| BackgroundAir pollution is a serious public health problem worldwide and poses a major threat to public health.Although countries around the world have taken many measures to control air pollution,the health hazards of air pollution cannot be ignored,especially for particulate matter.Particulate matter is related to a range of adverse health outcomes,such as cardiovascular disease,respiratory dysfunction and death.The health effect of particulate matter is closely related to its aerodynamic diameter,which determines its diffusion and penetration depth in respiratory system and cardiovascular system.Numerous studies have shown that particulate matter with smaller aerodynamic diameter has a greater impact on human health.Larger particles,such as inhalable particles,also known as PM10,usually affect the upper respiratory tract.Fine particulate matter PM2.5 can enter the blood circulation system through the respiratory system,and directly affect the functions of various organs and thus increase the risk of diseases.PM1 particles are smaller and can penetrate into the alveoli and further migrate into the cell tissue or circulatory system.Non-optimal ambient temperature is another important environmental risk factor.Numerous studies have reported that exposure to both extreme cold and extreme heat is associated with adverse health outcomes.Air temperature can affect surface air quality by affecting the transport and emission of air pollutants and atmospheric chemical reactions.On the other hand,air pollution may also amplify vulnerability to the adverse effects of temperature.In the context of global warming,the modification effect of air pollution on the association between temperature and death may be more pronounced.Although studies have explored the modifiers of particulate matter on cold-or heat-related health risks,few studies have investigated the modification effect of different particle size particles on temperaturehealth effects and their differences.This study can help to better understand the combined disease burden of these two environmental exposures and to develop more targeted health promotion strategies.In addition,the composition of particulate matter is complex,containing many major and minor components.PM2.5 is composed of various organic and inorganic substances,such as black carbon(BC),ammonium(NH4+),nitrate(NO3-),organic matter(OM),sulfate(SO42-),soil particles and sea salt(SS),and different components have different toxicity to human body.At present,there are extensive studies investigate the independent effects of PM2.5 components on human health,but few studies focus on the interaction between PM2.5 components and temperature.The study aims to provide a more comprehensive assessment of the health risks posed by PM2.5.The fifth annual Lancet Countdown report and national environmental monitoring data show that extreme temperature events have become more frequent in Shandong province in recent years.In addition,the elderly are susceptible to air pollution and climate change.Shandong Province,as the second largest province in population,is also a province with a high degree of population aging.Therefore,this study aims to quantify the impact of air pollution and extreme temperature on residents’ health and their interaction based on the monitoring data of residents’ causes of death in Shandong Province,so as to help prevent and reduce the health hazards of air pollution and extreme temperature,and to provide a scientific basis for improving air pollution monitoring and strengthening the risk prevention of extreme temperature.Objectives:1.To explore the impact of particulate matters with different particle sizes on the mortality risk of residents in Shandong Province,China.2.To explore the interaction effect between particulate matters with different particle sizes,PM2.5 components and extreme air temperature on the mortality risk of residents.Methods:The daily cause of death surveillance data of residents in 1822 township administrative districts in Shandong Province from 2013 to 2018 was obtained from the Shandong Provincial Center for Disease Control and Prevention.The basic information included the date of death,age,sex,education level and the cause of death under the definition of the 10th version of the International Classification of Diseases.The average daily concentrations of PM1 and PM2.5 were obtained from China National Environmental Monitoring Center with a spatial resolution of 0.01°×0.01°.PM2.5 component data are derived from the Tracking Air Pollution in China(TAP)dataset,including OM,BC,NO3-,SO42-and NH4+.The daily meteorological data were obtained from China Meteorological Data Network(http://data.cma.cn/)with a spatial resolution of 0.01°×0.01°,including daily mean temperature,relative humidity and wind speed.Meteorological and pollutant data were matched with daily deaths at street scale.In this study,a time-stratified case-crossover design was used to analyze the effects of PM1 and PM2.5 on population mortality in Shandong Province.This study combined the distributed lag nonlinear model with the conditional logistic regression model to explore the association between PM1 and PM2.5 and the mortality risk of residents.Considering the large difference in particulate matter concentration between winter and summer,the seasonal stratification method was adopted in this study to investigate the interaction of particulate matters with different particle sizes(PM1 and PM2.5)and PM2.5 components with extreme temperature in different seasons.Combined with previous literatures,this study defined the cold season as November to February of the next year and the hot season as June to September of each year according to the monthly average temperature.The modification effect of PM and PM2.5 components on temperature-mortality association ware explored by including the interaction terms between particulate matters with different particle sizes and PM2.5 components and ambient temperature,respectively.PM and PM2.5 components were divided into high and low levels by the 10th and 90th percentiles of their concentration range during the study period.The health effect of extreme cold and extreme heat were defined as the cumulative OR of mortality risk at the 1st temperature percentile during the cold season,and the cumulative OR of mortality risk at the 99th percentile during the hot season compared to the minimum mortality temperature(MMT),respectively.Main results:1.From 2013 to 2018,a total of 3847052 deaths were recorded in all township administrative districts in Shandong Province,among which males accounted for 56.8%and females accounted for 43.2%.In terms of causes of death,respiratory and circulatory diseases accounted for more than 2304902 deaths,accounting for 59.9%of the total number of deaths.The mean concentrations of PM1 and PM2.5 in Shandong Province were 42.5μg/m3 and 64.5μg/m3,and the mean temperature was 12.3℃.2.The cumulative OR values per10 μg/m3 increase in PM1 and PM2.5 was 1.0149(95%CI:1.0120,1.0178)and 1.0054(95%CI:1.0046,1.0063),respectively,and the mortality risk was higher for particulate matters with smaller particle size.Stratified analysis showed that women,people over 75 years and patients with respiratory and circulatory diseases were more susceptible to PM1 and PM2.5,with statistically significant differences among subgroups.3.During the hot season,the cumulative OR values related to PM1 and PM2.5 was 1.0145(95%CI:1.0066,1.0225)and 1.0075(95%CI:1.0036,1.0114),respectively.During the cold season,the cumulative OR values related to PM1 and PM2.5 was 1.0111(95%CI:1.0074,1.0147)and 1.0042(95%CI:1.0033,1.0051),respectively.The mortality risk associated with extreme temperatures was higher under higher levels of PM1 and PM2.5 pollution.During the cold season,the cumulative OR values corresponding to extreme cold with a lag of 0-12 days were 2.20(95%CI:1.83,2.64)and 2.24(95%CI:1.78,2.81)under high levels of PM1 and PM2.5 concentrations,while the cumulative OR values corresponding to extreme cold decreased to 1.60(95%CI:1.39,1.84)and 1.60(95%CI:1.37,1.88)under low levels of PM1 and PM2.5 concentrations.Stratified analysis showed that elderly over 75 years and patients with respiratory and circulatory diseases were more susceptible to the modification effect of air temperature on particulate matter.4.During the cold season,the mortality risk related to OM was the highest(OR=1.0313,95%CI:1.0223,1.0404)among all PM2.5 components when the concentration of each PM2.5 components increased by one interquartile range(IQR).The mortality risk associated with extreme temperatures was higher when the five major components of PM2.5 were at high pollution levels.In cold season,the mortality risk related to extreme cold was highest for each IQR increase in OM(OR=1.53,95%CI:1.24,1.88).In hot season,the mortality risk associated with extreme heat was the highest(OR=1.55,95%CI:1.22,1.97)for each IQR increase in NO3-.Stratified analysis showed that elderly over 75 years and patients with respiratory and circulatory diseases were more susceptible to the modification effect of air temperature on PM2.5 components.Conclusions:1.Short-term exposure to particulate matter is significantly associated with the mortality risk of residents in Shandong Province,and the mortality risk associated with smaller particle size PM1 is significantly higher than that of PM2.5.2.The influence of particulate matter and PM2.5 components and air temperature on mortality has bidirectional modification effect.The mortality risk related to PM1 and PM2.5 was higher in hot season,while the mortality risk related to PM2.5 components was higher in cold season.Higher concentrations of particulate matter and PM2.5 components increased the risk of extreme temperature-related death,and the modification effect was stronger for smaller particulate matter.3.People over 75 years and those with respiratory and circulatory diseases are vulnerable to extreme temperature and particulate matter pollution,and should be prioritized when developing health care strategies. |
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