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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
Open accessAbstract
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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“Consistently, recent studies in Asia revealed a significant ozone effect on daily mortality in cold or winter months in China (Chen et al., 2013; Kan et al., 2008; Li et al., 2015; Liu et al., 2013; Yang et al., 2012), Japan (Ng et al., 2013), and Thailand (Guo et al., 2014).”
From Acute effect of ozone exposure on daily mortality in seven cities of Jiangsu Province, China: no clear evidence for threshold (2017) · cites this paper as Kan et al., 2008
In the citing paper
“Because PM2.5 was not officially monitored nationally in China before 2013, previous studies assessing the relationship between ozone and mortality in China were unable to test for confounding by PM2.5 (Chen et al., 2013; Chen et al., 2014; Kan et al., 2008; Liu et al., 2013; Yang et al., 2012).”
From Acute effect of ozone exposure on daily mortality in seven cities of Jiangsu Province, China: no clear evidence for threshold (2017) · cites this paper as Kan et al., 2008
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Flagged first, then by citations
1 of the 54 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Health Effects Institute, 2004, Health Effects of Outdoor Air Pollution in Developing Countries of Asia: A Literature Review
- WHO, 2000, Air Quality Guideline for Europe
- Xu, 2005, Effect evaluation on smoking control plan for one year in Shanghai-China/WHO smoking control capability construction cooperation items, Chin J Health Educ, 21, 412
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Brook, R. D., Rajagopalan, S., Pope, C. A., Brook, J. R., Bhatnagar, A., Diez-Roux, A. V., Holguin, F., Hong, Y., Luepker, R. V., Mittleman, M. A., et al. (2010) · Circulation · doi:10.1161/cir.0b013e3181dbece1 · Cited by 6,548
Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities
Chen, R., Yin, P., Meng, X., Liu, C., Wang, L., Xu, X., Ross, J. A., Tse, L. A., Zhao, Z., Kan, H., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201609-1862oc · Cited by 751
Self-citationAmbient air pollution, climate change, and population health in China
Kan, H., Chen, R., & Tong, S. (2011) · Environment International · doi:10.1016/j.envint.2011.03.003 · Cited by 729
Self-citationA Growing Role for Gender Analysis in Air Pollution Epidemiology
Clougherty, J. E. (2009) · Environmental Health Perspectives · doi:10.1289/ehp.0900994 · Cited by 628
Particulate Matter–Induced Health Effects: Who Is Susceptible?
Sacks, J. D., Stanek, L. W., Luben, T. J., Johns, D. O., Buckley, B. J., Brown, J. S., & Ross, M. (2010) · Environmental Health Perspectives · doi:10.1289/ehp.1002255 · Cited by 578
Metadata
- 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
- 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
- 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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