مقاله انگلیسی رایگان در مورد انجمن شهری آلودگی هوا با مرگ و میر ناشی از پنومونی – الزویر 2019

Background: City is becoming warmer, especially in the process of urbanization and climate change. However, it is largely unknown whether this warming urban climate may modify the short-term effects of air pollution. Objectives: To test whether warmer urban climates intensify the acute mortality effects of air pollution on pneumonia in Hong Kong. Methods: Participants who died of pneumonia from a prospective Chinese elderly cohort between 1998 and 2011 were selected as cases. Urban climatic (UC) classes of cases were determined by an established Urban Climatic Map according to their residential addresses. UC classes were first dichotomized into cool and warm climates and case-crossover analysis was used to estimate the short-term association of pneumonia mortality with air pollution. We further classified UC classes into climate quartiles and used case-only analysis to test the trend of urban climate modification on the short-term association of pneumonia mortality with air pollution. Results: Among 66,820 elders (≥65 years), 2208 pneumonia deaths (cases) were identified during the 11–14 years of follow-up. The effects of air pollution for cases residing in the warm climate were statistically significant (p b 0.05) higher than those living in the cool climate. There was an increasing linear trend of urban climate modification on the association of pneumonia mortality with NO2 (nitrogen dioxide) (p for trend = 0.035). Compared to climate Quartile 1 (the lowest), deaths resided in climate Quartile 2, 3, and 4 (the highest) were associated with an additional percent change of 9.07% (0.52%, 17.62%), 12.89% (4.34%, 21.43%), and 8.45% (−0.10%, 17.00%), respectively. Conclusions: Warmer urban climate worsened the acute mortality effects of pneumonia associated with air pollutants in Hong Kong. Our findings suggest that warmer urban climate introduced by climate change and urbanization may increase the risks of air pollution-related pneumonia.

Introduction

Pneumonia is one of the most common infectious diseases and is a leading cause of morbidity and mortality worldwide (World Health Organization, 2008). It affects about 450 million people globally and results in approximately 4 million deaths per year, accounting for 7% of the world’s total deaths (Ruuskanen et al., 2011). The annual incidence of pneumonia in the elder population is up to four-times than that of the younger group (Janssens and Krause, 2004). With the world is aging rapidly, pneumonia is becoming a major global public health problem. Air pollution is recognized as the world’s largest single environmental problem (Landrigan et al., 2018), and it is one significant risk factor for pneumonia diseases, especially for elders (Zanobetti and Woodhead, 2010). The adverse effects of air pollution on pneumonia morbidity and mortality have been well documented (Faustini et al., 2013; Meng et al., 2012; Nhung et al., 2018; Tian and Sun, 2017). However, the relative risk magnitudes of air pollution effects differ according to geographical regions (Katsouyanni et al., 2009; Kioumourtzoglou et al., 2015). For instance, a large-scale multi-city epidemiological study (Katsouyanni et al., 2009) reported that relative risk estimates for both particulate matter and ozone (O3) showed substantial heterogeneities among cities in Canada, Europe, and the United States. One of the proposed factors to explain the observed effect heterogeneity of air pollution was the city climate. However, no study has tested this hypothesis by utilizing a reliable tool to characterize the city climate.