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Background: In the winter of 2016-2017, the number of deaths recorded in the north-west Europe was significantly higher than that in previous years. This spike in mortality was attributed principally to an influenza epidemic, but the contribution of air pollution and cold temperature has not been investigated. Information on the combined effect of low temperatures, influenza epidemic, and air pollution on mortality is inadequate. The objective of this study was to estimate the excess mortality in the winter of 2016-2017 in the metropolitan area of Milan, and to evaluate the independent short-term effect of 3 risk factors: low temperatures, the influenza epidemic, and air pollution., Methods: We used a case-crossover, time-stratified study design. Mortality data were collected on all people aged > 65 years who died of natural causes, due to respiratory diseases or cardiovascular diseases, between December 1, 2016 and February 15, 2017. Environmental data were extracted from the Regional Environmental Protection Agency. The National Surveillance Network provided data on influenza epidemic., Results: Among the 7590 natural deaths in people aged > 65 years, 965 (13%) were caused by respiratory conditions, and 2688 (35%) were caused by cardiovascular conditions. There were statistically significant associations between the minimum recorded temperature and deaths due to natural causes (OR = 0.966, 95% CI: 0.944-0.989), and cardiovascular conditions (OR = 0.961, 95% CI: 0.925-0.999). There were also statistically significant association between the influenza epidemic and deaths due to natural causes (OR = 1.198, 95% CI: 1.156-1.241), cardiovascular conditions (OR = 1.153, 95% CI: 1.088-1.223), and respiratory conditions (OR = 1.303, 95% CI: 1.166-1.456). High levels of PM10 (60 and 70 μg/m 3 ) were associated with a statistically significant increase in natural and cause-specific mortality. There were statistically significant interactions between PM10 and influenza for cardiovascular-related mortality, and between influenza and temperature for deaths due to natural causes., Conclusions: Excess of mortality in Milan during winter 2016-2017 was associated with influenza epidemic and concomitant environmental exposures, specifically, the combined effect of air pollution and low temperatures. Policies mitigating the effects of environmental risk factors should be implemented to prevent future excess mortality.

Objective: To compare the performance of frequentist and Bayesian generalized additive models (GAMs) in terms of accuracy and precision for assessing the association between daily exposure to fine particles and respiratory mortality using simulated data based on a real time-series study. Methods : In our study, we examined the estimates from a fully Bayesian GAM using simulated data based on a genuine time-series study on fine particles with a diameter of 2.5 μm or less (PM 2.5 ) and respiratory deaths conducted in Shanghai, China. The simulation was performed by multiplying the observed daily death with a random error. The underlying priors for Bayesian analysis are estimated using the real world time-series data. We also examined the sensitivity of Bayesian GAM to the choice of priors and to true parameter. Results : The frequentist GAM and Bayesian GAM show similar means and variances of the estimates of the parameters of interest. However, the estimates from Bayesian GAM show relatively more fluctuation, which to some extent reflects the uncertainty inherent in Bayesian estimation. Conclusions : Although computationally intensive, Bayesian GAM would be a better solution to avoid potentially over-confident inferences. With the increasing computing power of computers and statistical packages available, fully Bayesian methods for decision making may become more widely applied in the future.

Although the growths of ambient pollutants have been attracting public concern, the characteristic of the associations between air pollutants and mortality remains elusive. Time series analysis with a generalized additive model was performed to estimate the associations between ambient air pollutants and mortality outcomes in Shenzhen City for the period of 2012-2014. The results showed that nitrogen dioxide (NO 2 )-induced excess risks (ER) of total non-accidental mortality and cardiovascular mortality were significantly increased (6.05% (95% CI 3.38%, 8.78%); 6.88% (95% CI 2.98%, 10.93%), respectively) in interquartile range (IQR) increase analysis. Also, these associations were strengthened after adjusting for other pollutants. Moreover, similar associations were estimated for sulfur dioxide (SO 2 ), particulate matter with an aerodynamic diameter of <10 μm (PM 10 ), and total non-accidental mortality. There were significant higher ERs of associations between PM 10 and mortality for men than women; while there were significant higher ERs of associations between PM 10 /NO 2 and mortality for elders (65 or elder) than youngers (64 or younger). Season analyses showed that associations between NO 2 and total non-accidental mortality were more pronounced in hot seasons than in warm seasons. Taken together, NO 2 was positively associated with total non-accidental mortality and cardiovascular mortality in Shenzhen even when the concentrations were below the ambient air quality standard. Policy measures should aim at reducing residents' exposure to anthropogenic NO 2 emissions.

Background: In 2013 southeast China suffered from an unusual high temperature, which had broken the heat records in the past 141 years. Few studies have examined the impact of heat waves on mortality in Asia., Objective: To estimate the impact of the heat wave in 2013 on mortality among the registered permanent residence population and identify susceptible subpopulations in Pudong New Area., Methods: To model the relationship between the maximum temperature and mortality, a quasi-poisson generalized additive model was applied using data from 1 January 2008 to 15 June 2013. Extrapolating the model the estimated daily expected number of deaths was calculated over the period of 16 June 2013 to 15 September 2013., Results: There were four heat waves in 2013, causing 167 (95% CI: 46-280) excess deaths in all-cause mortality, corresponding to an excess mortality of 10.51%. After the first two heat waves, the cumulative excess death counts gradually reduced to the level before the start of the heat waves. In contrast, the cumulative excess death numbers increased rapidly during the last two heat waves, without decreasing after the heat waves. Females (male: 10.43%, female: 11.79%) and people aged ≥ 80 years old (excess deaths were 129 (95% CI: 47-203) and excess mortality was 16.64%) were strongly affected by the heat waves. The excess mortalities of cardiovascular and respiratory disease were 22.34% and 20.68% respectively, which were higher than that of all-cause deaths., Conclusions: The 2013 heat wave had a significant impact on mortality even after the considered "mortality displacement". Females and people aged ≥ 80 years old were significantly vulnerable to the heat waves. The observed excess mortalities of cardiovascular and respiratory disease were higher than all-cause deaths. These results could provide scientific evidences for policy makers to frame heat wave-related prevention measures, which may help in reducing the mortality., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Rationale: Body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) mortality, but the underlying mechanisms are unclear. The effect of genetic variants aggregated into a polygenic score may elucidate the causal mechanisms and predict risk. Objectives: To examine the associations of genetically predicted BMI with all-cause and cause-specific mortality in COPD. Methods: We developed a polygenic score (PGS) for BMI (PGSBMI) and tested for associations of the PGSBMI with all-cause, respiratory, and cardiovascular mortality in participants with COPD from the COPDGene (Genetic Epidemiology of COPD), ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points), and Framingham Heart studies. We calculated the difference between measured BMI and PGS-predicted BMI (BMIdiff) and categorized participants into groups of discordantly low (BMIdiff <20th percentile), concordant (BMIdiff between the 20th and 80th percentiles), and discordantly high (BMIdiff >80th percentile) BMI. We applied Cox models, examined potential nonlinear associations of the PGSBMI and BMIdiff with mortality, and summarized results with meta-analysis. Measurements and Main Results: We observed significant nonlinear associations of measured BMI and BMIdiff, but not PGSBMI, with all-cause mortality. In meta-analyses, a one–standard deviation increase in the PGSBMI was associated with an increased hazard for cardiovascular mortality (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.12–1.49), but not for respiratory or all-cause mortality. Compared with participants with concordant measured and genetically predicted BMI, those with discordantly low BMI had higher risks for all-cause mortality (HR, 1.57; 95% CI, 1.41–1.74) and respiratory death (HR, 2.01; 95% CI, 1.61–2.51). Conclusions: In people with COPD, a higher genetically predicted BMI is associated with higher cardiovascular mortality but not respiratory mortality. Individuals with a discordantly low BMI have higher all-cause and respiratory mortality rates than those with a concordant BMI. [ABSTRACT FROM AUTHOR]

Air pollution is a major cause of specific deaths worldwide. This review article aimed to investigate the results of cohort studies for air pollution connected with the all-cause, cardio-respiratory, and lung cancer mortality risk by performing a meta-analysis. Relevant cohort studies were searched in electronic databases (PubMed/Medline, Web of Science, and Scopus). We used a random effect model to estimate the pooled relative risks (RRs) and their 95% CIs (confidence intervals) of mortality. The risk of bias for each included study was also assessed by Office of Health Assessment and Translation (OHAT) checklists. We applied statistical tests for heterogeneity and sensitivity analyses. The registration code of this study in PROSPERO was CRD42023422945. A total of 88 cohort studies were eligible and included in the final analysis. The pooled relative risk (RR) per 10 μg/m3 increase of fine particulate matter (PM2.5) was 1.080 (95% CI 1.068–1.092) for all-cause mortality, 1.058 (95% CI 1.055–1.062) for cardiovascular mortality, 1.066 (95%CI 1.034–1.097) for respiratory mortality and 1.118 (95% CI 1.076–1.159) for lung cancer mortality. We observed positive increased associations between exposure to PM2.5, PM10, black carbon (BC), and nitrogen dioxide (NO2) with all-cause, cardiovascular and respiratory diseases, and lung cancer mortality, but the associations were not significant for nitrogen oxides (NOx), sulfur dioxide (SO2) and ozone (O3). The risk of mortality for males and the elderly was higher compared to females and younger age. The pooled effect estimates derived from cohort studies provide substantial evidence of adverse air pollution associations with all-cause, cardiovascular, respiratory, and lung cancer mortality. [ABSTRACT FROM AUTHOR]

Background: Although the health impacts of ambient ozone (O3) have been widely assessed, studies simultaneously investigating the acute and chronic effects of O3 on mortality from respiratory diseases (RESP) are scarce. Methods: We extracted personal information of all recorded deaths from RESP throughout 2013-2018 in six provinces in China. The daily, seasonal, and annual mean air pollutant concentrations at the township/subdistrict level were estimated by a random forest model. The acute association between the maximum daily average 8h ozone (MDA8 O3) and RESP mortality was examined by a time-stratified casecrossover study design, and the chronic association was estimated by a difference-in-differences (DID) analysis approach. We also calculated the attributable fraction (AF) of RESP mortality attributable to MDA8 O3. Results: There were 1,034,226 RESP deaths included in this study. The excess risks (ERs) of overall RESP mortality for each 10 µg/m³ increase in short-term (lag03 days) and long-term (one-year average) exposure to MDA8 O3 were 0.38 % (95%CI: 0.26 %, 0.50 %) and 4.37 % (3.91 %, 4.84 %), respectively. The AFs of overall RESP mortality ascribed to short- and long-term MDA8 O3 exposures were 3.00 % (2.03 %, 3.95 %) and 29.45 % (26.86 %, 31.95 %), respectively. The average annual number of RESP deaths attributable to short-term MDA8 O3 exposure was 30,790 and 302,254 were attributable to long-term MDA8 O3 exposure across China during 2013-2018. Conclusion: Both short- and long-term exposure to ambient MDA8 O3 were positively associated with RESP mortality, and long-term exposure to MDA8 O3 may lead to a greater RESP mortality burden than short-term exposure to MDA8 O3. [ABSTRACT FROM AUTHOR]

Background: In China, the increasing concentration of ozone (O3) has emerged as a significant air pollution issue, leading to adverse effects on public health, particularly the respiratory system. Despite the progress made in managing air pollution in China, it is crucial to address the problem of environmental O3 pollution at present. Methods: The connection between O3 exposure and respiratory mortality in Shenyang, China, from 2014 to 2018 was analyzed by a time-series generalized additive regression model (GAM) with quasi-Poisson regression. Additionally, the potential combined effects of fine particulate matter (PM2.5) and O3 were investigated using the synergy index (SI). Results: Our findings indicate that each 10 μg/m3 increase in O3 at lag 2 days was associated with a maximum relative risk (RR) of 1.0150 (95% CI: 1.0098–1.0202) for respiratory mortality in the total population. For individuals aged ≥55 years, unmarried individuals, those engaged in indoor occupations, and those with low educational attainment, each 10 μg/m3 increase in O3 at lag 07 days was linked to RR values of 1.0301 (95% CI: 1.0187–1.0417), 1.0437 (95% CI: 1.0266–1.0610), 1.0317 (95% CI: 1.0186–1.0450), and 1.0346 (95% CI: 1.0222–1.0471), respectively. Importantly, we discovered a synergistic effect of PM2.5 and O3, resulting in an SI of 2.372 on the occurrence of respiratory mortality. Conclusions: This study confirmed a positive association between O3 exposure and respiratory mortality. Furthermore, it highlighted the interaction between O3 and PM2.5 in exacerbating respiratory deaths. [ABSTRACT FROM AUTHOR]

Although there is a growing interest in the association between ambient temperatures and mortality, little evidence is available for Thessaloniki, the second largest city of Greece. In this study, we present an assessment of the effects of temperature on daily mortality from 2006 to 2016 in the urban area of Thessaloniki, by describing the exposure-lag-response association between temperature and cause-specific mortality with the use of a distributed lag non-linear model (DLNM). A J-shaped relationship was found between temperature and mortality. The highest values of risk were evident for respiratory (RR > 10) and cardiovascular causes (RR > 3), probably due to the fact that health status of individuals with chronic respiratory and cardiovascular diseases rapidly deteriorates during hot periods. Cold effects had longer lags of up to 15 days, whereas heat effects were short-lived, up to 4 days. Percentage change in all- and cause-specific mortality per 1 °C change above and below Minimum Mortality Temperature showed a larger increase for all-cause mortality in heat (1.95%, 95% CI: 1.07–2.84), in contrast to a smaller increase in cold (0.54%, 95% CI: 0, 1.09). Overall, 3.51% of all-cause deaths were attributable to temperature, whereas deaths attributed to heat (2.34%) were more than deaths attributed to cold (1.34%). The findings of this study present important evidence for planning public-health interventions, to reduce the health impact of extreme temperatures. [ABSTRACT FROM AUTHOR]

The European Centres for Disease Prevention and Control (ECDC) estimates that seasonal influenza causes 4–50 million symptomatic infections in the EU/EEA each year and 15,000–70,000 European citizens die of causes associated with influenza. We used modelling methods to estimate influenza-associated mortality for the European Union by age group and country. We compiled influenza-associated respiratory mortality estimates for 31 countries around the world (11 countries in the EU) during 2002–2011 (excluding the 2009 pandemic). From these we extrapolated the influenza mortality burden for all 193 countries of the world, including the 28 countries of the EU, using a multiple imputation approach. To study the effect of vaccination programs, we obtained data from the EU-funded VENICE project regarding the percentage of persons over 65 who were vaccinated in each country; the data ranged from 2% to 82% between the 21 countries which provided estimates for the 2006/07 reference season. We estimated that an average of 27,600 (range 16,200-39,000) respiratory deaths were associated with seasonal influenza in the 28 EU countries per winter; 88% were among people 65 years and older, and the rates of mortality in this age group were roughly 35 times higher compared with those < 65 years. Estimates varied considerably across the EU; for example, rates in the elderly ranged from 21.6 (12.5–35.1) per 100,000 in Portugal to 36.5 (16.4–62.5) in Luxembourg, a difference of nearly 70%. We were unable to find a negative correlation between vaccination coverage rates and influenza-associated mortality estimates in the elderly. Our EU estimate of influenza-associated respiratory mortality is broadly consistent with the ECDC estimate. More research is needed to explain the observed variation in mortality across the EU, and on possible bias that could explain the unexpected lack of mortality benefits associated with European elderly influenza vaccination programs. [ABSTRACT FROM AUTHOR]

The spatial synoptic classification (SSC) is a holistic categorical assessment of the daily weather conditions at specific locations; it is a useful tool for assessing weather effects on health. In this study, we assessed (a) the effect of hot weather types and the duration of heat events on cardiovascular and respiratory mortality in summer and (b) the effect of cold weather types and the duration of cold events on cardiovascular and respiratory mortality in winter. A time-stratified case-crossover design combined with a distributed lag nonlinear model was carried out to investigate the association of weather types with cause-specific mortality in two southern (Skåne and Stockholm) and two northern (Jämtland and Västerbotten) locations in Sweden. During summer, in the southern locations, the Moist Tropical (MT) and Dry Tropical (DT) weather types increased cardiovascular and respiratory mortality at shorter lags; both hot weather types substantially increased respiratory mortality mainly in Skåne. The impact of heat events on mortality by cardiovascular and respiratory diseases was more important in the southern than in the northern locations at lag 0. The cumulative effect of MT, DT and heat events lagged over 14 days was particularly high for respiratory mortality in all locations except in Jämtland, though these did not show a clear effect on cardiovascular mortality. During winter, the dry polar and moist polar weather types and cold events showed a negligible effect on cardiovascular and respiratory mortality. This study provides valuable information about the relationship between hot oppressive weather types with cause-specific mortality; however, the cold weather types may not capture sufficiently effects on cause-specific mortality in this sub-Arctic region. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions.Design: Whole-country, birth cohort study using linked administrative health databases from Scotland.Setting and Participants: Children aged 2 months to less than 5 years in Scotland between 2000 and 2014.Main Outcome Measures: Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2-11 months and at 1-4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression.Results: The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2-11 months: HR 68.48, 95% CI (40.57 to 115.60), 1-4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2-11 months: HR 2.42, 95% CI (1.67 to 3.63), 1-4 years: HR 2.53, 95% CI (1.36 to 4.71)).Conclusions: The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures. [ABSTRACT FROM AUTHOR]

• Significant associations exist between heatwaves and cause-specific mortality. • The associations are also significant for socio-demographic subgroups. • Relative risk (RR) decreased for all subgroups over time except for RD. • The association between heatwave characteristics and mortality changed over time. • The female, elderly, and low-/middle-educational groups had higher RR to heatwaves. Heatwaves are projected to increase in frequency, intensity, and duration as the climate warms. However, it is unclear whether human mortality from heatwaves is changing in frequency with time. We used Quasi-Poisson regression with a distributed non-linear model (DLNM) to examined associations of heatwaves and their characteristics (intensity, duration, and timing) with human mortality due to different diseases and total non-accidental diseases (TND) for different sociodemographic subgroups between 2002 and 2004 and 2012–2014 in Shanghai, China. We found that heatwaves showed a significant association with cause-specific mortality and TND for socio-demographic subgroups during the two study periods. Relative risks (RR) of mortality decreased for most demographic subgroups from 2002 to 2004 to 2012–2014, while RR of respiratory diseases (RD) increased over time. The association between heatwave characteristics and human mortality changed over time. RRs of heatwaves on mortality were higher for females, the elderly, and low- and middle-educational level populations than for males, younger and highly educated counterparts, respectively. Overall, heatwaves had a stronger association with the mortality of RD from 2002 to 2004 to 2012–2014. Heatwave duration also had an enhanced association with all subgroups over time. Our research findings could provide insights into the design of sustainable cities and society. [ABSTRACT FROM AUTHOR]

There is limited evidence of temporal changes in the association between air temperature and the risk of cause-specific cardiovascular [CVD] and respiratory [RD] mortality. We explored temporal variations in the association between short-term exposures to air temperature and non-accidental and cause-specific CVD and RD mortality in the 15 largest German cities over 24 years (1993–2016) using time-stratified time series analysis. We applied location-specific confounder-adjusted Poisson regression with distributed lag non-linear models with a lag period of 14 days to estimate the temperature–mortality associations. We then pooled the estimates by a multivariate meta-analytical model. We analysed the whole study period and the periods 1993–2004 and 2005–16, separately. We also carried out age- and sex-stratified analysis. Cold and heat effects are reported as relative risk [RR] at the 1st and the 99th temperature percentile, relative to the 25th and the 75th percentile, respectively. We analysed a total of 3,159,292 non-accidental, 1,063,198 CVD and 183,027 RD deaths. Cold-related RR for CVD mortality was seen to rise consistently over time from 1.04 (95% confidence interval [95% CI] 1.02, 1.06) in the period 1993–2004 to 1.10 (95% CI 1.09, 1.11) in the period 2005–16. A similar increase in cold-related RR was also observed for RD mortality with risk increasing from 0.99 (95% CI 0.96, 1.03) to 1.07 (95% CI 1.03, 1.10). Cold-related ischemic, cerebrovascular, and heart failure mortality risk were seen to be increasing over time. Similarly, COPD, the commonly speculated driver of heat-related RD mortality was found to have a constant heat-related risk over time. Males were increasingly vulnerable to cold with time for all causes of death. Females showed increasing sensitivity to cold for CVD mortality. Our results indicated a significant increased cold and heat vulnerability of the youngest age-groups (<64) to non-accidental and RD mortality, respectively. Similarly, the older age group (>65) were found to have significantly increased susceptibility to cold for CVD mortality. We found evidence of rising population susceptibility to both heat- and cold-related CVD and RD mortality risk from 1993 to 2016. Climate change mitigation and targeted adaptation strategies might help to reduce the number of temperature-related deaths in the future. • Temporal variations temperature-cause-specific mortality association was explored. • Evidence of rising population susceptibility to both heat- and cold-related mortality. • COPD, the commonly speculated driver of heat-related respiratory mortality, found to have a constant heat-related risk over time. • Climate change mitigation and targeted adaptation strategies recommended. [ABSTRACT FROM AUTHOR]

Studies on health effects of air pollution often use daily mean concentration to estimate exposure while ignoring daily variations. This study examined the health effects of daily variation of PM 2.5 . We calculated daily mean and standard deviations of PM 2.5 in Hong Kong between 1998 and 2011. We used a generalized additive model to estimate the association between respiratory mortality and daily mean and variation of PM 2.5 , as well as their interaction. We controlled for potential confounders, including temporal trends, day of the week, meteorological factors, and gaseous air pollutants. Both daily mean and standard deviation of PM 2.5 were significantly associated with mortalities from overall respiratory diseases and pneumonia. Each 10 μg/m 3 increment in daily mean concentration at lag 2 day was associated with a 0.61% (95% CI: 0.19%, 1.03%) increase in overall respiratory mortality and a 0.67% (95% CI: 0.14%, 1.21%) increase in pneumonia mortality. And a 10 μg/m 3 increase in standard deviation at lag 1 day corresponded to a 1.40% (95% CI: 0.35%, 2.46%) increase in overall respiratory mortality, and a 1.80% (95% CI: 0.46%, 3.16%) increase in pneumonia mortality. We also observed a positive but non-significant synergistic interaction between daily mean and variation on respiratory mortality and pneumonia mortality. However, we did not find any significant association with mortality from chronic obstructive pulmonary diseases. Our study suggests that, besides mean concentration, the standard deviation of PM 2.5 might be one potential predictor of respiratory mortality in Hong Kong, and should be considered when assessing the respiratory effects of PM 2.5 . [ABSTRACT FROM AUTHOR]

Although interest in assessing the impacts of hot temperature and mortality in Hong Kong has increased, less evidence on the effect of cold temperature on mortality is available. We examined both the effects of heat and cold temperatures on daily mortality in Hong Kong for the last decade (2002-2011). A quasi-Poisson model combined with a distributed lag non-linear model was used to assess the non-linear and delayed effects of temperatures on cause-specific and age-specific mortality. Non-linear effects of temperature on mortality were identified. The relative risk of non-accidental mortality associated with cold temperature (11.1 °C, 1st percentile of temperature) relative to 19.4 °C (25th percentile of temperature) was 1.17 (95 % confidence interval (CI): 1.04, 1.29) for lags 0-13. The relative risk of non-accidental mortality associated with high temperature (31.5 °C, 99th percentile of temperature) relative to 27.8 °C (75th percentile of temperature) was 1.09 (95 % CI: 1.03, 1.17) for lags 0-3. In Hong Kong, extreme cold and hot temperatures increased the risk of mortality. The effect of cold lasted longer and greater than that of heat. People older than 75 years were the most vulnerable group to cold temperature, while people aged 65-74 were the most vulnerable group to hot temperature. Our findings may have implications for developing intervention strategies for extreme cold and hot temperatures. [ABSTRACT FROM AUTHOR]

Background China has experienced increasingly severe levels of air pollution in the past decades, yet studies on the health effects of air pollution in China at a national study level, remain limited. This study assess the sub-chronic effect of ambient air pollution on respiratory mortality in the 32 largest Chinese cities. Methods We employ two-way fixed effects panel data analysis and monthly air pollution and mortality panel data. We estimate associations between monthly respiratory mortality and air pollution; pollution is defined as particulate matter with aerodynamic diameter <10 μm. We adjust for city characteristics, seasonality (monthly effects), and weather conditions (precipitation and temperature). We examine the associations between monthly injury mortality and air pollution to check for robustness. Results The results show positive and statistically significant associations of air pollution with respiratory mortality. During the study period (2006–2010) a 10 μg/m 3 increase in monthly PM 10 concentration is associated with a 1.05% (95% CI, 0.08–2.04%) increase in adult respiratory mortality rate. The air pollution effect is the most salient in northern cities (with central heating system) during the cold season (October–April); a 10 μg/m 3 increase in monthly PM 10 concentrations is associated with a 1.62% (95% CI, 0.22–3.46%) increase in the elderly respiratory mortality rate. There is no statistically significant association between the young adult respiratory mortality and air pollution. Conclusions The elderly respiratory mortality rate in China is positively and statistically significantly associated with air pollution. The effect is largest in northern cities during cold months when coal is burned for heating. [ABSTRACT FROM AUTHOR]

Context: Respiratory diseases are one of the leading causes of deaths world-wide. There are no published studies on the pattern and determinants of respiratory mortality from South India. Aims: The aim was to find out the pattern and determinants of respiratory mortality during July 1, 2002 to June 31, 2008 in Varkala, Thiruvananthapuram district, Kerala. Settings and Design: A nested case control study from a prospective cohort was done to find out the determinants for respiratory mortality. The main outcome measure was mortality due to respiratory causes. Materials and Methods: The data collected here are from the Population Registry of Lifestyle Diseases study, a prospective cohort study involving the long-term followup of the residents of Varkala rural development block Thiruvananthapuram district of South Kerala. Statistical analysis used: The age specific respiratory mortality rate was calculated. Chi-square test and odds ratio (OR) were measured to find out the association between exposure and outcome variables. Logistic regression was performed. Results: A total of 3467 deaths were reported among 77881 subjects above the age group of 20 years during the follow-up period. Of which 531 (15.9%) were due to respiratory causes. On logistic regression smoking (AdjOR [95% confidence interval]; 1.65 [1.25, 2.17]), lower socioeconomic status (AdjOR; 1.52 [1.24, 1.87]), lower educational status (AdJOR; 2.22 [1.15, 4.29]) and old age (>60 years) (AdjOR; 2.6 [2.03, 3.33]) were found to be the significant risk factors for respiratory mortality. Conclusion: Mortality due to respiratory causes was found to be high in Kerala, a state which has the best health indicators compared to other states in India. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although interest in assessing the impacts of temperature on mortality has increased, few studies have used a case-crossover design to examine nonlinear and distributed lag effects of temperature on mortality. Additionally, little evidence is available on the temperature-mortality relationship in China or on what temperature measure is the best predictor of mortality. OBJECTIVES: Our objectives were to use a distributed lag nonlinear model (DLNM) as a part of case-crossover design to examine the nonlinear and distributed lag effects of temperature on mortality in Tianjin, China and to explore which temperature measure is the best predictor of mortality. METHODS: We applied the DLNM to a case-crossover design to assess the nonlinear and delayed effects of temperatures (maximum, mean, and minimum) on deaths (nonaccidental, cardiopulmonary, cardiovascular, and respiratory). RESULTS: A U-shaped relationship was found consistently between temperature and mortality. Cold effects (i.e., significantly increased mortality associated with low temperatures) were delayed by 3 days and persisted for 10 days. Hot effects (i.e., significantly increased mortality associated with high temperatures) were acute and lasted for 3 days and were followed by mortality displacement for nonaccidental, cardiopulmonary, and cardiovascular deaths. Mean temperature was a better predictor of mortality (based on model fit) than maximum or minimum temperature. CONCLUSIONS: In Tianjin, extreme cold and hot temperatures increased the risk of mortality. The effects of cold last longer than the effects of heat. Combining the DLNM and the case-crossover design allows the case-crossover design to flexibly estimate the nonlinear and delayed effects of temperature (or air pollution) while controlling for season. [ABSTRACT FROM AUTHOR]

Although there is growing evidence that psychological factors affect an individual's susceptibility to respiratory illnesses, psychological predictors of respiratory mortality have received little attention. This study investigated whether an age-specific psychological factor, older individuals’ beliefs about their own aging, predicted the likelihood of their dying from respiratory causes (ICD-9: 460–519). The sample was composed of 620 individuals, aged 50–87 years at baseline, who participated in a longitudinal study with six waves. Our research found that individuals with higher baseline positive self-perceptions of aging were significantly less likely to die of respiratory causes over the next 23 years, after controlling for age, functional health, gender, loneliness, marital status, self-rated health, and socioeconomic status (hazard ratio&ThickSpace;=&ThickSpace;0.695; p &ThickSpace;<&ThickSpace;0.005). This is the first study to link individual beliefs about aging to cause-specific mortality. Future research is warranted to further elucidate the relationship between self-perceptions of aging and resistance to respiratory mortality. [ABSTRACT FROM AUTHOR]

The associations between temperature and daily mortality was studied among the citizens of Oslo, Norway, 1990–1995. Data on daily mortality were linked with daily temperatures, relative humidity, wind velocity and air pollution. At temperatures below 10 °C, a 1 °C fall in the last 7 days average temperature increased the daily mortality from all diseases by 1.4%, respiratory diseases 2.1%, and cardiovascular diseases 1.7%. Above 10 °C, there was no statistically significant increase in daily mortality, except for respiratory mortality, which increased by 4.7% per 1 °C increase in the last 7 days average temperature. Daily mortality in Oslo increases with temperatures falling below 10 °C. The increase starts at lower temperatures than shown in warmer regions of the world, but at higher temperatures than in regions with even colder climates. As well insulated and heated dwellings are standard in Norway today, more adequate clothing during outdoor visits is probably the most important preventive measure for temperature related mortality. [ABSTRACT FROM AUTHOR]

Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is increasing evidence that short-term exposure to nitrogen dioxide (NO 2), is related to adverse health effects and mortality. We conducted a systematic review of short-term NO 2 and daily mortality, which were indexed in PubMed and Embase up to June 2021. We calculated random-effects estimates by different continents and globally, and tested for heterogeneity and publication bias. We included 87 articles in our quantitative analysis. NO 2 and all-cause as well as cause-specific mortality were positively associated in the main analysis. For all-cause mortality, a 10 ppb increase in NO 2 was associated with a 1.58% (95%CI 1.28%–1.88%, I2 = 96.3%, Eggers' test p < 0.01, N = 57) increase in the risk of death. For cause-specific mortality, a 10 ppb increase in NO 2 was associated with a 1.72% (95%CI 1.41%–2.04%, I2 = 87.4%, Eggers' test p < 0.01, N = 42) increase in cardiovascular mortality and a 2.05% (95%CI 1.52%–2.59%, I2 = 78.5%, Eggers' test p < 0.01, N = 38) increase in respiratory mortality. In the sensitivity analysis, the meta-estimates for all-cause mortality, cardiovascular and respiratory mortality were nearly identical. The heterogeneity would decline to varying degrees through regional and study-design stratification. This study provides evidence of an association between short-term exposure to NO 2 , a proxy for traffic-sourced air pollutants, and all-cause, cardiovascular and respiratory mortality. • A meta-analysis of short-term exposure to NO2 and all-cause, cardiovascular, and respiratory mortality. • Including the most studies up to date, stratified by region and study design. • NO2 has significant and independent impacts on mortality. [ABSTRACT FROM AUTHOR]

Respiratory diseases cause significant morbidity and mortality, especially in developing countries. Recently, the influence of global warming on respiratory disease mortality has become a growing concern in research. Data on respiratory disease mortality, meteorological elements and air pollutants during 2014–2017 were collected from Yancheng in China. We applied the distributed lag non-linear model (DLNM) and performed a quasi-Poisson distribution fitting to evaluate the baseline relationship between the mean temperature and total respiratory diseases mortality, and then projected the future changes of total respiratory diseases mortality without adaptation and with adaptation in Yancheng during three future periods under two Representative Concentration Pathways (RCP) scenarios(RCP4.5 and RCP8.5) and three population scenarios including one constant and two Shared Socio-economic Pathways (SSP) scenarios (SSP2 and SSP5). Under four combination scenarios, future warming causes additional heat-related mortality but reduced cold-related mortality in Yancheng from the 2030s to the 2070s. Under SSP population scenarios, the reduced numbers of cold-related deaths offsetting the additional numbers of heat-related deaths lead to the decreases in net temperature-related mortality in the 2050s and 2070s. Future population change has more influence on respiratory mortality than future climate change scenarios does. When the adaptation was adpoted, the heat-related mortality risks and the net temperature-related mortality risks become smaller, but the cold-related mortality risks become larger than that without adaptation. • Projecting the future additional temperature-related total respiratory disease mortality in Yancheng. • The non-linear temperature-related mortality relationship between total respiratory disease and mean temperature. • Cold-related respiratory disease mortality will decrease in the future. • Impact on respiratory disease mortality by the future Chinese population. [ABSTRACT FROM AUTHOR]

Poor air quality is one of the most important environmental problems in many large cities of the world, which can cause a wide range of acute and chronic health effects, including partial physiological disorders and cardiac death due to respiratory and cardiovascular diseases. According to the latest edition of the national standard for air quality, maximum contamination level is 15 μg/m3 per year and 35 μg/m3 per day. The aim of this study was to evaluate cardiovascular, respiratory, and total mortality attributed to PM2.5 in the city of Mashhad during 2013. To this end, the Air Q model was used to assess health impacts of PM2.5 and human exposure to it. In this model, the attributable proportion of health outcome, annual number of excess cases of mortality for all causes, and cardiovascular and respiratory diseases were estimated. The results showed that the number of excess cases of mortality for all causes and cardiovascular and respiratory diseases attributable to PM2.5 was 32, 263, and 332 μg/m3, respectively. Moreover, the annual average of PM2.5 in Mashhad was obtained to be 37.85 μg/m3. This study demonstrated that a high percentage of mortality resulting from this pollutant could be due to the high average concentration of PM2.5 in the city during 2013. In this case, using the particle control methods, such as optimal use of fuel, management of air quality in urban areas, technical inspection of vehicles, faster development of public transport, and use of industrial technology can be effective in reducing air pollution in cities and turning existing situations into preferred ones. [ABSTRACT FROM AUTHOR]