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. 2016 Jul 11;15(1):73.
doi: 10.1186/s12940-016-0164-6.

Temperature-related mortality estimates after accounting for the cumulative effects of air pollution in an urban area

Svetlana Stanišić Stojić  1 , Nemanja Stanišić  2 , Andreja Stojić  3
Affiliations

Temperature-related mortality estimates after accounting for the cumulative effects of air pollution in an urban area

Svetlana Stanišić Stojić et al. Environ Health. .

Abstract

Background: To propose a new method for including the cumulative mid-term effects of air pollution in the traditional Poisson regression model and compare the temperature-related mortality risk estimates, before and after including air pollution data.

Results: The analysis comprised a total of 56,920 residents aged 65 years or older who died from circulatory and respiratory diseases in Belgrade, Serbia, and daily mean PM10, NO2, SO2 and soot concentrations obtained for the period 2009-2014. After accounting for the cumulative effects of air pollutants, the risk associated with cold temperatures was significantly lower and the overall temperature-attributable risk decreased from 8.80 to 3.00 %. Furthermore, the optimum range of temperature, within which no excess temperature-related mortality is expected to occur, was very broad, between -5 and 21 °C, which differs from the previous findings that most of the attributable deaths were associated with mild temperatures.

Conclusions: These results suggest that, in polluted areas of developing countries, most of the mortality risk, previously attributed to cold temperatures, can be explained by the mid-term effects of air pollution. The results also showed that the estimated relative importance of PM10 was the smallest of four examined pollutant species, and thus, including PM10 data only is clearly not the most effective way to control for the effects of air pollution.

Keywords: Air pollution; Developing countries; Environmental exposure; Mortality; Temperature.

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Figures

Fig. 1
Fig. 1
Smoothed empirical mortality annual variations for the period 2009–2014. Mortality variations exhibit seasonal pattern, with peak values in the middle of February and minimum values around the start of September
Fig. 2
Fig. 2
Plot of the exposure-lag-response relationship between temperature and all-cause mortality, with reference at 21 °C. The effects of heat are observed on the same day or after 1–3 days, whereas the effects of cold were distributed across few days of exposure
Fig. 3
Fig. 3
Overall cumulative exposure-response curve and temperature distribution in Belgrade 2009–2014. Dotted and dashed lines represent optimum and extreme temperatures, respectively
Fig. 4
Fig. 4
The procedure for including air pollutants in the final model. The estimation of the timeframe-specific relative risk was repeated each time after exclusion of the pollutant with the most clear harvesting effect pattern. Dotted lines refer to timeframes that are associated with highest positive or negative relative risk
Fig. 5
Fig. 5
Overall cumulative exposure-response curve after accounting for the effects of air pollution and temperature distribution. After adjusting for air pollution, the optimum temperature range was relatively broad
Fig. 6
Fig. 6
Model-averaged relevance of terms. Dotted line represents threshold importance
See this image and copyright information in PMC

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