دانلود رایگان مقاله انگلیسی تجمع شهری کوتاه مدت تعدیل شده جوی آلودگی هوا با مرگ و میر ناشی از پنومونی - الزویر 2019

abstract

Background: City is becoming warmer, especially in the process of urbanization and climate change. However, it is largely unknown whether this warming urban climate may modify the short-term effects of air pollution. Objectives: To test whether warmer urban climates intensify the acute mortality effects of air pollution on pneumonia in Hong Kong. Methods: Participants who died of pneumonia from a prospective Chinese elderly cohort between 1998 and 2011 were selected as cases. Urban climatic (UC) classes of cases were determined by an established Urban Climatic Map according to their residential addresses. UC classes were first dichotomized into cool and warm climates and case-crossover analysis was used to estimate the short-term association of pneumonia mortality with air pollution. We further classified UC classes into climate quartiles and used case-only analysis to test the trend of urban climate modification on the short-term association of pneumonia mortality with air pollution. Results: Among 66,820 elders (≥65 years), 2208 pneumonia deaths (cases) were identified during the 11–14 years of follow-up. The effects of air pollution for cases residing in the warm climate were statistically significant (p b 0.05) higher than those living in the cool climate. There was an increasing linear trend of urban climate modification on the association of pneumonia mortality with NO2 (nitrogen dioxide) (p for trend = 0.035). Compared to climate Quartile 1 (the lowest), deaths resided in climate Quartile 2, 3, and 4 (the highest) were associated with an additional percent change of 9.07% (0.52%, 17.62%), 12.89% (4.34%, 21.43%), and 8.45% (−0.10%, 17.00%), respectively. Conclusions: Warmer urban climate worsened the acute mortality effects of pneumonia associated with air pollutants in Hong Kong. Our findings suggest that warmer urban climate introduced by climate change and urbanization may increase the risks of air pollution-related pneumonia.

4. Discussion

In the present study, pneumonia cases resided in the warm climate or warmer climate quartiles were associated with stronger acute mortality effects of air pollution on pneumonia, especially for NO2 air pollution. Our findings indicate that warmer urban climate may worsen the association of pneumonia mortality with air pollution. Our findings were consistent with a few large-scale multicity studies using annual mean temperature or using latitude to represent city climate which suggested that the risk estimates of air pollution were higher in warmer cities (Katsouyanni et al., 2009; Katsouyanni et al., 2001; Kioumourtzoglou et al., 2015). For example, the Air Pollution and Health: A European Approach Phase-2, a large-scale multi-city epidemiological study, examined 29 European cities, and reported that mortality effect of PM10 per 10 μg/m3 increase in ER% was stronger in cities with warm climate (0.82%) than that in relatively cold climate (0.29%) (Katsouyanni et al., 2001). Although few studies have investigated the interaction between climate and air pollution on human health, a great number of epidemiological studies have investigated the modification effects of weather (De Sario et al., 2013; Medina-Ramon et al., 2006; Meng et al., 2012; Sun et al., 2015). Meng et al. (2012) examined eight Chinese cities with a total population of 36.1 million and demonstrated that the risk estimates on high temperature days (N95th percentile) versus normal temperature days (5th–95th percentile) increased by 0.81% for total mortality, 1.01% for cardiovascular mortality, and 0.99% for respiratory diseases per 10 μg/m3 increment in PM10. These findings were based on the short-term modification of weather, instead of urban climate modification where we need to take potential acclimatization into account.