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Chen, K.* ; Breitner-Busch, S. ; Wolf, K. ; Stafoggia, M.* ; Sera, F.* ; Vicedo-Cabrera, A.M.* ; Guo, Y.* ; Tong, S.* ; Lavigne, E.* ; Matus, P.* ; Valdés, N.* ; Kan, H.* ; Jaakkola, J.J.K.* ; Ryti, N.R.I.* ; Huber, V.* ; Scortichini, M.* ; Hashizume, M.* ; Honda, Y.* ; Nunes, B.* ; Madureira, J.* ; Holobâcă, I.H.* ; Fratianni, S.* ; Kim, H.* ; Lee, W.* ; Tobias, A.* ; Iñiguez, C.* ; Forsberg, B.* ; Åström, C.* ; Ragettli, M.S.* ; Guo, Y.L.* ; Chen, B.Y.* ; Li, S.* ; Milojevic, A.* ; Zanobetti, A.* ; Schwartz, J.* ; Bell, M.L.* ; Gasparrini, A.* ; Schneider, A.E.

Ambient carbon monoxide and daily mortality: A global time-series study in 337 cities.

Lancet Planet Health 5, e191-e199 (2021)
Publ. Version/Full Text Postprint Research data DOI PMC
Open Access Gold
Creative Commons Lizenzvertrag
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.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
ISSN (print) / ISBN 2542-5196
e-ISSN 2542-5196
Journal The Lancet planetary health
Quellenangaben Volume: 5, Issue: 4, Pages: e191-e199 Article Number: , Supplement: ,
Publisher Elsevier
Publishing Place Amsterdam
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology II (EPI2)
Grants Spanish Ministry of Economy, Industry and Competitiveness
Portuguese Foundation for Science and Technology European Commission
European Commission
Federal Ministry of Education & Research (BMBF)
National Health and Medical Research Council of Australia
Science & Technology Commission of Shanghai Municipality (STCSM)