Cited by 582Air Quality and Health ImpactsIndoor Air Quality and Microbial ExposureClimate Change and Health Impacts

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Season, Sex, Age, and Education as Modifiers of the Effects of Outdoor Air Pollution on Daily Mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

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Kan, Haidong, London, Stephanie J., Chen, Guohai, Zhang, Yunhui, Song, Guixiang, Zhao, Naiqing, Jiang, Lili, Chen, Bingheng·2008·Environmental Health Perspectives

DOI 10.1289/ehp.10851PMC PMC2535620

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Abstract

BACKGROUND: Various factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries. OBJECTIVES: We conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004). METHODS: Using a natural spline model to analyze the data, we examined effects of air pollution for the warm season (April-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality. RESULTS: Outdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 mug/m(3) in a 2-day average concentration of PM(10), SO(2), NO(2), and O(3) corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0.58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above). CONCLUSIONS: Season, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.

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Authors: Kan, H., London, S. J., Chen, G., Zhang, Y., Song, G., Zhao, N., Jiang, L., & Chen, B.
Affiliations: National Institutes of Health (US)
Shanghai Environmental Monitoring Center, Shanghai, China
Fudan University (CN)
Shanghai Municipal Center For Disease Control Prevention (CN)
Corresponding author: Kan, Haidong
ORCID: Kan, Haidong
London, Stephanie J.
Chen, Guohai
Zhang, Yunhui
Jiang, Lili
Chen, Bingheng
Venue: Environmental Health Perspectives
Publisher: American Chemical Society (ACS)
Published: 2008-07-09
Volume: 116
Issue: 9
Pages: 1183-1188
ISSN: 0091-6765 (ISSN-L)
1552-9924
DOI: 10.1289/ehp.10851
PMC: PMC2535620
OpenAlex: W2063572932
Cited by: 582
References: 54
Citations by year: 2026: 17 · 2025: 23 · 2024: 32 · 2023: 36 · 2022: 38 · 2021: 46 · 2020: 41 · 2019: 48 · 2018: 48 · 2017: 48 · 2016: 33 · 2015: 37 · 2014: 31 · 2013: 32 · 2012: 20
FWCI: 11.95
Type: journal article
Language: en
Open access: gold
doi.org
Licence: public-domain
creativecommons.org/licenses/by/4.0/ (vor, 3460 d)
Locations: Environmental Health Perspectives (publishedVersion, public-domain)
PubMed Central (publishedVersion, public-domain)
PubMed (publishedVersion)
Funders: U.S. Department of Health and Human Services
Health Effects Institute
National Institutes of Health
NHLBI Division of Intramural Research
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
Keywords: outdoor air pollution, daily mortality, PM10, sulfur dioxide, nitrogen dioxide, ozone, seasonal variation, sex differences, age differences, educational attainment, cardiovascular mortality, respiratory mortality, Shanghai, developing countries
MeSH terms: Adolescent, Adult, Age Factors, Aged, Air Pollution, Child, Child, Preschool, China, Educational Status, Female, Humans, Male, Middle Aged, Public Health, Seasons, Sex Factors

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Season, Sex, Age, and Education as Modifiers of the Effects of Outdoor Air Pollution on Daily Mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

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