NDLI: Modification of heat-related effects on mortality by air pollution concentration, at small-area level, in the Attica prefecture, Greece

Content Provider	Springer Nature : BioMed Central
Author	Zafeiratou, Sofia Samoli, Evangelia Analitis, Antonis Dimakopoulou, Konstantina Giannakopoulos, Christos Varotsos, Konstantinos V. Schneider, Alexandra Stafoggia, Massimo Aunan, Kristin Katsouyanni, Klea
Abstract	Background The independent effects of short-term exposure to increased air temperature and air pollution on mortality are well-documented. There is some evidence indicating that elevated concentrations of air pollutants may lead to increased heat-related mortality, but this evidence is not consistent. Most of these effects have been documented through time-series studies using city-wide data, rather than at a finer spatial level. In our study, we examined the possible modification of the heat effects on total and cause-specific mortality by air pollution at municipality level in the Attica region, Greece, during the warm period of the years 2000 to 2016. Methods A municipality-specific over-dispersed Poisson regression model during the warm season (May–September) was used to investigate the heat effects on mortality and their modification by air pollution. We used the two-day average of the daily mean temperature and daily mean PM10, NO2 and 8 hour-max ozone (O3), derived from models, in each municipality as exposures. A bivariate tensor smoother was applied for temperature and each pollutant alternatively, by municipality. Α random-effects meta-analysis was used to obtain pooled estimates of the heat effects at different pollution levels. Heterogeneity of the between-levels differences of the heat effects was evaluated with a Q-test. Results A rise in mean temperature from the 75th to the 99th percentile of the municipality-specific temperature distribution resulted in an increase in total mortality of 12.4% (95% Confidence Interval (CI):7.76–17.24) on low PM10 days, and 21.25% (95% CI: 17.83–24.76) on high PM10 days. The increase on mortality was 10.09% (95% CI: − 5.62- 28.41) on low ozone days, and 14.95% (95% CI: 10.79–19.27) on high ozone days. For cause-specific mortality an increasing trend of the heat effects with increasing PM10 and ozone levels was also observed. An inconsistent pattern was observed for the modification of the heat effects by NO2, with higher heat effects estimated in the lower level of the pollutant. Conclusions Our results support the evidence of elevated heat effects on mortality at higher levels of PM10 and 8 h max O3. Under climate change, any policy targeted at lowering air pollution levels will yield significant public health benefits.
Related Links	https://ehjournal.biomedcentral.com/counter/pdf/10.1186/s12940-024-01053-7.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s12940-024-01053-7
Journal	Environmental Health
Issue Number	1
Volume Number	23
Language	English
Publisher	BioMed Central
Publisher Date	2024-01-24
Access Restriction	Open
Subject Keyword	Occupational Medicine Industrial Medicine Public Health Environmental Health Mortality Air temperature Air pollution Effect modification Occupational Medicine/Industrial Medicine
Content Type	Text
Resource Type	Article
Subject	Health, Toxicology and Mutagenesis Public Health, Environmental and Occupational Health
Journal Impact Factor	5.4/2023
5-Year Journal Impact Factor	6.7/2023

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