); and 1.13 (1.07, 1.20) for the AQI at lag 0-30 (for females, all ages). Generally, the RRs were slightly larger for NO than PM and AQI. We found somewhat larger RRs in females, age group >65 years of age, and in cooler months. In summary, positive associations were found in most models. This is the first study to report short-term associations between all-cause non-accidental mortality and ambient PM and NO in Iran.
目前有关中东地区死亡率与大气污染之间短期关联的证据有限,且尚无研究评估距死亡前约一个月的暴露窗口期。我们调查了 2011 年 3 月至 2014 年 3 月期间伊朗德黑兰大都市全因非意外每日死亡率及其与细颗粒物(PM)、二氧化氮(NO)和空气质量指数(AQI)之间的关联。广义加性拟泊松模型在分布式滞后线性建模框架内使用,以估算 PM、NO 和 AQI 的滞后效应,最长可达 45 天。我们进一步进行了多污染物模型分析,并按性别、年龄组和季节进行了分层分析。所有季节、两性和所有年龄段的 PM、NO 和 AQI 在滞后 0 时的相对风险(95%置信区间(CI))分别为 1.004(1.001,1.007)、1.003(0.999,1.007)和 1.004(1.001,1.007),每四分位距(IQR)增量(PM 为 18.8μg/m,NO 为 12.6ppb,AQI 为 31.5)。在多污染物模型中,PM 相关性几乎独立于 NO。然而,在调整 PM 后,NO 的相对风险(RR)略有降低,但仍基本独立于 PM。每个 IQR 增量的累积相对风险(95%CI)在较冷月份达到最大值,包括:滞后 0-31 时 PM 为 1.13(1.06,1.20)(所有年龄组的女性);滞后 0-45 时 NO 为 1.17(1.10,1.25)(所有年龄组的男性);滞后 0-30 时 AQI 为 1.13(1.07,1.20)(所有年龄组的女性)。通常,NO 的 RR 略高于 PM 和 AQI。我们发现女性、年龄>65 岁和较冷月份的 RR 略大。总的来说,大多数模型中都发现了正相关。这是第一项报告伊朗全因非意外死亡率与环境 PM 和 NO 之间短期关联的研究。