School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
Department of Statistics, Computer Science, and Applications "G. Parenti", University of Florence, Florence, Italy.
Am J Respir Crit Care Med. 2022 Oct 15;206(8):999-1007. doi: 10.1164/rccm.202111-2657OC.
The associations between ambient coarse particulate matter (PM) and daily mortality are not fully understood on a global scale. To evaluate the short-term associations between PM and total, cardiovascular, and respiratory mortality across multiple countries/regions worldwide. We collected daily mortality (total, cardiovascular, and respiratory) and air pollution data from 205 cities in 20 countries/regions. Concentrations of PM were computed as the difference between inhalable and fine PM. A two-stage time-series analytic approach was applied, with overdispersed generalized linear models and multilevel meta-analysis. We fitted two-pollutant models to test the independent effect of PM from copollutants (fine PM, nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide). Exposure-response relationship curves were pooled, and regional analyses were conducted. A 10 μg/m increase in PM concentration on lag 0-1 day was associated with increments of 0.51% (95% confidence interval [CI], 0.18%-0.84%), 0.43% (95% CI, 0.15%-0.71%), and 0.41% (95% CI, 0.06%-0.77%) in total, cardiovascular, and respiratory mortality, respectively. The associations varied by country and region. These associations were robust to adjustment by all copollutants in two-pollutant models, especially for PM. The exposure-response curves for total, cardiovascular, and respiratory mortality were positive, with steeper slopes at lower exposure ranges and without discernible thresholds. This study provides novel global evidence on the robust and independent associations between short-term exposure to ambient PM and total, cardiovascular, and respiratory mortality, suggesting the need to establish a unique guideline or regulatory limit for daily concentrations of PM.
在全球范围内，环境粗颗粒物 (PM) 与日死亡率之间的关联尚未完全阐明。为了评估全球多个国家/地区的 PM 与总死亡率、心血管死亡率和呼吸死亡率之间的短期关联。我们收集了来自 20 个国家/地区 205 个城市的每日死亡率（总死亡率、心血管死亡率和呼吸死亡率）和空气污染数据。PM 浓度计算为可吸入颗粒物和细颗粒物之间的差值。采用两阶段时间序列分析方法，采用过度分散广义线性模型和多层次荟萃分析。我们拟合了双污染物模型，以检验来自共污染物（细颗粒物、二氧化氮、二氧化硫、臭氧和一氧化碳）的 PM 的独立影响。汇总了暴露-反应关系曲线，并进行了区域分析。PM 浓度每增加 10μg/m，滞后 0-1 天，总死亡率、心血管死亡率和呼吸死亡率分别增加 0.51%（95%置信区间 [CI]，0.18%-0.84%）、0.43%（95% CI，0.15%-0.71%）和 0.41%（95% CI，0.06%-0.77%）。这些关联因国家和地区而异。在双污染物模型中，这些关联在调整所有共污染物后仍然稳健，尤其是对于 PM。总死亡率、心血管死亡率和呼吸死亡率的暴露-反应曲线呈阳性，在较低的暴露范围内斜率更陡，且没有明显的阈值。本研究提供了关于环境 PM 短期暴露与总死亡率、心血管死亡率和呼吸死亡率之间存在稳健且独立关联的新的全球证据，表明有必要为 PM 的日浓度制定独特的指南或监管限值。
