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- W54493774 abstract "A large number of studies have shown that both temperature and air pollution (eg, particulatematter and ozone) are associated with health outcomes. So far, it has received limitedattention whether air pollution and temperature interact to affect health outcomes. A fewstudies have examined interactive effects between temperature and air pollution, but producedconflicting results. This thesis aimed to examine whether air pollution (including ozone andparticulate matter) and temperature interacted to affect health outcomes in Brisbane, Australiaand 95 large US communities.In order to examine the consistency across different cities and different countries, we usedtwo datasets to examine interactive effects of temperature and air pollution. One dataset wascollected in Brisbane City, Australia, during 1996-2000. The dataset included air pollution(PM10, ozone and nitrogen dioxide), weather conditions (minimum temperature, maximumtemperature, relative humidity and rainfall) and different health outcomes. Another datasetwas collected from the 95 large US communities, which included air pollution (ozone wasused in the thesis), weather conditions (maximum temperature and dew point temperature)and mortality (all non-external cause mortality and cardiorespiratory mortality).Firstly, we used three parallel time-series models to examine whether maximum temperaturemodified PM10 effects on cardiovascular hospital admissions (CHA), respiratory hospitaladmissions (RHA), cardiovascular emergency visits (CEV), respiratory emergency visits(REV), cardiovascular mortality (CM) and non-external cause mortality (NECM), at lags of0-2 days in Brisbane. We used a Poisson generalized additive model (GAM) to fit a bivariatemodel to explore joint response surfaces of both maximum temperature and particulate matterless than 10 μm in diameter (PM10) on individual health outcomes at each lag. Results showthat temperature and PM10 interacted to affect different health outcomes at various lags. Then,we separately fitted non-stratification and stratification GAM models to quantify theinteractive effects. In the non-stratification model, we examined the interactive effects byincluding a pointwise product for both temperature and the pollutant. In the stratificationmodel, we categorized temperature into two levels using different cut-offs and then includedan interactive term for both pollutant and temperature. Results show that maximumtemperature significantly and positively modified the associations of PM10 with RHA, CEV,REV, CM and NECM at various lags, but not for CHA.Then, we used the above Poisson regression models to examine whether PM10 modified theassociations of minimum temperature with CHA, RHA, CEV, REV, CM and NECM at lagsof 0-2 days. In this part, we categorized PM10 into two levels using the mean as cut-off to fitthe stratification model. The results show that PM10 significantly modified the effects oftemperature on CHA, RHA, CM and NECM at various lags. The enhanced adversetemperature effects were found at higher levels of PM10, but there was no clear evidence forsynergistic effects on CEV and REV at various lags. Three parallel models produced similarresults, which strengthened the validity of these findings.Thirdly, we examined whether there were the interactive effects between maximumtemperature and ozone on NECM in individual communities between April and October,1987-2000, using the data of 60 eastern US communities from the National Morbidity,Mortality, and Air Pollution Study (NMMAPS). We divided these communities into tworegions (northeast and southeast) according to the NMMAPS study. We first used thebivariate model to examine the joint effects between temperature and ozone on NECM ineach community, and then fit a stratification model in each community by categorizingtemperature into three levels. After that, we used Bayesian meta-analysis to estimate overalleffects across regions and temperature levels from the stratification model. The bivariatemodel shows that temperature obviously modified ozone effects in most of the northeastcommunities, but the trend was not obviously in the southeast region. Bayesian meta-analysisshows that in the northeast region, a 10-ppb increment in ozone was associated with 2.2%(95% posterior interval [PI]: 1.2%, 3.1 %), 3.1% (95% PI: 2.2%, 3.8 %) and 6.2 % (95% PI:4.8%, 7.6 %) increase in mortality for low, moderate and high temperature levels, respectively,while in the southeast region, a 10-ppb increment in ozone was associated with 1.1% (95% PI:-1.1%, 3.2 %), 1.5% (95% PI: 0.2%, 2.8%) and 1.3% (95% PI: -0.3%, 3.0 %) increase inmortality.In addition, we examined whether temperature modified ozone effects on cardiovascularmortality in 95 large US communities between May and October, 1987-2000 using the samemodels as the above. We divided the communities into 7 regions according to the NMMAPSstudy (Northeast, Industrial Midwest, Upper Midwest, Northwest, Southeast, Southwest andSouthern California). The bivariate model shows that temperature modified ozone effects inmost of the communities in the northern regions (Northeast, Industrial Midwest, UpperMidwest, Northwest), but such modification was not obvious in the southern regions(Southeast, Southwest and Southern California). Bayesian meta-analysis shows thattemperature significantly modified ozone effects in the Northeast, Industrial Midwest andNorthwest regions, but not significant in Upper Midwest, Southeast, Southwest and SouthernCalifornia. Nationally, temperature marginally positively modified ozone effects oncardiovascular mortality. A 10-ppb increment in ozone was associated with 0.4% (95%posterior interval [PI]: -0.2, 0.9 %), 0.3% (95% PI: -0.3%, 1.0%) and 1.6% (95% PI: 4.8%,7.6%) increase in mortality for low, moderate and high temperature levels, respectively. Thedifference of overall effects between high and low temperature levels was 1.3% (95% PI: -0.4%, 2.9%) in the 95 communities.Finally, we examined whether ozone modified the association between maximum temperatureand cardiovascular mortality in 60 large eastern US communities during the warmer days,1987-2000. The communities were divided into the northeast and southeast regions. Werestricted the analyses to the warmer days when temperature was equal to or higher than themedian in each community throughout the study period. We fitted a bivariate model toexplore the joint effects between temperature and ozone on cardiovascular mortality inindividual communities and results show that in general, ozone positively modified theassociation between temperature and mortality in the northeast region, but such modificationwas not obvious in the southeast region. Because temperature effects on mortality mightpartly intermediate by ozone, we divided the dataset into four equal subsets using quartiles ascut-offs. Then, we fitted a parametric model to examine the associations between temperatureand mortality across different levels of ozone using the subsets. Results show that the higherthe ozone concentrations, the stronger the temperature-mortality associations in the northeastregion. However, such a trend was not obvious in the southeast region.Overall, this study found strong evidence that temperature and air pollution interacted toaffect health outcomes. PM10 and temperature interacted to affect different health outcomes atvarious lags in Brisbane, Australia. Temperature and ozone also interacted to affect NECMand CM in US communities and such modification varied considerably across differentregions. The symmetric modification between temperature and air pollution was observed inthe study. This implies that it is considerably important to evaluate the interactive effect whileestimating temperature or air pollution effects and further investigate reasons behind theregional variability." @default.
- W54493774 created "2016-06-24" @default.
- W54493774 creator A5044260589 @default.
- W54493774 date "2007-01-01" @default.
- W54493774 modified "2023-09-23" @default.
- W54493774 title "Evaluation of interactive effects between temperature and air pollution on health outcomes" @default.
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