TY  - JOUR
AB  - BACKGROUND: The presence of benzene, toluene, ethylbenzene, and xylene isomers (BTEX) in the environment is of increasing concern due to their toxicity and ubiquity. Although the adverse health effects of BTEX exposure have been documented, robust epidemiological evidence from large-scale, multicountry studies using advanced exposure assessment methodologies remains scarce. We aimed to assess the association of short-term ambient exposure to individual BTEX components and their mixture with daily total, cardiovascular, and respiratory mortality on a global scale. METHODS: Daily data on mortality, meteorological factors, and air pollution were collected from 757 locations across 46 countries or regions. Data on individual chemicals (ie, benzene, toluene, xylenes [summation of ethylbenzene, m-xylene, p-xylene, and o-xylene]) and the aggregate mixture (ie, BTEX) were estimated using a chemistry-climate model. We examined the short-term associations of each individual chemical as well as the BTEX mixture with daily total, cardiovascular, and respiratory mortality in a multicountry framework. Using a two-stage time-series design, we first applied generalised additive models with a quasi-Poisson distribution to obtain location-specific associations, which were subsequently pooled using random-effects meta-analysis. Two-pollutant models were used to assess the independent effects of BTEX after adjusting for co-pollutants (PM2⋅5, PM10, nitrogen dioxide, sulphur dioxide, ozone, and carbon monoxide). Additionally, we assessed the overall exposure-response curves with spline terms. FINDINGS: An IQR increment of BTEX concentration on lag 0-2 days (3-day moving average of the present day and the previous 2 days) was associated with increases of 0⋅57% (95% CI 0⋅49-0⋅65), 0⋅42% (0⋅30-0⋅54), and 0⋅68% (0⋅50-0⋅86) in total, cardiovascular, and respiratory mortality, respectively. The corresponding effect estimates for an IQR increment in individual chemicals (benzene, toluene, and xylenes) were 0⋅38-0⋅61%, 0⋅44-0⋅70%, and 0⋅41-0⋅65%, respectively. The associations remained significant after adjusting for co-pollutants, with a general decline in magnitude, except for a slight increase after adjustment for ozone. The shape of the exposure-response curves for all pollutants and causes of death was almost linear, with steeper slopes at low concentrations and no discernible thresholds. INTERPRETATION: This global study provides novel evidence linking short-term exposure to ambient BTEX, both individually and as a mixture, with increased daily total, cardiovascular, and respiratory mortality. Our findings underscore the need for comprehensive air pollution mitigation policies, including stringent controls on BTEX emissions, to protect public health. FUNDING: Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Natural Science Foundation of China, Shanghai Municipal Science and Technology Major Project, Shanghai B&R Joint Laboratory Project, and Shanghai International Science and Technology Partnership Project.
AU  - Zhou, L.*
AU  - Xiong, Y.*
AU  - Sera, F.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Abrutzky, R.*
AU  - Guo, Y.*
AU  - Tong, S.*
AU  - de Sousa Zanotti Stagliorio Coélho, M.*
AU  - Nascimento Saldiva, P.H.*
AU  - Lavigne, E.*
AU  - Correa, P.M.*
AU  - Valdés Ortega, N.*
AU  - Osorio, S.*
AU  - Royé, D.*
AU  - Kyselý, J.*
AU  - Orru, H.*
AU  - Maasikmets, M.*
AU  - Jaakkola, J.J.*
AU  - Ryti, N.*
AU  - Pascal, M.*
AU  - Huber, V.
AU  - Breitner-Busch, S.
AU  - Schneider, A.E.
AU  - Katsouyanni, K.*
AU  - Samoli, E.*
AU  - Entezari, A.*
AU  - Mayvaneh, F.*
AU  - Goodman, P.*
AU  - Zeka, A.*
AU  - Raz, R.*
AU  - Scortichini, M.*
AU  - Stafoggia, M.*
AU  - Honda, Y.*
AU  - Hashizume, M.*
AU  - Sheng Ng, C.F.*
AU  - Alahmad, B.*
AU  - Diaz, M.H.*
AU  - Félix Arellano, E.E.*
AU  - Overcenco, A.*
AU  - Klompmaker, J.*
AU  - Rao, S.*
AU  - Carrasco, G.*
AU  - Seposo, X.*
AU  - Carlos Chua, P.L.*
AU  - Pereira da Silva, S.D.N.*
AU  - Madureira, J.*
AU  - Holobaca, I.H.*
AU  - Scovronick, N.*
AU  - Garland, R.M.*
AU  - Kim, H.*
AU  - Lee, W.*
AU  - Tobias, A.*
AU  - Iñiguez, C.*
AU  - Forsberg, B.*
AU  - Ragettli, M.S.*
AU  - Guo, Y.L.*
AU  - Pan, S.C.*
AU  - Li, S.*
AU  - Masselot, P.*
AU  - Colistro, V.*
AU  - Bell, M.*
AU  - Zanobetti, A.*
AU  - Schwartz, J.*
AU  - Dang, T.N.*
AU  - Van Dung, D.*
AU  - Gasparrini, A.*
AU  - Huang, Y.*
AU  - Kan, H.*
C1  - 75776
C2  - 57989
TI  - Associations of ambient exposure to benzene, toluene, ethylbenzene, and xylene with daily mortality: A multicountry time-series study in 757 global locations.
JO  - Lancet Planet Health
PY  - 2025
ER  - 

TY  - JOUR
AB  - BACKGROUND: Wildfire activity is an important source of tropospheric ozone (O3) pollution. However, no study to date has systematically examined the associations of wildfire-related O3 exposure with mortality globally. METHODS: We did a multicountry two-stage time series analysis. From the Multi-City Multi-Country (MCC) Collaborative Research Network, data on daily all-cause, cardiovascular, and respiratory deaths were obtained from 749 locations in 43 countries or areas, representing overlapping periods from Jan 1, 2000, to Dec 31, 2016. We estimated the daily concentration of wildfire-related O3 in study locations using a chemical transport model, and then calibrated and downscaled O3 estimates to a resolution of 0·25° × 0·25° (approximately 28 km2 at the equator). Using a random-effects meta-analysis, we examined the associations of short-term wildfire-related O3 exposure (lag period of 0-2 days) with daily mortality, first at the location level and then pooled at the country, regional, and global levels. Annual excess mortality fraction in each location attributable to wildfire-related O3 was calculated with pooled effect estimates and used to obtain excess mortality fractions at country, regional, and global levels. FINDINGS: Between 2000 and 2016, the highest maximum daily wildfire-related O3 concentrations (≥30 μg/m3) were observed in locations in South America, central America, and southeastern Asia, and the country of South Africa. Across all locations, an increase of 1 μg/m3 in the mean daily concentration of wildfire-related O3 during lag 0-2 days was associated with increases of 0·55% (95% CI 0·29 to 0·80) in daily all-cause mortality, 0·44% (-0·10 to 0·99) in daily cardiovascular mortality, and 0·82% (0·18 to 1·47) in daily respiratory mortality. The associations of daily mortality rates with wildfire-related O3 exposure showed substantial geographical heterogeneity at the country and regional levels. Across all locations, estimated annual excess mortality fractions of 0·58% (95% CI 0·31 to 0·85; 31 606 deaths [95% CI 17 038 to 46 027]) for all-cause mortality, 0·41% (-0·10 to 0·91; 5249 [-1244 to 11 620]) for cardiovascular mortality, and 0·86% (0·18 to 1·51; 4657 [999 to 8206]) for respiratory mortality were attributable to short-term exposure to wildfire-related O3. INTERPRETATION: In this study, we observed an increase in all-cause and respiratory mortality associated with short-term wildfire-related O3 exposure. Effective risk and smoke management strategies should be implemented to protect the public from the impacts of wildfires. FUNDING: Australian Research Council and the Australian National Health and Medical Research Council.
AU  - Chen, G.*
AU  - Guo, Y.*
AU  - Yue, X.*
AU  - Xu, R.*
AU  - Yu, W.*
AU  - Ye, T.*
AU  - Tong, S.*
AU  - Gasparrini, A.*
AU  - Bell, M.L.*
AU  - Armstrong, B.*
AU  - Schwartz, J.*
AU  - Jaakkola, J.J.K.*
AU  - Lavigne, E.*
AU  - Saldiva, P.H.N.*
AU  - Kan, H.*
AU  - Royé, D.*
AU  - Urban, A.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Tobias, A.*
AU  - Forsberg, B.*
AU  - Sera, F.*
AU  - Lei, Y.*
AU  - Abramson, M.J.*
AU  - Li, S.*
AU  - Multi-Country Multi-City Collaborative Research Network (Breitner-Busch, S.
AU  - Schneider, A.E.)
C1  - 71367
C2  - 56062
SP  - e452-e462
TI  - All-cause, cardiovascular, and respiratory mortality and wildfire-related ozone: A multicountry two-stage time series analysis.
JO  - Lancet Planet Health
VL  - 8
IS  - 7
PY  - 2024
ER  - 

TY  - JOUR
AB  - BACKGROUND: Climate change can directly impact temperature-related excess deaths and might subsequently change the seasonal variation in mortality. In this study, we aimed to provide a systematic and comprehensive assessment of potential future changes in the seasonal variation, or seasonality, of mortality across different climate zones. METHODS: In this modelling study, we collected daily time series of mean temperature and mortality (all causes or non-external causes only) via the Multi-Country Multi-City Collaborative (MCC) Research Network. These data were collected during overlapping periods, spanning from Jan 1, 1969 to Dec 31, 2020. We projected daily mortality from Jan 1, 2000 to Dec 31, 2099, under four climate change scenarios corresponding to increasing emissions (Shared Socioeconomic Pathways [SSP] scenarios SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). We compared the seasonality in projected mortality between decades by its shape, timings (the day-of-year) of minimum (trough) and maximum (peak) mortality, and sizes (peak-to-trough ratio and attributable fraction). Attributable fraction was used to measure the burden of seasonality of mortality. The results were summarised by climate zones. FINDINGS: The MCC dataset included 126 809 537 deaths from 707 locations within 43 countries or areas. After excluding the only two polar locations (both high-altitude locations in Peru) from climatic zone assessments, we analysed 126 766 164 deaths in 705 locations aggregated in four climate zones (tropical, arid, temperate, and continental). From the 2000s to the 2090s, our projections showed an increase in mortality during the warm seasons and a decrease in mortality during the cold seasons, albeit with mortality remaining high during the cold seasons, under all four SSP scenarios in the arid, temperate, and continental zones. The magnitude of this changing pattern was more pronounced under the high-emission scenarios (SSP3-7.0 and SSP5-8.5), substantially altering the shape of seasonality of mortality and, under the highest emission scenario (SSP5-8.5), shifting the mortality peak from cold seasons to warm seasons in arid, temperate, and continental zones, and increasing the size of seasonality in all zones except the arid zone by the end of the century. In the 2090s compared with the 2000s, the change in peak-to-trough ratio (relative scale) ranged from 0·96 to 1·11, and the change in attributable fraction ranged from 0·002% to 0·06% under the SSP5-8.5 (highest emission) scenario. INTERPRETATION: A warming climate can substantially change the seasonality of mortality in the future. Our projections suggest that health-care systems should consider preparing for a potentially increased demand during warm seasons and sustained high demand during cold seasons, particularly in regions characterised by arid, temperate, and continental climates. FUNDING: The Environment Research and Technology Development Fund of the Environmental Restoration and Conservation Agency, provided by the Ministry of the Environment of Japan.
AU  - Madaniyazi, L.*
AU  - Armstrong, B.*
AU  - Tobias, A.*
AU  - Mistry, M.N.*
AU  - Bell, M.L.*
AU  - Urban, A.*
AU  - Kyselý, J.*
AU  - Ryti, N.*
AU  - Cvijanovic, I.*
AU  - Ng, C.F.S.*
AU  - Royé, D.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Tong, S.*
AU  - Lavigne, E.*
AU  - Iñiguez, C.*
AU  - da Silva, S.d.N.P.*
AU  - Madureira, J.*
AU  - Jaakkola, J.J.K.*
AU  - Sera, F.*
AU  - Honda, Y.*
AU  - Gasparrini, A.*
AU  - Hashizume, M.*
AU  - Multi-Country Multi-City Collaborative Research Network (Huber, V.)
AU  - Multi-Country Multi-City Collaborative Research Network (Schneider, A.E.)
C1  - 71360
C2  - 56055
SP  - e86-e94
TI  - Seasonality of mortality under climate change: A multicountry projection study.
JO  - Lancet Planet Health
VL  - 8
IS  - 2
PY  - 2024
ER  - 

TY  - JOUR
AB  - BACKGROUND: Ambient air pollution, including particulate matter (such as PM10 and PM2·5) and nitrogen dioxide (NO2), has been linked to increases in mortality. Whether populations' vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time. METHODS: We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO2, PM10, and PM2·5 on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models. FINDINGS: Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM10, PM2·5, or NO2 and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI -0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m3 increase in PM2·5. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO2. INTERPRETATION: Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility. FUNDING: None.
AU  - Schwarz, M.
AU  - Peters, A.
AU  - Stafoggia, M.*
AU  - de'Donato, F.*
AU  - Sera, F.*
AU  - Bell, M.L.*
AU  - Guo, Y.*
AU  - Honda, Y.*
AU  - Huber, V.*
AU  - Jaakkola, J.J.K.*
AU  - Urban, A.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Masselot, P.*
AU  - Lavigne, E.*
AU  - Achilleos, S.*
AU  - Kyselý, J.*
AU  - Samoli, E.*
AU  - Hashizume, M.*
AU  - Fook Sheng Ng, C.*
AU  - das Neves Pereira da Silva, S.*
AU  - Madureira, J.*
AU  - Garland, R.M.*
AU  - Tobias, A.*
AU  - Armstrong, B.*
AU  - Schwartz, J.*
AU  - Gasparrini, A.*
AU  - Schneider, A.E.
AU  - Breitner-Busch, S.
C1  - 71644
C2  - 56166
SP  - e657-e665
TI  - Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: A pooled analysis of 380 urban areas over a 22-year period.
JO  - Lancet Planet Health
VL  - 8
IS  - 9
PY  - 2024
ER  - 

TY  - JOUR
AB  - BACKGROUND: Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks. METHODS: We included urban areas across Europe between Jan 1, 2000, and Dec 12, 2019, using the Urban Audit dataset of Eurostat and adults aged 20 years and older living in these areas. Data were extracted from Eurostat, the Multi-country Multi-city Collaborative Research Network, Moderate Resolution Imaging Spectroradiometer, and Copernicus. We applied a three-stage method to estimate risks of temperature continuously across the age and space dimensions, identifying patterns of vulnerability on the basis of city-specific characteristics and demographic structures. These risks were used to derive minimum mortality temperatures and related percentiles and raw and standardised excess mortality rates for heat and cold aggregated at various geographical levels. FINDINGS: Across the 854 urban areas in Europe, we estimated an annual excess of 203 620 (empirical 95% CI 180 882-224 613) deaths attributed to cold and 20 173 (17 261-22 934) attributed to heat. These corresponded to age-standardised rates of 129 (empirical 95% CI 114-142) and 13 (11-14) deaths per 100 000 person-years. Results differed across Europe and age groups, with the highest effects in eastern European cities for both cold and heat. INTERPRETATION: Maps of mortality risks and excess deaths indicate geographical differences, such as a north-south gradient and increased vulnerability in eastern Europe, as well as local variations due to urban characteristics. The modelling framework and results are crucial for the design of national and local health and climate policies and for projecting the effects of cold and heat under future climatic and socioeconomic scenarios. FUNDING: Medical Research Council of UK, the Natural Environment Research Council UK, the EU's Horizon 2020, and the EU's Joint Research Center.
AU  - Masselot, P.*
AU  - Mistry, M.*
AU  - Vanoli, J.*
AU  - Schneider, R.*
AU  - Iungman, T.*
AU  - García-León, D.*
AU  - Ciscar, J.C.*
AU  - Feyen, L.*
AU  - Orru, H.*
AU  - Urban, A.*
AU  - Breitner-Busch, S.
AU  - Huber, V.
AU  - Schneider, A.E.
AU  - Samoli, E.*
AU  - Stafoggia, M.*
AU  - de'Donato, F.*
AU  - Rao, S.*
AU  - Armstrong, B.*
AU  - Nieuwenhuijsen, M.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Gasparrini, A.*
C1  - 67708
C2  - 54016
CY  - The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, Oxon, England
SP  - e271-e281
TI  - Excess mortality attributed to heat and cold: A health impact assessment study in 854 cities in Europe.
JO  - Lancet Planet Health
VL  - 7
IS  - 4
PB  - Elsevier Sci Ltd
PY  - 2023
ER  - 

TY  - JOUR
AB  - Background: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation: Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding: Bill & Melinda Gates Foundation.
AU  - GBD 2019 Diabetes and Air Pollution Collaborators (Breitner-Busch, S.)
C1  - 66508
C2  - 52858
SP  - e586-e600
TI  - Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019: An analysis of data from the Global Burden of Disease Study 2019.
JO  - Lancet Planet Health
VL  - 6
IS  - 7
PY  - 2022
ER  - 

TY  - JOUR
AB  - Background: The health impacts of climate warming are usually quantified based on daily average temperatures. However, extra health risks might result from hot nights. We project the future mortality burden due to hot nights. Methods: We selected the hot night excess (HNE) to represent the intensity of night-time heat, which was calculated as the excess sum of high temperature during night time. We collected historical mortality data in 28 cities from three east Asian countries, from 1981 to 2010. The associations between HNE and mortality in each city were firstly examined using a generalised additive model in combination with a distributed lag non-linear model over lag 0–10 days. We then pooled the cumulative associations using a univariate meta-regression model at the national or regional levels. Historical and future hourly temperature series were projected under two scenarios of greenhouse-gas emissions from 1980–2099, with ten general circulation models. We then projected the attributable fraction of mortality due to HNE under each scenario. Findings: Our dataset comprised 28 cities across three countries (Japan, South Korea, and China), including 9 185 598 deaths. The time-series analyses showed the HNE was significantly associated with increased mortality risks, the relative mortality risk on days with hot nights could be 50% higher than on days with non-hot nights. Compared with the rise in daily mean temperature (lower than 20%), the frequency of hot nights would increase more than 30% and the intensity of hot night would increase by 50% by 2100s. The attributable fraction of mortality due to hot nights was projected to be 3·68% (95% CI 1·20 to 6·17) under a strict emission control scenario (SSP126). Under a medium emission control scenario (SSP245), the attributable fraction of mortality was projected to increase up to 5·79% (2·07 to 9·52), which is 0·95% (−0·39 to 2·29) more than the attributable fraction of mortality due to daily mean temperature. Interpretation: Our study provides evidence for significant mortality risks and burden in association with night-time warming across Japan, South Korea, and China. Our findings suggest a growing role of night-time warming in heat-related health effects in a changing climate. Funding: The National Natural Science Foundation of China, Shanghai International Science and Technology Partnership Project.
AU  - He, C.*
AU  - Kim, H.*
AU  - Hashizume, M.*
AU  - Lee, W.*
AU  - Honda, Y.*
AU  - Kim, S.E.*
AU  - Kinney, P.L.*
AU  - Schneider, A.E.
AU  - Zhang, Y.*
AU  - Zhu, Y.*
AU  - Zhou, L.*
AU  - Chen, R.*
AU  - Kan, H.*
C1  - 65856
C2  - 52640
SP  - e648-e657
TI  - The effects of night-time warming on mortality burden under future climate change scenarios: A modelling study.
JO  - Lancet Planet Health
VL  - 6
IS  - 8
PY  - 2022
ER  - 

TY  - JOUR
AB  - BACKGROUND: As the climate changes, it is crucial to focus not only on mitigation measures but also on building climate change resilience by developing efficient adaptation strategies. Although population adaptation is a major determinant of future climate-related health burden, it is not well accounted for in studies that project the health impact of climate change. We propose a methodological framework for temperature-related mortality that incorporates two simultaneous adaptation-sensitivity pathways: the physiological pathway, considering both heat adaptation and cold sensitivity, and the socioeconomic pathway, which is influenced by changes in future adaptive capacities. To demonstrate its utility we apply the framework to a case study mortality time-series dataset from Bavaria, Germany. METHODS: In this modelling framework, we used extrapolated location-specific and age-specific baseline exposure-response functions and propose different future scenarios of cold sensitivity and heat adaptation on the basis of varying slopes of these exposure-response functions. We also incorporated future socioeconomic adaptation in the exposure-response functions using projections of gross domestic product under the respective shared socioeconomic pathways. Future adaptable fractions, representing the deaths avoided under each of the future scenarios, are projected under combinations of two climate change scenarios (shared socioeconomic pathway [SSP]1-2.6 and SSP3-7.0) and the respective plausible population projection scenarios (SSP1 and SSP3), also incorporating the future changes in demographic age structure and mortality. The case study for this framework was done for five districts in Bavaria, for both total non-accidental mortality and cardiovascular disease mortality. The baseline data was obtained for the period 1990-2006, and the future period was defined as 2083-99. FINDINGS: In our Bavaria case study, average temperature was projected to increase by 2099 by an average of 1·1°C under SSP1-2.6 and by 4·1°C under SSP3-7.0. We observed the adaptable fraction to be largely influenced by socioeconomic adaptation for both total mortality and cardiovascular disease mortality, and for both climate change scenarios. For example, for total mortality, the highest adaptable fraction of 18·56% (95% empirical CI 10·77-23·67) was observed under the SSP1-2.6 future scenario, in the presence of socioeconomic adaptation and under the highest heat adaptation (10%) provided the cold sensitivity remains 0%. The cold adaptable fraction is lower than the heat adaptable fraction under all scenarios. In the absence of socioeconomic adaptation, population ageing will lead to higher temperature-related mortality. INTERPRETATION: Our developed framework helps to systematically understand the effectiveness of adaptation mechanisms. In the future, socioeconomic adaptation is estimated to play a major role in determining temperature-related excess mortality. Furthermore, cold sensitivity might outweigh heat adaptation in the majority of locations worldwide. Similarly, population ageing is projected to continue to determine future temperature-related mortality. FUNDING: EU Horizon 2020 (EXHAUSTION).
AU  - Rai, M.
AU  - Breitner-Busch, S.
AU  - Wolf, K.
AU  - Peters, A.
AU  - Schneider, A.E.
AU  - Chen, K.*
C1  - 66339
C2  - 52785
SP  - e784-e792
TI  - Future temperature-related mortality considering physiological and socioeconomic adaptation: A modelling framework.
JO  - Lancet Planet Health
VL  - 6
IS  - 10
PY  - 2022
ER  - 

TY  - JOUR
AB  - BACKGROUND: Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE). METHODS: In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000-11; follow-up until 2011-17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and tropospheric warm-season ozone (O3) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis. FINDINGS: We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM2·5, NO2, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m3 increment in PM2·5, 1·044 (1·019-1·069) per 10 μg/m3 NO2, and 1·039 (1·018-1·059) per 0·5 × 10-5/m black carbon. Associations with PM2·5, NO2, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O3 was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM2·5 (10 μg/m3) and NO2 (40 μg/m3) were 1·078 (1·046-1·111) per 5 μg/m3 PM2·5 and 1·049 (1·024-1·075) per 10 μg/m3 NO2. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032-1·092) for exposure lower than 1·5× 10-5/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10-5/m. INTERPRETATION: Long-term exposure to concentrations of PM2·5 and NO2 lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions. FUNDING: Health Effects Institute.
AU  - Stafoggia, M.*
AU  - Oftedal, B.*
AU  - Chen, J.*
AU  - Rodopoulou, S.*
AU  - Renzi, M.*
AU  - Atkinson, R.W.*
AU  - Bauwelinck, M.*
AU  - Klompmaker, J.O.*
AU  - Mehta, A.*
AU  - Vienneau, D.*
AU  - Andersen, Z.J.*
AU  - Bellander, T.*
AU  - Brandt, J.*
AU  - Cesaroni, G.*
AU  - de Hoogh, K.*
AU  - Fecht, D.*
AU  - Gulliver, J.*
AU  - Hertel, O.*
AU  - Hoffmann, B.*
AU  - Hvidtfeldt, U.A.*
AU  - Jöckel, K.H.*
AU  - Jørgensen, J.T.*
AU  - Katsouyanni, K.*
AU  - Ketzel, M.*
AU  - Kristoffersen, D.T.*
AU  - Lager, A.*
AU  - Leander, K.*
AU  - Liu, S.*
AU  - Ljungman, P.L.S.*
AU  - Nagel, G.*
AU  - Pershagen, G.*
AU  - Peters, A.
AU  - Raaschou-Nielsen, O.*
AU  - Rizzuto, D.*
AU  - Schramm, S.*
AU  - Schwarze, P.E.*
AU  - Severi, G.*
AU  - Sigsgaard, T.*
AU  - Strak, M.*
AU  - van der Schouw, Y.T.*
AU  - Verschuren, M.*
AU  - Weinmayr, G.*
AU  - Wolf, K.
AU  - Zitt, E.*
AU  - Samoli, E.*
AU  - Forastiere, F.*
AU  - Brunekreef, B.*
AU  - Hoek, G.*
AU  - Janssen, N.A.H.*
C1  - 63998
C2  - 51793
SP  - e9-e18
TI  - Long-term exposure to low ambient air pollution concentrations and mortality among 28 million people: results from seven large European cohorts within the ELAPSE project.
JO  - Lancet Planet Health
VL  - 6
IS  - 1
PY  - 2022
ER  - 

TY  - JOUR
AB  - BACKGROUND: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000-19. METHODS: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000-19. Temperature variability was calculated as the SD of the average of the same and previous days' minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. FINDINGS: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901-2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2-4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7-5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3-10·4), followed by Europe (4·4%, 2·2-5·6) and Africa (3·3, 1·9-4·6). INTERPRETATION: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. FUNDING: Australian Research Council, Australian National Health & Medical Research Council.
AU  - Wu, Y.*
AU  - Li, S.*
AU  - Zhao, Q.*
AU  - Wen, B.*
AU  - Gasparrini, A.*
AU  - Tong, S.*
AU  - Overcenco, A.*
AU  - Urban, A.*
AU  - Schneider, A.E.
AU  - Entezari, A.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Zanobetti, A.*
AU  - Analitis, A.*
AU  - Zeka, A.*
AU  - Tobias, A.*
AU  - Nunes, B.*
AU  - Alahmad, B.*
AU  - Armstrong, B.*
AU  - Forsberg, B.*
AU  - Pan, S.C.*
AU  - Iñiguez, C.*
AU  - Ameling, C.*
AU  - De la Cruz Valencia, C.*
AU  - Åström, C.*
AU  - Houthuijs, D.*
AU  - Van Dung, D.*
AU  - Royé, D.*
AU  - Indermitte, E.*
AU  - Lavigne, E.*
AU  - Mayvaneh, F.*
AU  - Acquaotta, F.*
AU  - de'Donato, F.*
AU  - Rao, S.*
AU  - Sera, F.*
AU  - Carrasco-Escobar, G.*
AU  - Kan, H.*
AU  - Orru, H.*
AU  - Kim, H.*
AU  - Holobaca, I.H.*
AU  - Kyselý, J.*
AU  - Madureira, J.*
AU  - Schwartz, J.*
AU  - Jaakkola, J.J.K.*
AU  - Katsouyanni, K.*
AU  - Hurtado Diaz, M.*
AU  - Ragettli, M.S.*
AU  - Hashizume, M.*
AU  - Pascal, M.*
AU  - de Sousa Zanotti Stagliorio Coélho, M.*
AU  - Ortega, N.V.*
AU  - Ryti, N.*
AU  - Scovronick, N.*
AU  - Michelozzi, P.*
AU  - Correa, P.M.*
AU  - Goodman, P.J.*
AU  - Nascimento Saldiva, P.H.*
AU  - Abrutzky, R.*
AU  - Osorio, S.*
AU  - Dang, T.N.*
AU  - Colistro, V.*
AU  - Huber, V.*
AU  - Lee, W.*
AU  - Seposo, X.*
AU  - Honda, Y.*
AU  - Guo, Y.L.*
AU  - Bell, M.L.*
AU  - Guo, Y.*
C1  - 65005
C2  - 52150
SP  - e410-e421
TI  - Global, regional, and national burden of mortality associated with short-term temperature variability from 2000-19: A three-stage modelling study.
JO  - Lancet Planet Health
VL  - 6
IS  - 5
PY  - 2022
ER  - 

TY  - JOUR
AB  - BACKGROUND: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world. METHODS: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated. FINDINGS: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period. INTERPRETATION: Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires. FUNDING: Australian Research Council, Australian National Health & Medical Research Council.
AU  - Chen, G.*
AU  - Guo, Y.*
AU  - Yue, X.*
AU  - Tong, S.*
AU  - Gasparrini, A.*
AU  - Bell, M.L.*
AU  - Armstrong, B.*
AU  - Schwartz, J.*
AU  - Jaakkola, J.J.K.*
AU  - Zanobetti, A.*
AU  - Lavigne, E.*
AU  - Nascimento Saldiva, P.H.*
AU  - Kan, H.*
AU  - Royé, D.*
AU  - Milojevic, A.*
AU  - Overcenco, A.*
AU  - Urban, A.*
AU  - Schneider, A.E.
AU  - Entezari, A.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Zeka, A.*
AU  - Tobias, A.*
AU  - Nunes, B.*
AU  - Alahmad, B.*
AU  - Forsberg, B.*
AU  - Pan, S.C.*
AU  - Iñiguez, C.*
AU  - Ameling, C.*
AU  - De la Cruz Valencia, C.*
AU  - Åström, C.*
AU  - Houthuijs, D.*
AU  - Van Dung, D.*
AU  - Samoli, E.*
AU  - Mayvaneh, F.*
AU  - Sera, F.*
AU  - Carrasco-Escobar, G.*
AU  - Lei, Y.*
AU  - Orru, H.*
AU  - Kim, H.*
AU  - Holobaca, I.H.*
AU  - Kyselý, J.*
AU  - Teixeira, J.P.*
AU  - Madureira, J.*
AU  - Katsouyanni, K.*
AU  - Hurtado-Diaz, M.*
AU  - Maasikmets, M.*
AU  - Ragettli, M.S.*
AU  - Hashizume, M.*
AU  - Stafoggia, M.*
AU  - Pascal, M.*
AU  - Scortichini, M.*
AU  - de Sousa Zanotti Stagliorio Coélho, M.*
AU  - Valdés Ortega, N.*
AU  - Ryti, N.R.I.*
AU  - Scovronick, N.*
AU  - Matus, P.*
AU  - Goodman, P.J.*
AU  - Garland, R.M.*
AU  - Abrutzky, R.*
AU  - Garcia, S.O.*
AU  - Rao, S.*
AU  - Fratianni, S.*
AU  - Dang, T.N.*
AU  - Colistro, V.*
AU  - Huber, V.*
AU  - Lee, W.*
AU  - Seposo, X.*
AU  - Honda, Y.*
AU  - Guo, Y.L.*
AU  - Ye, T.*
AU  - Yu, W.*
AU  - Abramson, M.J.*
AU  - Samet, J.M.*
AU  - Li, S.*
C1  - 63065
C2  - 51130
SP  - e579-e587
TI  - Mortality risk attributable to wildfire-related PM2·5 pollution: A global time series study in 749 locations.
JO  - Lancet Planet Health
VL  - 5
IS  - 9
PY  - 2021
ER  - 

TY  - JOUR
AB  - BACKGROUND: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. METHODS: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. FINDINGS: Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. INTERPRETATION: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants. FUNDING: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.
AU  - Chen, K.*
AU  - Breitner-Busch, S.
AU  - Wolf, K.
AU  - Stafoggia, M.*
AU  - Sera, F.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Guo, Y.*
AU  - Tong, S.*
AU  - Lavigne, E.*
AU  - Matus, P.*
AU  - Valdés, N.*
AU  - Kan, H.*
AU  - Jaakkola, J.J.K.*
AU  - Ryti, N.R.I.*
AU  - Huber, V.*
AU  - Scortichini, M.*
AU  - Hashizume, M.*
AU  - Honda, Y.*
AU  - Nunes, B.*
AU  - Madureira, J.*
AU  - Holobâcă, I.H.*
AU  - Fratianni, S.*
AU  - Kim, H.*
AU  - Lee, W.*
AU  - Tobias, A.*
AU  - Iñiguez, C.*
AU  - Forsberg, B.*
AU  - Åström, C.*
AU  - Ragettli, M.S.*
AU  - Guo, Y.L.*
AU  - Chen, B.Y.*
AU  - Li, S.*
AU  - Milojevic, A.*
AU  - Zanobetti, A.*
AU  - Schwartz, J.*
AU  - Bell, M.L.*
AU  - Gasparrini, A.*
AU  - Schneider, A.E.
C1  - 61784
C2  - 50176
SP  - e191-e199
TI  - Ambient carbon monoxide and daily mortality: A global time-series study in 337 cities.
JO  - Lancet Planet Health
VL  - 5
IS  - 4
PY  - 2021
ER  - 

TY  - JOUR
AB  - BACKGROUND: Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. METHODS: We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. FINDINGS: From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8-19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01-1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04-1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02-1·10] per 0·5 10-5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01-1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. INTERPRETATION: Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. FUNDING: Health Effects Institute.
AU  - Wolf, K.
AU  - Hoffmann, B.*
AU  - Andersen, Z.J.*
AU  - Atkinson, R.W.*
AU  - Bauwelinck, M.*
AU  - Bellander, T.*
AU  - Brandt, J.*
AU  - Brunekreef, B.*
AU  - Cesaroni, G.*
AU  - Chen, J.*
AU  - de Faire, U.*
AU  - de Hoogh, K.*
AU  - Fecht, D.*
AU  - Forastiere, F.*
AU  - Gulliver, J.*
AU  - Hertel, O.*
AU  - Hvidtfeldt, U.A.*
AU  - Janssen, N.A.H.*
AU  - Jørgensen, J.T.*
AU  - Katsouyanni, K.*
AU  - Ketzel, M.*
AU  - Klompmaker, J.O.*
AU  - Lager, A.*
AU  - Liu, S.*
AU  - MacDonald, C.J.*
AU  - Magnusson, P.K.E.*
AU  - Mehta, A.J.*
AU  - Nagel, G.*
AU  - Oftedal, B.*
AU  - Pedersen, N.L.*
AU  - Pershagen, G.*
AU  - Raaschou-Nielsen, O.*
AU  - Renzi, M.*
AU  - Rizzuto, D.*
AU  - Rodopoulou, S.*
AU  - Samoli, E.*
AU  - van der Schouw, Y.T.*
AU  - Schramm, S.*
AU  - Schwarze, P.*
AU  - Sigsgaard, T.*
AU  - Sørensen, M.*
AU  - Stafoggia, M.*
AU  - Strak, M.*
AU  - Tjønneland, A.*
AU  - Verschuren, W.M.M.*
AU  - Vienneau, D.*
AU  - Weinmayr, G.*
AU  - Hoek, G.*
AU  - Peters, A.
AU  - Ljungman, P.L.S.*
C1  - 63064
C2  - 49052
SP  - e620-e632
TI  - Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: A pooled analysis of six European cohorts within the ELAPSE project.
JO  - Lancet Planet Health
VL  - 5
IS  - 9
PY  - 2021
ER  - 

TY  - JOUR
AB  - Background Impaired insulin sensitivity could be an intermediate step that links exposure to air pollution to the development of type 2 diabetes. However, longitudinal associations of air pollution with insulin sensitivity remain unclear. Our study investigated the associations of long-term air pollution exposure with the degree and rate of change of insulin sensitivity.Methods In this longitudinal study, we analysed data from the Cooperative Health Research in the Region of Augsburg (KORA) cohort from Augsburg, Germany, which recruited participants aged 25-74 years in the survey between 1999 and 2001 (KORA S4), with two follow-up examinations in 2006-08 (KORA F4) and 2013-14 (KORA FF4). Serum concentrations of fasting insulin and glucose, and homoeostasis model assessment of insulin resistance (HOMA-IR, a surrogate measure of insulin sensitivity) and beta-cell function (HOMA-B, a surrogate marker for fasting insulin secretion) were assessed at up to three visits between 1999 and 2014. Annual average air pollutant concentrations at the residence were estimated by land-use regression models. We examined the associations of air pollution with repeatedly assessed biomarker levels using mixed-effects models, and we assessed the associations with the annual rate of change in biomarkers using quantile regression models.Findings Among 9620 observations from 4261 participants in the KORA cohort, we included 6008 (62.5%) observations from 3297 (77.4%) participants in our analyses. Per IQR increment in annual average air pollutant concentrations, HOMA-IR significantly increased by 2.5% (95% CI 0.3 to 4.7) for coarse particulate matter, by 3.1% (0.9 to 5.3) for PM2.5 by 3.6% (1.0 to 6.3) for PM2.5absorbance and by 3.2% (0.6 to 5.8) for nitrogen dioxide, and borderline significantly increased by 2.2% (-0.1 to 4.5) for ozone, whereas it did not significantly increase for the whole range of ultrafine particles. Similar positive associations in slightly smaller magnitude were observed for HOMA-B and fasting insulin levels. In addition, air pollutant concentrations were positively associated with the annual rate of change in HOMA-IR, HOMA-B, and fasting insulin. Neither the level nor the rate of change of fasting glucose were associated with air pollution exposure.Interpretation Our study indicates that long-term air pollution exposure could contribute to the development of insulin resistance, which is one of the key factors in the pathogenesis of type 2 diabetes.
AU  - Zhang, S.
AU  - Mwiberi, S.
AU  - Pickford, R.
AU  - Breitner-Busch, S.
AU  - Huth, C.
AU  - Koenig, W.*
AU  - Rathmann, W.*
AU  - Herder, C.*
AU  - Roden, M.*
AU  - Cyrys, J.
AU  - Peters, A.
AU  - Wolf, K.
AU  - Schneider, A.E.
C1  - 61261
C2  - 49810
CY  - The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, Oxon, England
SP  - E39-E49
TI  - Longitudinal associations between ambient air pollution and insulin sensitivity: Results from the KORA cohort study.
JO  - Lancet Planet Health
VL  - 5
IS  - 1
PB  - Elsevier Sci Ltd
PY  - 2021
ER  - 

TY  - JOUR
AB  - BACKGROUND: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. METHODS: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature-mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature-mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. FINDINGS: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967-5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58-11·07) of all deaths (8·52% [6·19-10·47] were cold-related and 0·91% [0·56-1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60-87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000-03 to 2016-19, the global cold-related excess death ratio changed by -0·51 percentage points (95% eCI -0·61 to -0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13-0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. INTERPRETATION: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. FUNDING: Australian Research Council and the Australian National Health and Medical Research Council.
AU  - Zhao, Q.*
AU  - Guo, Y.*
AU  - Ye, T.*
AU  - Gasparrini, A.*
AU  - Tong, S.*
AU  - Overcenco, A.*
AU  - Urban, A.*
AU  - Schneider, A.E.
AU  - Entezari, A.*
AU  - Vicedo-Cabrera, A.M.*
AU  - Zanobetti, A.*
AU  - Analitis, A.*
AU  - Zeka, A.*
AU  - Tobias, A.*
AU  - Nunes, B.*
AU  - Alahmad, B.*
AU  - Armstrong, B.*
AU  - Forsberg, B.*
AU  - Pan, S.C.*
AU  - Iñiguez, C.*
AU  - Ameling, C.*
AU  - De la Cruz Valencia, C.*
AU  - Åström, C.*
AU  - Houthuijs, D.*
AU  - Dung, D.V.*
AU  - Royé, D.*
AU  - Indermitte, E.*
AU  - Lavigne, E.*
AU  - Mayvaneh, F.*
AU  - Acquaotta, F.*
AU  - de'Donato, F.*
AU  - Di Ruscio, F.*
AU  - Sera, F.*
AU  - Carrasco-Escobar, G.*
AU  - Kan, H.*
AU  - Orru, H.*
AU  - Kim, H.*
AU  - Holobaca, I.H.*
AU  - Kyselý, J.*
AU  - Madureira, J.*
AU  - Schwartz, J.*
AU  - Jaakkola, J.J.K.*
AU  - Katsouyanni, K.*
AU  - Hurtado Diaz, M.*
AU  - Ragettli, M.S.*
AU  - Hashizume, M.*
AU  - Pascal, M.*
AU  - de Sousa Zanotti Stagliorio Coélho, M.*
AU  - Valdés Ortega, N.*
AU  - Ryti, N.*
AU  - Scovronick, N.*
AU  - Michelozzi, P.*
AU  - Matus Correa, P.*
AU  - Goodman, P.J.*
AU  - Nascimento Saldiva, P.H.*
AU  - Abrutzky, R.*
AU  - Osorio, S.*
AU  - Rao, S.*
AU  - Fratianni, S.*
AU  - Dang, T.N.*
AU  - Colistro, V.*
AU  - Huber, V.*
AU  - Lee, W.*
AU  - Seposo, X.*
AU  - Honda, Y.*
AU  - Guo, Y.L.*
AU  - Bell, M.L.*
AU  - Li, S.*
C1  - 62513
C2  - 50782
SP  - e415-e425
TI  - Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: A three-stage modelling study.
JO  - Lancet Planet Health
VL  - 5
IS  - 7
PY  - 2021
ER  - 

TY  - JOUR
AU  - Halonen, J.I.*
AU  - Erhola, M.*
AU  - Furman, E.*
AU  - Haahtela, T.*
AU  - Jousilahti, P.*
AU  - Barouki, R.*
AU  - Bergman, Å.*
AU  - Billo, N.E.*
AU  - Fuller, R.*
AU  - Haines, A.*
AU  - Kogevinas, M.*
AU  - Kolossa-Gehring, M.*
AU  - Krauze, K.*
AU  - Lanki, T.*
AU  - Vicente, J.L.*
AU  - Messerli, P.*
AU  - Nieuwenhuijsen, M.*
AU  - Paloniemi, R.*
AU  - Peters, A.
AU  - Posch, K.H.*
AU  - Timonen, P.*
AU  - Vermeulen, R.*
AU  - Virtanen, S.M.*
AU  - Bousquet, J.*
AU  - Antó, J.M.*
C1  - 60524
C2  - 49343
SP  - e503-e505
TI  - The Helsinki Declaration 2020: Europe that protects.
JO  - Lancet Planet Health
VL  - 4
IS  - 11
PY  - 2020
ER  - 

TY  - JOUR
AB  - BACKGROUND: Ongoing climate change might, through rising temperatures, alter allergenic pollen biology across the northern hemisphere. We aimed to analyse trends in pollen seasonality and pollen load and to establish whether there are specific climate-related links to any observed changes. METHODS: For this retrospective data analysis, we did an extensive search for global datasets with 20 years or more of airborne pollen data that consistently recorded pollen season indices (eg, duration and intensity). 17 locations across three continents with long-term (approximately 26 years on average) quantitative records of seasonal concentrations of multiple pollen (aeroallergen) taxa met the selection criteria. These datasets were analysed in the context of recent annual changes in maximum temperature (T) and minimum temperature (T) associated with anthropogenic climate change. Seasonal regressions (slopes) of variation in pollen load and pollen season duration over time were compared to T, cumulative degree day T, T, cumulative degree day T, and frost-free days among all 17 locations to ascertain significant correlations. FINDINGS: 12 (71%) of the 17 locations showed significant increases in seasonal cumulative pollen or annual pollen load. Similarly, 11 (65%) of the 17 locations showed a significant increase in pollen season duration over time, increasing, on average, 0·9 days per year. Across the northern hemisphere locations analysed, annual cumulative increases in T over time were significantly associated with percentage increases in seasonal pollen load (r=0·52, p=0·034) as were annual cumulative increases in T (r=0·61, p=0·010). Similar results were observed for pollen season duration, but only for cumulative degree days (higher than the freezing point [0°C or 32°F]) for T (r=0·53, p=0·030) and T (r=0·48, p=0·05). Additionally, temporal increases in frost-free days per year were significantly correlated with increases in both pollen load (r=0·62, p=0·008) and pollen season duration (r=0·68, p=0·003) when averaged for all 17 locations. INTERPRETATION: Our findings reveal that the ongoing increase in temperature extremes (T and T) might already be contributing to extended seasonal duration and increased pollen load for multiple aeroallergenic pollen taxa in diverse locations across the northern hemisphere. This study, done across multiple continents, highlights an important link between ongoing global warming and public health-one that could be exacerbated as temperatures continue to increase. FUNDING: None.
AU  - Ziska, L.H.*
AU  - Makra, L.*
AU  - Harry, S.K.*
AU  - Bruffaerts, N.*
AU  - Hendrickx, M.*
AU  - Coates, F.*
AU  - Saarto, A.*
AU  - Thibaudon, M.*
AU  - Oliver, G.*
AU  - Damialis, A.
AU  - Charalampopoulos, A.*
AU  - Vokou, D.*
AU  - Heiđmarsson, S.*
AU  - Guđjohnsen, E.*
AU  - Bonini, M.*
AU  - Oh, J.W.*
AU  - Sullivan, K.E.*
AU  - Ford, L.*
AU  - Brooks, G.D.*
AU  - Myszkowska, D.*
AU  - Severova, E.*
AU  - Gehrig, R.*
AU  - Ramón, G.D.*
AU  - Beggs, P.J.*
AU  - Knowlton, K.*
AU  - Crimmins, A.R.*
C1  - 55734
C2  - 46525
SP  - e124-e131
TI  - Temperature-related changes in airborne allergenic pollen abundance and seasonality across the northern hemisphere: A retrospective data analysis.
JO  - Lancet Planet Health
VL  - 3
IS  - 3
PY  - 2019
ER  - 

TY  - JOUR
AB  - BACKGROUND: Health effects of air pollution on diabetes have been scarcely studied in developing countries. We aimed to explore the associations of long-term exposure to ambient particulate matter (PM) and gaseous pollutants with diabetes prevalence and glucose-homoeostasis markers in China. METHODS: Between April 1 and Dec 31, 2009, we recruited a total of 15 477 participants aged 18-74 years using a random number generator and a four-staged, stratified and cluster sampling strategy from a large cross-sectional study (the 33 Communities Chinese Health Study) from three cities in Liaoning province, northeastern China. Fasting and 2 h insulin and glucose concentrations and the homoeostasis model assessment of insulin resistance index and β-cell function were used as glucose-homoeostasis markers. Diabetes was defined according to the American Diabetes Association's recommendations. We calculated exposure to air pollutants using data from monitoring stations (PM with an aerodynamic diameter of 10 μm or less [PM], sulphur dioxide, nitrogen dioxide, and ozone) and a spatial statistical model (PM with an aerodynamic diameter of 1 μm or less [PM] and 2·5 μm or less [PM]). We used two-level logistic regression and linear regression analyses to assess associations between exposure and outcomes, controlling for confounders. FINDINGS: All the studied pollutants were significantly associated with increased diabetes prevalence (eg, the adjusted odds ratios associated with an increase in IQR for PM, PM, and PMwere 1·13, 95% CI 1·04-1·22; 1·14, 1·03-1·25; and 1·20, 1·12-1·28, respectively). These air pollutants were also associated with higher concentrations of fasting glucose (0·04-0·09 mmol/L), 2 h glucose (0·10-0·19 mmol/L), and 2 h insulin (0·70-2·74 μU/L). No association was observed for the remaining biomarkers. Stratified analyses indicated greater effects on the individuals who were younger (<50 years) or overweight or obese. INTERPRETATION: Long-term exposure to air pollution was associated with increased risk of diabetes in a Chinese population, particularly in individuals who were younger or overweight or obese.
AU  - Yang, B.-Y.*
AU  - Qian, Z.M.*
AU  - Li, S.*
AU  - Chen, G.*
AU  - Bloom, M.S.*
AU  - Elliott, M.H.*
AU  - Syberg, K.W.*
AU  - Heinrich, J.
AU  - Markevych, I.
AU  - Wang, S.Q.*
AU  - Chen, D.*
AU  - Ma, H.C.*
AU  - Chen, D.H.*
AU  - Liu, Y.*
AU  - Komppula, M.*
AU  - Leskinen, A.*
AU  - Liu, K.K.*
AU  - Zeng, X.W.*
AU  - Hu, L.W.*
AU  - Guo, Y.*
AU  - Dong, G.H.*
C1  - 53367
C2  - 44569
SP  - e64-e73
TI  - Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: A cross-sectional study with findings from the 33 Communities Chinese Health Study.
JO  - Lancet Planet Health
VL  - 2
IS  - 2
PY  - 2018
ER  -