School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission (NHC) Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200433, China.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Environ Sci Technol. 2024 Jul 23;58(29):12865-12874. doi: 10.1021/acs.est.3c10951. Epub 2024 Jul 12.
Short-term exposure to PM or O can increase mortality risk; however, limited studies have evaluated their interaction. A multicity time series study was conducted to investigate the synergistic effect of PM and O on mortality in China, using mortality data and high-resolution pollutant predictions from 272 cities in 2013-2015. Generalized additive models were applied to estimate associations of PM and O with mortality. Modification and interaction effects were explored by stratified analyses and synergistic indexes. Deaths attributable to PM and O were evaluated with or without modification of the other pollutant. The risk of total nonaccidental mortality increased by 0.70% for each 10 μg/m increase in PM when O levels were high, compared to 0.12% at low O levels. The effect of O on total nonaccidental mortality at high PM levels (1.26%) was also significantly higher than that at low PM levels (0.59%). Similar patterns were observed for cardiovascular or respiratory diseases. The relative excess risk of interaction and synergy index of PM and O on nonaccidental mortality were 0.69% and 1.31 with statistical significance, respectively. Nonaccidental deaths attributable to short-term exposure of PM or O when considering modification of the other pollutant were 28% and 31% higher than those without considering modification, respectively. Our results found synergistic effects of short-term coexposure to PM and O on mortality and suggested underestimations of attributable risks without considering their synergistic effects.
短期暴露于 PM 或 O 会增加死亡率风险；然而，有限的研究评估了它们的相互作用。本项多城市时间序列研究利用 2013-2015 年来自 272 个城市的死亡率数据和高分辨率污染物预测数据，调查了 PM 和 O 对中国死亡率的协同作用。应用广义加性模型来估计 PM 和 O 与死亡率之间的关联。通过分层分析和协同指数来探索修饰和相互作用效应。评估了在不修饰或修饰另一种污染物的情况下，PM 和 O 导致的死亡归因。与低 O 水平时相比，当 O 水平较高时，每增加 10μg/m 的 PM ，总非意外死亡率增加 0.70%。在高 PM 水平时，O 对总非意外死亡率的影响（1.26%）也明显高于在低 PM 水平时（0.59%）。心血管或呼吸道疾病也存在类似的模式。PM 和 O 对非意外死亡率的交互和协同作用的相对超额风险分别为 0.69%和 1.31，具有统计学意义。在考虑修饰另一种污染物时，短期暴露于 PM 或 O 导致的非意外死亡归因风险分别比不考虑修饰时高 28%和 31%。我们的研究结果发现，PM 和 O 短期共存对死亡率有协同作用，并表明如果不考虑它们的协同作用，归因风险可能会被低估。
