School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University, P O Box 249, 130 Dong-An Road, Shanghai 200032, China.
Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention, Fudan University, Shanghai, China.
BMJ. 2021 Mar 24;372:n534. doi: 10.1136/bmj.n534.
To evaluate the short term associations between nitrogen dioxide (NO) and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide, using a uniform analytical protocol.
Two stage, time series approach, with overdispersed generalised linear models and multilevel meta-analysis.
398 cities in 22 low to high income countries/regions.
Daily deaths from total (62.8 million), cardiovascular (19.7 million), and respiratory (5.5 million) causes between 1973 and 2018.
On average, a 10 μg/m increase in NO 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 and PM, 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 concentration above the counterfactual zero level was 1.23% (95% confidence interval 0.96% to 1.51%) across the 398 cities.
This multilocation study provides key evidence on the independent and linear associations between short term exposure to NO 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.
使用统一的分析方案，评估全球多个国家/地区二氧化氮（NO）与总死亡、心血管死亡和呼吸死亡之间的短期关联。
两阶段时间序列方法，采用过离散广义线性模型和多层次荟萃分析。
22 个低到高收入国家/地区的 398 个城市。
1973 年至 2018 年期间总（6280 万）、心血管（1970 万）和呼吸（550 万）原因的每日死亡人数。
平均而言，NO 浓度在第 1 天（前一天）增加 10μg/m，总死亡、心血管死亡和呼吸死亡分别增加 0.46%（95%置信区间 0.36%至 0.57%）、0.37%（0.22%至 0.51%）和 0.47%（0.21%至 0.72%）。在调整了共污染物（空气动力学直径≤10μm 或≤2.5μm 的颗粒物（PM 和 PM 分别）、臭氧、二氧化硫和一氧化碳）后，这些关联仍然稳健。所有三种死因的汇总浓度-反应曲线几乎呈线性，没有明显的阈值。在 398 个城市中，NO 浓度高于假想零水平的死亡归因比例为 1.23%（95%置信区间 0.96%至 1.51%）。
这项多地点研究提供了关键证据，表明短期接触 NO 与总死亡、心血管死亡和呼吸死亡风险增加之间存在独立和线性关联，这表明通过收紧 NO 的指南和监管限值，将实现健康效益。
