Academic journal article Environmental Health Perspectives

Season, Sex, Age, and Education as Modifiers of the Effects of Outdoor Air Pollution on Daily Mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

Academic journal article Environmental Health Perspectives

Season, Sex, Age, and Education as Modifiers of the Effects of Outdoor Air Pollution on Daily Mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

Article excerpt

BACKGROUND: Various factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries.

OBJECTIVES: We conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 [micro]m in aerodynamic diameter ([PM.sub.10]), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004).

METHODS: Using a natural spline model to analyze the data, we examined effects of air pollution for the warm season (Apirl-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality.

RESULTS: Outdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 [micro]g/[m.sup.3] in a 2-day average concentration of [PM.sub.10], [SO.sub.2], [NO.sub.2], and [O.sub.3] corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0-58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above).

CONCLUSIONS: Season, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.

KEY WORDS: air pollution, modifier, mortality, time-series studies. Environ Health Perspect 116:1183-1188(2008). doi: 10.1289/ehp. 10851 available via http://dx.doi.org/[Online 9 July 2008]

Epidemiologic studies have reported associations of outdoor air pollution with daily mortality and morbidity from cardiorespiratoty diseases (Goldberg et al. 2003). Multicity analyses conducted in the United States, Canada, and Europe provide further evidence supporting coherence and plausibility of the associations (Burnett et al. 2000; Dominici et al. 2006; Katsouyanni et al. 1997, 2001; Samet et al. 2000a). Recently, interest has been focused on the possible modifying effect of season (Peng et al. 2005; Touloumi et al. 2006; Zeka et al. 2006), preexisting health status (Bateson and Schwartz 2004; Goldberg et al. 2001; Katsouyanni et al. 2001), and population demographic characteristics such as sex and age (Atkinson et al. 2001; Bateson and Schwartz 2004; Cakmak et al. 2006; Katsouyanni et al. 2001) on the relation between air pollution and daily mortality. It is also hypothesized that the effects of air pollution exposure on health are greater in people with lower socioeconomic status (SES) (O'Neill et al. 2003). However, prior findings about the modifying effect of SES remain inconsistent: some studies found evidence of modification (Finkelstein et al. 2003; Jerrett et al. 2004; Krewski et al. 2005; Zeka et al. 2006), but others did not (Bateson and Schwartz 2004; Cakmak et al. 2006; Samet et al. 2000b; Zanobetti and Schwartz 2000). Moreover, most of these studies were conducted in developed countries, and only a small number of studies have been conducted in Asia (Health Effects Institute 2004). The need remains for studies of cities in developing countries, where characteristics of outdoor air pollution (e.g., air pollution level and mixture, transport of pollutants), meteorological conditions, and sociodemographic patterns may differ from those in North America and Europe. …

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