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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]

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 unequal geographic distribution of health determinants could denote situations of environmental injustice. This work aims to identify spatial patterns of respiratory disease mortality and their association with the education level and the atmospheric pollution in Madrid. To this purpose, we applied spatial analysis through statistical techniques and Geographic Information Systems at the census tract level. The analysis showed a slight but significantly higher risk of mortality in areas with more unfavourable socioeconomic and environmental conditions. This work has the potential to inform public policy and research on links among social, environmental and health inequalities in Madrid City. [ABSTRACT FROM AUTHOR]

Excessive Ca intakes have been proposed to associate with vascular calcification and a higher risk of prostate cancer. We investigated the associations of supplemental and dietary Ca intake with mortality using data from 497 828 UK Biobank participants. The average follow-up was 4·2 years and 14 255 participants died, 8297 from cancer, 2959 from CVD and 572 from respiratory disease. The use of Ca supplements and milk consumption were associated with differences in mortality in younger (≤65 years) but not in older participants (>65 years, P interaction ≤ 0·04 for all comparisons). Among participants <65 years, there was an inverse association between Ca supplementation (OR 0·91, 95 % CI 0·83, 0·99) and milk consumption (OR 0·93, 95 % CI 0·86, 1·00) with respect to all-cause mortality. In the same age group, milk drinkers had lower odds of cancer mortality (OR 0·89, 95 % CI 0·80, 0·98) but Ca supplement use was associated with increased odds of respiratory mortality (OR 1·69, 95 % CI 1·16, 2·74). All associations in participants aged ≥65 years were null after full adjustment. In sensitivity analyses stratified by hormone replacement therapy, Ca supplement use was associated with decreased odds of cancer mortality in users but increased risk in other women (OR 0·81, 95 % CI 0·69, 0·94 v. OR 1·17, 95 % CI 1·01, 1·35, respectively). To conclude, we saw little evidence for harm with dietary or supplemental Ca. Further studies are required to confirm the proposed interaction with hormone replacement therapy and to exclude reverse causation as a determinant in the association between Ca supplements and increased risk of respiratory diseases. [ABSTRACT FROM AUTHOR]

Background: Understanding the shape of the relationship between long-term exposure to ambient fine particulate matter (PM2.5) concentrations and health risks is critical for health impact and risk assessment. Studies evaluating the health risks of exposure to low concentrations of PM2.5 are limited. Further, many existing studies lack individual-level information on potentially important behavioural confounding factors.Methods: A prospective cohort study was conducted among a subset of participants in a cohort that linked respondents of the Canadian Community Health Survey to mortality (n = 299,500) with satellite-derived ambient PM2.5 estimates. Participants enrolled between 2000 and 2008 were followed to date of death or December 31, 2011. Cox proportional hazards models were used to estimate hazard ratios (HRs) for mortality attributed to PM2.5 exposure, adjusted for individual-level and contextual covariates, including smoking behaviour and body mass index (BMI).Results: Approximately 26,300 non-accidental deaths, of which 32.5 % were due to circulatory disease and 9.1 % were due to respiratory disease, occurred during the follow-up period. Ambient PM2.5 exposures were relatively low (mean = 6.3 μg/m(3)), yet each 10 μg/m(3) increase in exposure was associated with increased risks of non-accidental (HR = 1.26; 95 % CI: 1.19-1.34), circulatory disease (HR = 1.19; 95 % CI: 1.07-1.31), and respiratory disease mortality (HR = 1.52; 95 % CI: 1.26-1.84) in fully adjusted models. Higher hazard ratios were observed for respiratory mortality among respondents who never smoked (HR = 1.97; 95 % CI: 1.24-3.13 vs. HR = 1.45; 95 % CI: 1.17-1.79 for ever smokers), and among obese (BMI ≥ 30) respondents (HR = 1.76; 95 % CI: 1.15-2.69 vs. HR = 1.41; 95 % CI: 1.04-1.91 for normal weight respondents), though differences between groups were not statistically significant. A threshold analysis for non-accidental mortality estimated a threshold concentration of 0 μg/m(3) (+95 % CI = 4.5 μg/m(3)).Conclusions: Increased risks of non-accidental, circulatory, and respiratory mortality were observed even at very low concentrations of ambient PM2.5. HRs were generally greater than most literature values, and adjusting for behavioural covariates served to reduce HR estimates slightly. [ABSTRACT FROM AUTHOR]

In large cities in China, the traffic-related air pollution has become the focus of attention, and its adverse effects on health have raised public concerns. We conducted a study to quantify the association between exposure to three major traffic-related pollutants — particulate matter < 10 μm in aerodynamic diameter (PM 10 ), carbon monoxide (CO) and nitrogen dioxide (NO 2 ) and the risk of respiratory mortality in Beijing, China at a daily spatiotemporal resolution. We used the generalized additive models (GAM) with natural splines and principal component regression method to associate air pollutants with daily respiratory mortality, covariates and confounders. The GAM analysis adjusting for the collinearity among pollutants indicated that PM 10 , CO and NO 2 had significant effects on daily respiratory mortality in Beijing. An interquartile range increase in 2-day moving averages concentrations of day 0 and day 1 of PM 10 , CO and NO 2 corresponded to 0.99 [95% confidence interval (CI): 0.30, 1.67], 0.89 (95% CI: 0.27, 1.51) and 0.95 (95% CI: 0.29, 1.61) percent increase in daily respiratory mortality, respectively. The effects were varied across the districts. The strongest effects were found in two rural districts and one suburban district but significant in only one district. In conclusion, high level of several traffic-related air pollutants is associated with an increased risk of respiratory mortality in Beijing over a short-time period. The high risk found in rural areas suggests a potential susceptible sub-population with undiagnosed respiratory diseases in these areas. Although the rural areas have relatively lower air pollution levels, they deserve more attention to respiratory disease prevention and air pollution reduction. [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]

Numerous studies have described the adverse associations between particle mass and respiratory health. The aim of the study was to analyze the associations of particle properties, especially size-segregated particle number concentrations (PNC), and respiratory mortality in Beijing, P.R. China. We gathered daily values of respiratory mortality and air pollution data of the Beijing urban area. Generalized additive models were used to estimate the associations. Single pollutant models showed that delayed concentrations of SO2, total PNCs, and PNC of 300–1000 nm were adversely associated with total respiratory mortality. There was an indication that adverse health effects of PNCs might be stronger for stagnant air masses. Two-pollutant models verified the independence of associations of total PNCs of other pollutants (SO2, NO2, and PM10). In conclusion, particle number concentrations, especially accumulation mode particles, might be factors influencing the adverse associations between particulate matter and respiratory health. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent toxicological and epidemiological studies have shown associations between particulate matter (PM) and adverse health effects, but which PM components are most influential is less well known. OBJECTIVES: In this study, we used time-series analyses to determine the associations between daily fine PM [PM ≤ 2.5 μm in aerodynamic diameter (PM2.5)] concentrations and daily mortality in two U.S. cities--Seattle, Washington, and Detroit, Michigan. METHODS: We obtained daily PM2.5 filters for the years of 2002-2004 and analyzed trace elements using X-ray fluorescence and black carbon using light reflectance as a surrogate measure of elemental carbon. We used Poisson regression and distributed lag models to estimate excess deaths for all causes and for cardiovascular and respiratory diseases adjusting for time-varying covariates. We computed the excess risks for interquartile range increases of each pollutant at lags of 0 through 3 days for both warm and cold seasons. RESULTS: The cardiovascular and respiratory mortality series exhibited different source and seasonal patterns in each city. The PM2.5 components and gaseous pollutants associated with mortality in Detroit were most associated with warm season secondary aerosols and traffic markers. In Seattle, the component species most closely associated with mortality included those for cold season traffic and other combustion sources, such as residual oil and wood burning. CONCLUSIONS: The effects of PM2.5 on daily mortality vary with source, season, and locale, consistent with the hypothesis that PM composition has an appreciable influence on the health effects attributable to PM. [ABSTRACT FROM AUTHOR]

Abstract: During the June 1996 eruption of Mt Ruapehu, New Zealand, traces of fine particulate volcanic ash were observed in or near the cities of Hamilton and Auckland, 166–282 km from the volcano. Although no health impacts in these cities were attributed to the eruption, hospital records at both cities for the following month show the highest rates of respiratory mortality for the 1990s. Alternative explanations for this increase in respiratory mortality were investigated, including urban air pollution, adverse weather conditions and influenza. Comparable records from Wellington city, assumed to be outside the zone of ash dispersal, were used as a ‘control’. Our results suggest that at Hamilton, where non-volcanic factors can largely be eliminated as making a significant contribution, diffuse volcanic ashfall may have been an important factor in respiratory mortality during the weeks following the eruption. At Auckland, further away from the volcano but with a much larger population than Hamilton, a case for a weaker volcanic contribution can be made, but is more equivocal because of coincidentally high urban air pollution and cold, stable weather. These findings support the concept that diffuse fine volcanic ash poses a risk to respiratory health at greater distances from an eruption than is currently perceived. This is because the finest ‘respirable’ fraction of erupted material with potentially hazardous physico-chemical properties is likely to be ejected highest into the atmosphere and dispersed the greatest distance. If significant amounts reach large cities, then large numbers of individuals may be at risk, especially those already suffering poor respiratory health. This work has important implications for environmental health and hazard management in New Zealand and in other regions that may be susceptible to a similar volcanic threat. [Copyright &y& Elsevier]

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]

Background: Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect.Methods: An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented.Results: The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed.Conclusions: This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure. [ABSTRACT FROM AUTHOR]

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/m3) 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. [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]