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- Interactive effects of ambient fine particulate matter and ozone on daily mortality in 372 cities: two stage time series analysisPublication . Liu, Cong; Chen, Renjie; Sera, Francesco; Vicedo-Cabrera, Ana Maria; Guo, Yuming; Tong, Shilu; Lavigne, Eric; Correa, Patricia Matus; Ortega, Nicolás Valdés; Achilleos, Souzana; Roye, Dominic; Jaakkola, Jouni J.K.; Ryti, Niilo; Pascal, Mathilde; Schneider, Alexandra; Breitner, Susanne; Entezari, Alireza; Mayvaneh, Fatemeh; Raz, Raanan; Honda, Yasushi; Hashizume, Masahiro; Ng, Chris Fook Sheng; Gaio, Vânia; Madureira, Joana; Holobaca, Iulian-Horia; Tobias, Aurelio; Íñiguez, Carmen; Guo, Yue Leon; Pan, Shih-Chun; Masselot, Pierre; Bell, Michelle L.; Zanobetti, Antonella; Schwartz, Joel; Gasparrini, Antonio; Kan, HaidongObjective: To investigate potential interactive effects of fine particulate matter (PM2.5) and ozone (O3) on daily mortality at global level. Design: Two stage time series analysis. Setting: 372 cities across 19 countries and regions. Population: Daily counts of deaths from all causes, cardiovascular disease, and respiratory disease. Main outcome measure: Daily mortality data during 1994-2020. Stratified analyses by co-pollutant exposures and synergy index (>1 denotes the combined effect of pollutants is greater than individual effects) were applied to explore the interaction between PM2.5 and O3 in association with mortality. Results: During the study period across the 372 cities, 19.3 million deaths were attributable to all causes, 5.3 million to cardiovascular disease, and 1.9 million to respiratory disease. The risk of total mortality for a 10 μg/m3 increment in PM2.5 (lag 0-1 days) ranged from 0.47% (95% confidence interval 0.26% to 0.67%) to 1.25% (1.02% to 1.48%) from the lowest to highest fourths of O3 concentration; and for a 10 μg/m3 increase in O3 ranged from 0.04% (-0.09% to 0.16%) to 0.29% (0.18% to 0.39%) from the lowest to highest fourths of PM2.5 concentration, with significant differences between strata (P for interaction <0.001). A significant synergistic interaction was also identified between PM2.5 and O3 for total mortality, with a synergy index of 1.93 (95% confidence interval 1.47 to 3.34). Subgroup analyses showed that interactions between PM2.5 and O3 on all three mortality endpoints were more prominent in high latitude regions and during cold seasons. Conclusion: The findings of this study suggest a synergistic effect of PM2.5 and O3 on total, cardiovascular, and respiratory mortality, indicating the benefit of coordinated control strategies for both pollutants.
- Mortality risks associated with floods in 761 communities worldwide: time series studyPublication . Yang, Zhengyu; Huang, Wenzhong; McKenzie, Joanne E.; Xu, Rongbin; Yu, Pei; Ye, Tingting; Wen, Bo; Gasparrini, Antonio; Armstrong, Ben; Tong, Shilu; Lavigne, Eric; Madureira, Joana; Kyselý, Jan; Guo, Yuming; Li, Shanshan; MCC Collaborative Research NetworkObjective: To evaluate lag-response associations and effect modifications of exposure to floods with risks of all cause, cardiovascular, and respiratory mortality on a global scale. Design: Time series study. Setting: 761 communities in 35 countries or territories with at least one flood event during the study period. Participants: Multi-Country Multi-City Collaborative Research Network database, Australian Cause of Death Unit Record File, New Zealand Integrated Data Infrastructure, and the International Network for the Demographic Evaluation of Populations and their Health Network database. Main outcome measures: The main outcome was daily counts of deaths. An estimation for the lag-response association between flood and daily mortality risk was modelled, and the relative risks over the lag period were cumulated to calculate overall effects. Attributable fractions of mortality due to floods were further calculated. A quasi-Poisson model with a distributed lag non-linear function was used to examine how daily death risk was associated with flooded days in each community, and then the community specific associations were pooled using random effects multivariate meta-analyses. Flooded days were defined as days from the start date to the end date of flood events. Results: A total of 47.6 million all cause deaths, 11.1 million cardiovascular deaths, and 4.9 million respiratory deaths were analysed. Over the 761 communities, mortality risks increased and persisted for up to 60 days (50 days for cardiovascular mortality) after a flooded day. The cumulative relative risks for all cause, cardiovascular, and respiratory mortality were 1.021 (95% confidence interval 1.006 to 1.036), 1.026 (1.005 to 1.047), and 1.049 (1.008 to 1.092), respectively. The associations varied across countries or territories and regions. The flood-mortality associations appeared to be modified by climate type and were stronger in low income countries and in populations with a low human development index or high proportion of older people. In communities impacted by flood, up to 0.10% of all cause deaths, 0.18% of cardiovascular deaths, and 0.41% of respiratory deaths were attributed to floods. Conclusions: This study found that the risks of all cause, cardiovascular, and respiratory mortality increased for up to 60 days after exposure to flood and the associations could vary by local climate type, socioeconomic status, and older age.