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Olstrup, H., Johansson, C., Forsberg, B., Tornevi, A., Ekebom, A. & Meister, K. (2019). A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden. International Journal of Environmental Research and Public Health, 16(1), Article ID 105.
Open this publication in new window or tab >>A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 1, article id 105Article in journal (Refereed) Published
Abstract [en]

In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O₃, PM10 and birch pollen in Stockholm during 2001⁻2005. This analysis showed per 10 µg·m⁻3 increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: -1.2⁻2.2), 0.3% (95% CI: -1.4⁻2.0) and 2.5% (95% CI: 0.3⁻4.8) for NOx, O₃ and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18⁻0.34) for 10 pollen grains·m⁻3. In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O₃, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO₂, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015⁻2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O₃ contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015⁻2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O₃ with 2.0%.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
AQHI, NOx, PM10, asthma, birch pollen, ozone, risk coefficients
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-154982 (URN)10.3390/ijerph16010105 (DOI)000459111400105 ()30609753 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-04-15Bibliographically approved
Liu, C., Chen, R., Sera, F., Vicedo-Cabrera, A. M., Guo, Y., Tong, S., . . . Kan, H. (2019). Ambient Particulate Air Pollution and Daily Mortality in 652 Cities. New England Journal of Medicine, 381(8), 705-715
Open this publication in new window or tab >>Ambient Particulate Air Pollution and Daily Mortality in 652 Cities
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2019 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 381, no 8, p. 705-715Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.

METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived.

RESULTS: On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations.

CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).

Place, publisher, year, edition, pages
Waltham: Massachusetts Medical Society, 2019
National Category
Occupational Health and Environmental Health Environmental Sciences
Identifiers
urn:nbn:se:umu:diva-162609 (URN)10.1056/NEJMoa1817364 (DOI)000483203400006 ()31433918 (PubMedID)
Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-10-31Bibliographically approved
Olstrup, H., Johansson, C., Forsberg, B. & Åström, C. (2019). Association between Mortality and Short-Term Exposure to Particles, Ozone and Nitrogen Dioxide in Stockholm, Sweden. International Journal of Environmental Research and Public Health, 16(6), Article ID E1028.
Open this publication in new window or tab >>Association between Mortality and Short-Term Exposure to Particles, Ozone and Nitrogen Dioxide in Stockholm, Sweden
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 6, article id E1028Article in journal (Refereed) Published
Abstract [en]

In this study, the effects on daily mortality in Stockholm associated with short-term exposure to ultrafine particles (measured as number of particles with a diameter larger than 4 nm, PNC₄), black carbon (BC) and coarse particles (PM2.5⁻10) have been compared with the effects from more common traffic-pollution indicators (PM10, PM2.5 and NO₂) and O₃ during the period 2000⁻2016. Air pollution exposure was estimated from measurements at a 20 m high building in central Stockholm. The associations between daily mortality lagged up to two days (lag 02) and the different air pollutants were modelled by using Poisson regression. The pollutants with the strongest indications of an independent effect on daily mortality were O₃, PM2.5⁻10 and PM10. In the single-pollutant model, an interquartile range (IQR) increase in O₃ was associated with an increase in daily mortality of 2.0% (95% CI: 1.1⁻3.0) for lag 01 and 1.9% (95% CI: 1.0⁻2.9) for lag 02. An IQR increase in PM2.5⁻10 was associated with an increase in daily mortality of 0.8% (95% CI: 0.1⁻1.5) for lag 01 and 1.1% (95% CI: 0.4⁻1.8) for lag 02. PM10 was associated with a significant increase only at lag 02, with 0.8% (95% CI: 0.08⁻1.4) increase in daily mortality associated with an IQR increase in the concentration. NO₂ exhibits negative associations with mortality. The significant excess risk associated with O₃ remained significant in two-pollutant models after adjustments for PM2.5⁻10, BC and NO₂. The significant excess risk associated with PM2.5⁻10 remained significant in a two-pollutant model after adjustment for NO₂. The significantly negative associations for NO₂ remained significant in two-pollutant models after adjustments for PM2.5⁻10, O₃ and BC. A potential reason for these findings, where statistically significant excess risks were found for O₃, PM2.5⁻10 and PM10, but not for NO₂, PM2.5, PNC₄ and BC, is behavioral factors that lead to misclassification in the exposure. The concentrations of O₃ and PM2.5⁻10 are in general highest during sunny and dry days during the spring, when exposure to outdoor air tend to increase, while the opposite applies to NO₂, PNC₄ and BC, with the highest concentrations during the short winter days with cold weather, when people are less exposed to outdoor air.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
PM2.5–10, excess risk, exposure, linear regression, mortality, ozone, particle number count (PNC)
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-157554 (URN)10.3390/ijerph16061028 (DOI)000465159500128 ()30901873 (PubMedID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-05-28Bibliographically approved
Nerpin, E., Olivieri, M., Gislason, T., Olin, A. C., Nielsen, R., Johannessen, A., . . . Malinovschi, A. (2019). Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III. Clinical and Experimental Allergy, 49(7), 969-979
Open this publication in new window or tab >>Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 7, p. 969-979Article in journal (Refereed) Published
Abstract [en]

Introduction: The fractional exhaled nitric oxide (FENO) is a marker for type 2 inflammation used in diagnostics and management of asthma. In order to use FENO as a reliable biomarker, it is important to investigate factors that influence FENO in healthy individuals. Men have higher levels of FENO than women, but it is unclear whether determinants of FENO differ by sex.

Objective: To identify determinants of FENO in men and women without lung diseases.

Method: FENO was validly measured in 3,881 healthy subjects that had answered the main questionnaire of the European Community Respiratory Health Survey III without airways or lung disease

Results: Exhaled NO levels were 21.3% higher in men compared with women p<0.001. Being in the upper age quartile (60.3–67.6 years) men had 19.2 ppb (95% CI: 18.3, 20.2) higher FENO than subjects in the lowest age quartile (39.7–48.3 years) p=0.02. Women in the two highest age quartiles (54.6–60.2 and 60.3–67.6 years) had 15.4 ppb (14.7, 16.2), p=0.03 and 16.4 ppb (15.6, 17.1), p=<0.001 higher FENO, compared with the lowest age quartile.

Height was related to 8% higher FENO level in men (p<0.001) and 5% higher FENO levels in women (p=0.008). Men who smoked had 37% lower FENO levels and women had 30% lower levels compared with never‐smokers (p<0.001 for both). Men and women sensitized to both grass and perennial allergens had higher FENO levels compared with non‐sensitized subjects 26% and 29%, p<0.001 for both.

Conclusion & Clinical Relevance: FENO levels were higher in men than women. Similar effects of current smoking, height, and IgE sensitization were found in both sexes. FENO started increasing at lower age in women than in men, suggesting that interpretation of FENO levels in adults aged over 50 years should take into account age and sex.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
FENO, IgE sensitization, healthy population, smoking
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-157857 (URN)10.1111/cea.13394 (DOI)000474610200004 ()30934155 (PubMedID)2-s2.0-85064513946 (Scopus ID)
Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-09-06Bibliographically approved
Olivieri, M., Murgia, N., Carsin, A.-E., Heinrich, J., Benke, G., Bono, R., . . . Verlato, G. (2019). Effects of Smoking Bans on Passive Smoking Exposure at Work and at Home. The European Community Respiratory Health Survey. Indoor Air, 29(4), 670-679
Open this publication in new window or tab >>Effects of Smoking Bans on Passive Smoking Exposure at Work and at Home. The European Community Respiratory Health Survey
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2019 (English)In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 29, no 4, p. 670-679Article in journal (Refereed) Published
Abstract [en]

This longitudinal study investigated whether smoking bans influence passive smoking at work and/or at home in the same subjects. Passive smoking at work and/or at home was investigated in random population samples (European Community Respiratory Health Survey) in 1990-95, with follow-up interviews in 1998-2003 and 2010-2014. National smoking bans were classified as partial (restricted to public workplaces) or global (extended to private workplaces). Multivariable analysis was accomplished by three-level logistic regression models, where level-1, level-2 and level-3 units were respectively questionnaire responses, subjects and centres. Passive smoking at work was reported by 31.9% in 1990-95, 17.5% in 1998-2003 and 2.5% in 2010-14. Concurrently passive smoking at home decreased from 28.9% to 18.2% and 8.8%. When controlling for sex, age, education, smoking status and ECHRS wave, the odds of passive smoking at work was markedly reduced after global smoking bans (OR=0.45, 95%CI 0.25-0.81), particularly among non-smokers, while the protective effect of global smoking bans on passive smoking at home was only detected in non-smokers. Smoking bans both in public and private workplaces were effective in reducing passive smoking at work in Europe. However, given the inefficacy of smoking bans in current smokers' dwellings, better strategies are needed to avoid smoking indoors. 

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
follow-up study, home environment, secondhand smoke, smoking restriction, social settings, workplace
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-158174 (URN)10.1111/ina.12556 (DOI)000471273100013 ()30963644 (PubMedID)
Available from: 2019-04-15 Created: 2019-04-15 Last updated: 2019-07-10Bibliographically approved
Mogensen, I., Alving, K., Dahlen, S.-E., James, A., Forsberg, B., Ono, J., . . . Malinovschi, A. (2019). Fixed airflow obstruction relates to eosinophil activation in asthmatics.. Clinical and Experimental Allergy, 49(2), 155-162
Open this publication in new window or tab >>Fixed airflow obstruction relates to eosinophil activation in asthmatics.
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 2, p. 155-162Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some asthmatics develop irreversible chronic airflow obstruction, e.g., fixed airflow obstruction (fixed-AO). This is probably a consequence of airway remodeling, but neither its relation to inflammation, nor which asthma biomarkers can be clinically useful are elucidated. We hypothesized that the presence of type-2 inflammation relates to fixed-AO.

OBJECTIVES: Evaluate the presence of four markers for type-2 inflammation in fixed airflow obstruction among asthmatics.

METHODS: This was a cross-sectional study of 403 participants with asthma, aged 17-75 years, from three Swedish centers. Fixed airflow obstruction was defined as forced expiratory volume during the first second (FEV1 ) over forced vital capacity (FVC) being below the lower limit of normal (LLN). The following type-2 inflammation markers were assessed: exhaled nitric oxide (FeNO), serum periostin, serum eosinophil cationic protein (S-ECP) and urinary eosinophil-derived neurotoxin (U-EDN).

RESULTS: Elevated U-EDN (values in the highest tertile, ≥ 65.95 mg/mol creatinine) was more common in subjects with fixed-AO vs. subjects without fixed-AO: 55% vs. 29%, p<0.001. Elevated U-EDN related to increased likelihood of having fixed-AO in both all subjects and never-smoking subjects, with adjusted (adjusted for sex, age group, use of inhaled corticosteroids last week, atopy, early onset asthma, smoking history and packyears) odds ratios (aOR) of 2.38 (1.28-4.41) and 2.51 (1.04-6.07), respectively. In a separate analysis, having both elevated S-ECP (>20 μg/L) and U-EDN was related to having the highest likelihood of fixed-AO (aOR (95% CI) 6.06 (2.32-15.75)). Elevated serum periostin or FeNO did not relate to fixed-AO.

CONCLUSIONS AND CLINICAL RELEVANCE: These findings support that type-2 inflammation, and in particular eosinophil inflammation, is found in asthma with fixed-AO. This could indicate a benefit from eosinophil-directed therapies. Further longitudinal studies are warranted to investigate causality and relation to lung function decline. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-152938 (URN)10.1111/cea.13302 (DOI)000457469600003 ()30365193 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research CouncilStockholm County CouncilSwedish Asthma and Allergy AssociationSwedish Foundation for Strategic Research
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-22Bibliographically approved
Bråbäck, L., Olsson, D. & Forsberg, B. (2019). Grandmaternal smoking during pregnancy and asthma in grandchildren [Letter to the editor]. Journal of Allergy and Clinical Immunology, 144(2), Article ID 624.
Open this publication in new window or tab >>Grandmaternal smoking during pregnancy and asthma in grandchildren
2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 144, no 2, article id 624Article in journal, Letter (Refereed) Published
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-162528 (URN)10.1016/j.jaci.2019.03.036 (DOI)000478789300039 ()31213286 (PubMedID)
Available from: 2019-08-21 Created: 2019-08-21 Last updated: 2019-08-23Bibliographically approved
Kriit, H. K., Stewart Williams, J., Lindholm, L., Forsberg, B. & Sommar, J. (2019). Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden. BMJ Open, 9(9), Article ID e030466.
Open this publication in new window or tab >>Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 9, article id e030466Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To conduct a health economic evaluation of a proposed investment in urban bicycle infrastructure in Stockholm County, Sweden.

DESIGN: A cost-effectiveness analysis is undertaken from a healthcare perspective. Investment costs over a 50-year life cycle are offset by averted healthcare costs and compared with estimated long-term impacts on morbidity, quantified in disability-adjusted life years (DALYs). The results are re-calculated under different assumptions to model the effects of uncertainty.

SETTING: The Municipality of Stockholm (population 2.27 million) committed funds for bicycle path infrastructure with the aim of achieving a 15% increase in the number of bicycle commuters by 2030. This work is based on a previously constructed scenario, in which individual registry data on home and work address and a transport model allocation to different modes of transport identified 111 487 individuals with the physical capacity to bicycle to work within 30 min but that currently drive a car to work.

RESULTS: Morbidity impacts and healthcare costs attributed to increased physical activity, change in air pollution exposure and accident risk are quantified under the scenario. The largest reduction in healthcare costs is attributed to increased physical activity and the second largest to reduced air pollution exposure among the population of Greater Stockholm. The expected net benefit from the investment is 8.7% of the 2017 Stockholm County healthcare budget, and 3.7% after discounting. The economic evaluation estimates that the intervention is cost-effective and each DALY averted gives a surplus of €9933. The results remained robust under varied assumptions pertaining to reduced numbers of additional bicycle commuters.

CONCLUSION: Investing in urban infrastructure to increase bicycling as active transport is cost-effective from a healthcare sector perspective.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
DALY, commuting, health economic evaluation, health impacts, transport mode shift
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163491 (URN)10.1136/bmjopen-2019-030466 (DOI)31530609 (PubMedID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-26Bibliographically approved
Engstrom, E. & Forsberg, B. (2019). Health impacts of active commuters' exposure to traffic-related air pollution in Stockholm, Sweden. Journal of Transport and Health, 14, Article ID 100601.
Open this publication in new window or tab >>Health impacts of active commuters' exposure to traffic-related air pollution in Stockholm, Sweden
2019 (English)In: Journal of Transport and Health, ISSN 2214-1405, E-ISSN 2214-1405, Vol. 14, article id 100601Article in journal (Refereed) Published
Abstract [en]

Introduction: Addressing walking and cycling commuters, this study aimed to measure personal exposure to traffic-related air pollution and analyze the associated health risks. Method: Diffusive NO2-samplers were worn by 19 participants as they commuted to work in rush-hour traffic in May 2018 in Stockholm, Sweden (in total 336 trips, 197 h). The average NO2-concentration per route was measured, and the health impacts were calculated based on previous epidemiological studies of the association between annual NO2-exposure and premature death. Result: The measured average concentration per route ranged from 48 to 105 mu gNO(2)/m(3), and the average 67 mu gNO(2)/m(3) was more than five times higher than the urban background. This corresponded to an annual mean exposure of 16.4 mu gNO(2)/m(3), 40% higher than the average exposure at other times. Thus, the increased risk for premature death was 3.3%, with a range of 1.9%-4.8%, as related to assumptions regarding breathing rates and risk relationships between NO2-exposure and premature death. For active commuters in Stockholm in general, this indicated that one-fourth (23%) of the annual inhaled dose of NO2 could be attributed to commuting, and that the risk for premature death increased by 2.5% (1.4%-3.7%) due to air pollution. Note that these results were indicative rather than precise. These relationships may be applicable to active commuters in other cities. Conclusion: The results indicated that active commuting in Stockholm is associated with significant exposure to traffic-related air pollution and that this increases the risk of premature death. It is recommended that future studies consider longer time periods to assess active commuters' personal exposure with higher precision. Policy implications include greater separation between active commuters and motor traffic, and promotion of behavioral changes in favor of emissions free vehicles and active modes of transport.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
National Category
Other Civil Engineering
Identifiers
urn:nbn:se:umu:diva-164470 (URN)10.1016/j.jth.2019.100601 (DOI)000487982100044 ()
Available from: 2019-10-22 Created: 2019-10-22 Last updated: 2019-10-29Bibliographically approved
Sera, F., Armstrong, B., Tobias, A., Vicedo-Cabrera, A. M., Åström, C., Bell, M. L., . . . Gasparrini, A. (2019). How urban characteristics affect vulnerability to heat and cold: a multi-country analysis. International Journal of Epidemiology, 48(4), 1101-1112
Open this publication in new window or tab >>How urban characteristics affect vulnerability to heat and cold: a multi-country analysis
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2019 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 4, p. 1101-1112Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators.

METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities.

RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat.

CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
Temperature, cities, climate, epidemiology, heat, mortality
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-157116 (URN)10.1093/ije/dyz008 (DOI)000484383300017 ()30815699 (PubMedID)2-s2.0-85067299967 (Scopus ID)
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-11-14Bibliographically approved
Projects
The potential for prevention of heat related deaths when heat waves become more extreme [2009-00454_Forte]; Umeå UniversityClimate change, source water quality, treatment and distribution ? assessment of microbial risks from health studies [2010-134_Formas]; Umeå UniversityDoes traffic related air pollution accelerate brain aging and dementia? A prospective cohort study with individual exposure data [2011-01218_Forte]; Umeå UniversityShifting from car to active transport ? an integrated environment and health impact assessment [2012-01296_Forte]; Umeå UniversityTrichloramine (NCl3) in air of indoor swimming pools and its relationship to health effects in exposed children. [2013-431_Formas]; Umeå UniversityIs exercise in an air polluted place good or bad for health [2014-01908_Forte]; Umeå UniversityThe effects of noise, socioeconomic status and genetics in the relationship between air pollution and dementia [2015-1099_Formas]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0159-6657

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