Extreme Temperature Events, Fine Particulate Matter, and Myocardial Infarction Mortality.

BACKGROUND: Extreme temperature events (ETEs), including heat wave and cold spell, have been linked to myocardial infarction (MI) morbidity; however, their effects on MI mortality are less clear. Although ambient fine particulate matter (PM2.5) is suggested to act synergistically with extreme temperatures on cardiovascular mortality, it remains unknown if and how ETEs and PM2.5 interact to trigger MI deaths. METHODS: A time-stratified case-crossover study of 202 678 MI deaths in Jiangsu province, China, from 2015 to 2020, was conducted to investigate the association of exposure to ETEs and PM2.5 with MI mortality and evaluate their interactive effects. On the basis of ambient apparent temperature, multiple temperature thresholds and durations were used to build 12 ETE definitions. Daily ETEs and PM2.5 exposures were assessed by extracting values from validated grid datasets at each subject's geocoded residential address. Conditional logistic regression models were applied to perform exposure-response analyses and estimate relative excess odds due to interaction, proportion attributable to interaction, and synergy index. RESULTS: Under different ETE definitions, the odds ratio of MI mortality associated with heat wave and cold spell ranged from 1.18 (95% CI, 1.14-1.21) to 1.74 (1.66-1.83), and 1.04 (1.02-1.06) to 1.12 (1.07-1.18), respectively. Lag 01-day exposure to PM2.5 was significantly associated with an increased odds of MI mortality, which attenuated at higher exposures. We observed a significant synergistic interaction of heat wave and PM2.5 on MI mortality (relative excess odds due to interaction >0, proportion attributable to interaction >0, and synergy index >1), which was higher, in general, for heat wave with greater intensities and longer durations. We estimated that up to 2.8% of the MI deaths were attributable to exposure to ETEs and PM2.5 at levels exceeding the interim target 3 value (37.5 µg/m3) of World Health Organization air quality guidelines. Women and older adults were more vulnerable to ETEs and PM2.5. The interactive effects of ETEs or PM2.5 on MI mortality did not vary across sex, age, or socioeconomic status. CONCLUSIONS: This study provides consistent evidence that exposure to both ETEs and PM2.5 is significantly associated with an increased odds of MI mortality, especially for women and older adults, and that heat wave interacts synergistically with PM2.5 to trigger MI deaths but cold spell does not. Our findings suggest that mitigating both ETE and PM2.5 exposures may bring health cobenefits in preventing premature deaths from MI.

Ozone, Heat Wave, and Cardiovascular Disease Mortality: A Population-Based Case-Crossover Study.

A case-crossover study among 511,767 cardiovascular disease (CVD) deaths in Jiangsu province, China, during 2015-2021 was conducted to assess the association of exposure to ambient ozone (O3) and heat wave with CVD mortality and explore their possible interactions. Heat wave was defined as extreme high temperature for at least two consecutive days. Grid-level heat waves were defined by multiple combinations of apparent temperature thresholds and durations. Residential O3 and heat wave exposures were assessed using grid data sets (spatial resolution: 1 km × 1 km for O3; 0.0625° × 0.0625° for heat wave). Conditional logistic regression models were applied for exposure-response analyses and evaluation of additive interactions. Under different heat wave definitions, the odds ratios (ORs) of CVD mortality associated with medium-level and high-level O3 exposures ranged from 1.029 to 1.107 compared with low-level O3, while the ORs for heat wave exposure ranged from 1.14 to 1.65. Significant synergistic effects on CVD mortality were observed for the O3 and heat wave exposures, which were generally greater with higher levels of the O3 exposure, higher temperature thresholds, and longer durations of heat wave exposure. Up to 5.8% of the CVD deaths were attributable to O3 and heat wave. Women and older adults were more vulnerable to the exposure to O3 and heat wave exposure. Exposure to both O3 and heat wave was significantly associated with an increased odds of CVD mortality, and O3 and heat wave can interact synergistically to trigger CVD deaths.

Heat wave exposure and semen quality in sperm donation volunteers: A retrospective longitudinal study in south China.

BACKGROUND: Previous studies have suggested an association between non-optimum ambient temperature and decreased semen quality. However, the effect of exposure to heat waves on semen quality remains unclear. METHODS: Volunteers who intended to donate sperm in Guangdong provincial human sperm bank enrolled. Heat waves were defined by temperature threshold and duration, with a total of 9 definitions were employed, specifying daily mean temperature exceeding the 85th, 90th, or 95th percentile for at least 2, 3, or 4 consecutive days. Residential exposure to heat waves during 0-90 days before ejaculation was evaluated using a validated gridded dataset on ambient temperature. Association and potential windows of susceptibility were evaluated and identified using linear mixed models and distributed lag non-linear models. RESULTS: A total of 2183 sperm donation volunteers underwent 8632 semen analyses from 2018 to 2019. Exposure to heat wave defined as daily mean temperature exceeding the 95th percentile for at least 4 consecutive days (P95-D4) was significantly associated with a 0.11 (95% confidence interval [CI]: 0.03, 0.18) ml, 3.36 (1.35, 5.38) × 106/ml, 16.93 (7.95, 25.91) × 106, and 2.11% (1.4%, 2.83%) reduction in semen volume, sperm concentration, total sperm number, and normal forms, respectively; whereas exposure to heat wave defined as P90-D4 was significantly associated with a 1.98% (1.47%, 2.48%) and 2.08% (1.57%, 2.58%) reduction in total motility and progressive motility, respectively. Sperm count and morphology were susceptible to heat wave exposure during the early stage of spermatogenesis, while sperm motility was susceptible to exposure during the late stage. CONCLUSION: Heat wave exposure was significantly associated with a reduction in semen quality. The windows of susceptibility during 0-90 days before ejaculation varied across sperm count, motility, and morphology. Our findings suggest that reducing heat wave exposure before ejaculation may benefit sperm donation volunteers and those attempting to conceive.

Short-term exposure to ambient air pollution and pneumonia hospital admission among patients with COPD: a time-stratified case-crossover study.

BACKGROUND: Pneumonia is a major contributor to hospital admission for patients with chronic obstructive pulmonary disease (COPD). However, evidence for acute effects of ambient air pollution exposure on pneumonia hospital admission among patients with COPD is scarce. We aimed to examine the association between short-term exposure to ambient air pollution and pneumonia hospital admission among patients with COPD. METHODS: We enrolled COPD cases aged ≥ 60 years old and further filtered those who were admitted into hospitals from pneumonia during 2016-2019 in Guangdong province, China for main analysis. A time-stratified case-crossover design was applied to investigate the association and conditional logistic regression model was used for data analysis. We performed inverse distance weighting method to estimate daily individual-level exposure on particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) based on personal residential addresses. RESULTS: We included 6473 pneumonia hospital admissions during the study period. Each interquartile range (IQR) increase in PM2.5 (lag 2; IQR, 22.1 µg/m3), SO2 (lag 03; IQR, 4.2 µg/m3), NO2 (lag 03; IQR, 21.4 µg/m3), and O3 (lag 04; IQR, 57.9 µg/m3) was associated with an odds ratio in pneumonia hospital admission of 1.043 (95% CI: 1.004-1.083), 1.081 (95% CI: 1.026-1.140), 1.045 (95% CI: 1.005-1.088), and 1.080 (95% CI: 1.018-1.147), respectively. Non-linear trends for PM2.5, PM10, and SO2 were observed in the study. Sex, age at hospital admission, and season at hospital admission did not modify the associations. CONCLUSIONS: We found significantly positive associations of short-term exposure to PM2.5, SO2, NO2, and O3 with pneumonia hospital admission among COPD patients. It provides new insight for comprehensive pneumonia prevention and treatment among COPD patients.

Association of short-term exposure to ambient air pollution with mortality from ischemic and hemorrhagic stroke.

BACKGROUND: Short-term exposure to ambient air pollution has been linked to increased risk of stroke mortality, but its adverse effects on mortality from specific types of stroke including ischemic stroke and hemorrhagic stroke remain poorly understood. METHODS: Using the China National Mortality Surveillance System, we conducted a time-stratified case-crossover study among 412,567 stroke deaths in Jiangsu province, China during 2015-2019. Residential daily PM2.5 , PM10 , SO2 , NO2 , CO, and O3 exposure concentrations were extracted from the ChinaHighAirPollutants dataset for each subject. Conditional logistic regression models were performed to conduct exposure-response analyses. RESULTS: Each 10 µg/m3 increase of PM2.5 , PM10 , SO2 , NO2 , CO, and O3 was respectively associated with a 1.44%, 0.93%, 5.55%, 2.90%, 0.148%, and 0.54% increase in odds of mortality from ischemic stroke, which was significantly stronger than that from hemorrhagic stroke (percent change in odds: 0.74%, 0.51%, 3.11%, 1.15%, 0.090%, and 0.10%). The excess fraction of ischemic stroke mortality associated with PM2.5 , PM10 , SO2 , NO2 , CO, and O3 exposure was 6.90%, 6.48%, 8.21%, 8.61%, 9.67%, and 4.76%, respectively, which was also significantly higher than that of hemorrhagic stroke mortality (excess fraction: 3.49%, 3.48%, 4.69%, 3.48%, 5.86%, and 0.88%). These differences in adverse effects generally remained across sex, age, and season. CONCLUSIONS: Short-term exposure to ambient air pollution was significantly associated with increased risk of both ischemic and hemorrhagic stroke mortality and posed considerable excess mortality. Our results suggest that air pollution exposure may lead to substantially greater adverse effects on mortality from ischemic stroke than that from hemorrhagic stroke.

Asthma mortality attributable to ambient temperatures: A case-crossover study in China.

BACKGROUND: Whether ambient temperature exposure contributes to death from asthma remains unknown to date. We therefore conducted a case-crossover study in China to quantitatively evaluate the association and burden of ambient temperature exposure on asthma mortality. METHODS: Using data from the National Mortality Surveillance System in China, we conducted a time-stratified case-crossover study of 15 888 individuals who lived in Hubei and Jiangsu province, China and died from asthma as the underlying cause in 2015-2019. Individual-level exposures to air temperature and apparent temperature on the date of death and 21 days prior were assessed based on each subject's residential address. Distributed lag nonlinear models based on conditional logistic regression were used to quantify exposure-response associations and calculate fraction and number of deaths attributable to non-optimum ambient temperatures. RESULTS: We observed a reverse J-shaped association between air temperature and risk of asthma mortality, with a minimum mortality temperature of 21.3 °C. Non-optimum ambient temperature is responsible for substantial excess mortality from asthma. In total, 26.3% of asthma mortality were attributable to non-optimum temperatures, with moderate cold, moderate hot, extreme cold and extreme hot responsible for 21.7%, 2.4%, 2.1% and 0.9% of asthma mortality, respectively. The total attributable fraction and number was significantly higher among adults aged less than 80 years in hot temperature. CONCLUSIONS: Exposure to non-optimum ambient temperature, especially moderate cold temperature, was responsible for substantial excess mortality from asthma. These findings have important implications for planning of public-health interventions to minimize the adverse respiratory damage from non-optimum ambient temperature.

Cause-specific cardiovascular disease mortality attributable to ambient temperature: A time-stratified case-crossover study in Jiangsu province, China.

BACKGROUND: Exposure to non-optimum ambient temperature has been linked to increased risk of total cardiovascular disease (CVD) mortality; however, the adverse effects on mortality from specific types of CVD remain less understood. OBJECTIVES: To comprehensively investigate the association of ambient temperature with cause-specific CVD mortality, and to estimate and compare the corresponding mortality burden. METHODS: We conducted a time-stratified case-crossover study of 1000,014 CVD deaths in Jiangsu province, China during 2015-2019 using data from the China National Mortality Surveillance System. Residential daily 24-hour average temperature for each subject was extracted from a validated grid data at a spatial resolution of 0.0625° × 0.0625°. We fitted distributed lag non-linear models (DLNM) based on conditional logistic regression to quantitatively investigate the association of ambient temperature with total and cause-specific CVD mortality, which was used to further estimate mortality burden attributable to non-optimum ambient temperatures. RESULTS: With adjustment for relative humidity, we observed reverse J-shaped exposure-response associations of ambient temperature with total and cause-specific CVD mortality, with minimum mortality temperatures ranging from 19.5 °C to 23.0 °C. An estimated 20.3% of the total CVD deaths were attributable to non-optimum temperatures, while the attributable fraction (AF) of mortality from chronic rheumatic heart diseases, hypertensive diseases, ischemic heart diseases (IHD), pulmonary heart disease, stroke, and sequelae of stroke was 22.4%, 23.2%, 23.3%, 20.9%, 17.6% and 21.3%, respectively. For total and cause-specific CVDs, most deaths were attributable to moderate cold temperature. We observed significantly higher mortality burden from total and certain cause-specific CVDs in adults 80 years or older and those who were widowed. CONCLUSION: Exposure to ambient temperature was significantly associated with increased risk of cause-specific CVD mortality. The burden of CVD mortality attributable to non-optimum temperature was substantial especially in older and widowed adults, and significantly varied across specific types of CVD.

The comparison of AOD-based and non-AOD prediction models for daily PM2.5 estimation in Guangdong province, China with poor AOD coverage.

The large amount of missing values has challenged the application of satellite-retrieved aerosol optical depth (AOD) in mapping surface PM2.5 concentrations. In this study, we developed a non-AOD random forest model to estimate daily concentrations of PM2.5 in Guangdong Province, China, where more than 80% of AOD data were missing. The predictive ability of the non-AOD model was compared with that of a AOD-based model. Daily ground-based measurements of PM2.5 were obtained from 148 ground-monitoring sites in Guangdong with a 60 km rectangle buffer from January 2016 to December 2018. Daily MODIS MAIAC AOD were downloaded from NASA at a resolution of approximately 1 km. Two random forest models were developed to predict ground-level PM2.5 with one included AOD as a predictor and the other one without AOD. The two random forest models were developed using the same dataset and their predictive abilities were compared. The results of 10-fold cross validation (CV) showed that the non-AOD and AOD-based random forest models yielded similar performance. The CV R2 (RMSE) for the non-AOD model in 2016-2018 were 0.82 (8.4 µg/m3), 0.81 (9.5 µg/m3) and 0.78 (9.4 µg/m3), and those for AOD-based model were 0.83 (8.2 µg/m3), 0.82 (9.2 µg/m3) and 0.80 (9.0 µg/m3), respectively. Higher consistency of estimated PM2.5 were observed in areas close to monitoring sites than those far away from sites, and in southern coastal than northern areas. As the non-AOD random forest model is not affected by AOD missingness, it can be used for epidemiological studies to estimate individual-level exposure to PM2.5 at a high resolution without spatial or temporal gaps.

Association of exposure to residential greenness with semen quality: A retrospective longitudinal study of sperm donation volunteers in Guangdong province, China.

BACKGROUND: Exposure to residential greenness has been associated with benefits on certain reproductive health outcomes. However, its potential benefits on semen quality remain unknown. OBJECTIVES: To quantitatively explore the association between exposure to residential greenness and semen quality. METHODS: We investigated 9142 sperm donation volunteers who underwent 38,682 semen examinations at Guangdong provincial human sperm bank in China during 2016-2019. Exposure to residential greenness was assessed using mean daily Normalized Difference Vegetation Index (NDVI) at each subject's residential address with a 400 m buffer during 0-90 days before each semen collection. Multivariate linear mixed models and linear regression models were used to assess the association between exposure to residential greenness and semen quality. RESULTS: An interquartile range increase in exposure to residential greenness was significantly associated with a 0.034 (95% confidence interval [CI]: 0.005, 0.063) ml, 4.06 (95% CI: 0.76, 7.37) × 106, and 0.32% (95% CI: 0.22%, 0.41%) increase in semen volume, total sperm number, and normal forms, respectively; similar trends were observed across quartiles of exposure to residential greenness (all p-values for liner trend <0.05 except for semen volume). The association of greenness exposure with semen volume and total sperm number was stronger in subjects 18-25 years, while the association with normal forms was stronger in subjects 26 years or older. The association for sperm concentration, total sperm number, and normal forms were stronger in cool season, while the association for semen volume was stronger in warm season. CONCLUSION: We found that exposure to residential greenness was significantly associated with higher semen quality. Further studies are warranted to determine the causality of the association and its underlying mechanisms.

Ambient air pollution and hospitalization for chronic obstructive pulmonary disease: Benefits from Three-Year Action Plan.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) hospitalization has been linked with ambient air pollution. However, the evidence on respiratory health benefits from air pollution control policy in China is limited. OBJECTIVE: To investigate benefits from the Three-Year Action Plan to Win the Battle for a Blue Sky (TYAP) for tackling COPD hospitalization due to ambient air pollution. METHODS: We conducted a time-stratified case-crossover study of 138,015 COPD hospitalizations aged ≥ 60 years in Guangdong province, China during 2016-2019 to investigate respiratory health benefits from TYAP. Inverse distance weighting method was used to assess daily individual-level exposures to ambient air pollutants including particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). Conditional logistic regression model was applied to analyze the associations between ambient air pollutants and COPD hospitalization. RESULTS: TYAP can modify the associations. Each 10 µg/m3 increase of exposure to PM2.5, PM10, and NO2 and 1 mg/m3 increase of exposure to CO were significantly associated with 2.5%, 2.0%, 3.0%, and 14.4% increase in odds of COPD hospitalization before TYAP, respectively; while 1.0%, 0.9%, 1.5%, and 5.8% increase in odds during TYAP. We found prominent declines in health burden of COPD hospitalizations due to air pollution among the elderly after TYAP implication when compared with that before TYAP. CONCLUSION: Reduced levels of ambient air pollutants by TYAP can effectively lower the risk for COPD hospitalization among the elderly, which provides evidence on the respiratory health benefits from consistent and effective air pollution control policy.