Associations between Coarse Particulate Matter Air Pollution and Cause-Specific Mortality: A Nationwide Analysis in 272 Chinese Cities

Abstract

Background: Coarse particulate matter with aerodynamic diameter between 2.5 and 10μm (PM2.5–10) air pollution is a severe environmental problem in developing countries, but its challenges to public health were rarely evaluated. Objective: We aimed to investigate the associations between day-to-day changes in PM2.5–10 and cause-specific mortality in China. Methods: We conducted a nationwide daily time-series analysis in 272 main Chinese cities from 2013 to 2015. The associations between PM2.5–10 concentrations and mortality were analyzed in each city using overdispersed generalized additive models. Two-stage Bayesian hierarchical models were used to estimate national and regional average associations, and random-effect models were used to pool city-specific concentration–response curves. Two-pollutant models were adjusted for fine particles with aerodynamic diameter ≤2.5μm (PM2.5) or gaseous pollutants. Results: Overall, we observed positive and approximately linear concentration–response associations between PM2.5–10 and daily mortality. A 10-μg/m3 increase in PM2.5–10 was associated with higher mortality due to nonaccidental causes [0.23%; 95% posterior interval (PI): 0.13, 0.33], cardiovascular diseases (CVDs; 0.25%; 95% PI: 0.13, 0.37), coronary heart disease (CHD; 0.21%; 95% PI: 0.05, 0.36), stroke (0.21%; 95% PI: 0.08, 0.35), respiratory diseases (0.26%; 95% PI: 0.07, 0.46), and chronic obstructive pulmonary disease (COPD; 0.34%; 95% PI: 0.12, 0.57). Associations were stronger for cities in southern vs. northern China, with significant differences for total and cardiovascular mortality. Associations with PM2.5–10 were of similar magnitude to those for PM2.5 in both single- and two-pollutant models with mutual adjustment. Associations were robust to adjustment for gaseous pollutants other than nitrogen dioxide and sulfur dioxide. Meta-regression indicated that a larger positive correlation between PM2.5–10 and PM2.5 predicted stronger city-specific associations between PM2.5–10 and total mortality. Conclusions: This analysis showed significant associations between short-term PM2.5–10 exposure and daily nonaccidental and cardiopulmonary mortality based on data from 272 cities located throughout China. Associations appeared to be independent of exposure to PM2.5, carbon monoxide, and ozone. https://doi.org/10.1289/EHP2711

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