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Worldwide epidemiological studies have demonstrated that short-term associations of particulate matter (PM), might be further complicated by ambient temperatures, and increase human mortality. In China, among various PM indices, the health effects of black carbon (BC) are less understood due to the lack of data availability. Additionally, it is unclear how temperature modifies simultaneous and adverse effects of BC, and fine (PM size <2.5 μm; PM 2.5), and coarse particles (PM 2.5-10), on mortality outcomes. We adopted time-series Poisson generalized additive models to investigate temperature modifying effects on the association between three different PMs (BC, PM 2.5 , and PM 2.5-10) and mortality (non-accidental, respiratory and cardiovascular mortality) in Beijing, China, from 2010 to 2016. Average daily BC, PM 2.5 , and PM 2.5-10 concentrations were 4.95, 72.3, and 52.1 μg/m3, respectively, which were all significantly associated with daily mortality. High temperature strongly amplified effects of BC, PM 2.5 , and PM 2.5-10 on human mortality, especially BC effects that were most pronounced at >28 °C. Harmful effects were estimated for increases in non-accidental, respiratory, and cardiovascular mortality per interquartile increments in BC (4.11 μg/m3), PM 2.5 (62.37 μg/m3), and PM 2.5-10 (46.71 μg/m3) concentrations from the moving average of current and previous day (lag01) under high temperature (>28 °C). Mortality increases in non-accidental, respiratory, and cardiovascular categories were 5.12% (95% confidence interval [CI]: 4.79, 5.45), 7.41% (95%CI: 6.42, 8.40), and 6.36% (95%CI: 2.45, 10.3) for BC; 3.85% (95%CI: 3.27, 4.43), 6.64% (95%CI: 5.63, 7.65), and 4.54% (95%CI: 3.31, 5.78) for PM 2.5 ; and 2.56% (95%CI: 1.45, 3.67), 3.41% (95%CI: 1.53, 5.29), and 3.19% (95%CI: 2.44, 3.94), for PM 2.5-10 , respectively. These findings suggest that controlling the emission of ambient particles, especially BC, and improving air quality during summer would substantially benefit population health. Furthermore, BC should be considered as a crucial air quality indicator to reflect PM health risk. Image 1 • To test the synergistic effects of temperature and black carbon (BC) on mortality. • High temperature amplified the harmful effects of BC and PM on mortality. • The modifying effects of temperature on BC were different from that on PMs. [ABSTRACT FROM AUTHOR]

Due to its twofold effects on climate change and air quality, black carbon (BC) is of wide concern in the atmospheric sciences. Considerable uncertainty exists as to the health effects of atmospheric BC for the limited epidemiological and toxicological studies. As combustion-derived BC is one important component of PM 2.5 (particles with aerodynamic diameters less than 2.5 μm), the question remains of whether or not BC may play an important role in PM 2.5 -related health risks. To quantitatively analyze the short-term health effects of BC and PM 2.5 , a confounder-adjusted semi-parametric generalized additive model (GAM) of a time series study was used to calculate the concentration-response relationship between BC and PM 2.5 and daily cardiovascular disease (CVD) mortality from 2006 to 2011 in Beijing. During the study period, the mean daily concentrations of BC and PM 2.5 were 6.8 μg/m3 and 75.9 μg/m3, respectively. The results showed that BC was significantly associated with CVD mortality, and an interquartile range (IQR) increase in BC (5.7 μg/m3) and PM 2.5 (64. 5 μg/m3) were associated with 2.70% (95% CI: 2.20, 3.21) and 4.06% (95% CI: 3.47, 4.65) increase in CVD mortality. The health risk associated with BC may less than that of PM 2.5. When adjusted for nitrogen dioxide (NO 2) and sulfur dioxide (SO 2), the effects of BC remained statistically significant. It showed the relatively difference between BC and PM 2.5 when it comes to the modification effects of age, gender and educational attainment. These findings provide valuable evidence to the rare studies of the concentration-response relationship of BC with human health in developing countries. Image 1 • Few studies in Asian developing countries have examined the health effects of BC. • We observed significant associations of BC and PM 2.5 with daily cardiovascular mortality in Beijing. • The health risk associated with ambient BC may less than that of PM 2.5. [ABSTRACT FROM AUTHOR]

Visibility can be used as a highly relevant visual indicator of the air pollution level. Published data on the correlations between visibility and health outcomes are very limited in China, and the health effects of slight haze on the human body have not been clarified. A semi-parametric generalized additive model (GAM) was used to assess the acute health effects of visibility on respiratory–cardiovascular mortality in Beijing, China. The correlation between visibility and PM 2.5 as well as the contributions of PM 2.5 to the health effects of visibility were analysed. Stratification model was employed to investigate the health effects of slight haze. The mortality risk of impaired visibility on the current exposure day peaked and was statistically significant for all the mortality outcomes. Every 1 km decrease in visibility corresponded to a 0.78% (95% CI: 0.62–0.95%) increase in total respiratory mortality and 0.54% (95% CI: 0.45–0.61%) increase in total cardiovascular mortality. Older people (age ≥65) were at a higher risk than the younger age group under impaired visibility. PM 2.5 had a negative logarithmic relationship relative to visibility. After adjustment for PM 2.5 , the risk estimates for both respiratory and cardiovascular mortality reduced. Short-term exposure to low visibility was significantly associated with increased respiratory and cardiovascular mortality in Beijing. The health risk of impaired visibility was particularly high, even in slight haze. The hazardous effects of visibility can be partially attributed to the effects of PM 2.5. These results can provide useful reference for relevant agencies to determine whether an adjustment to the haze warning level is warranted. Our findings indicate that visibility can be used as an alternative indicator for air quality assessments if air pollution data are insufficient or not available, particularly in developing countries. Image 1 • Studies on association between visibility and health outcomes are rare in China. • Exposure to impaired visibility is significantly related to increased mortality. • Health effects of impaired visibility can be partially explained by PM 2.5. • Health risk of impaired visibility is intense, even in slight haze. [ABSTRACT FROM AUTHOR]

The effect of temperature on cardiovascular disease (CVD) mortality has been extensively studied. However, it remains largely unknown over whether there is any difference between urban and suburban areas within the same city and how urbanization modifies the relationship between temperature and CVD mortality. In order to examine whether the association between temperature and CVD mortality existed difference in urban and suburban areas, and how urbanization modified this association, we used a distributed lag nonlinear model and a generalized additive model to investigate temperature-related CVD mortality in urban and suburban areas in Beijing, China, from 2006 to 2011. The age, gender, and educational attainment of the population were stratified to explore the modifying effect. We observed that the impacts of heat and cold temperature on CVD mortality were higher in suburban areas than in urban areas. In addition, the elderly and illiterate subjects in suburban areas were more vulnerable to both heat and cold than their counterparts in urban areas. Moreover, higher urbanization levels were significantly associated with districts having lower the excess risks for temperature- CVD mortality. Our findings provide evidence that populations in suburban Beijing have higher risk of temperature-related CVD mortality than those in urban areas. Therefore, greater attention should be paid to vulnerable groups in suburban areas to reduce temperature-related health burden. • Urban/suburban temperature-effect differences on mortality were compared. • Urbanization modifies the relationship between temperature and CVD mortality. • People living in suburban areas were more vulnerable to both hot and cold temperatures. • CVD mortality varied with age, gender, and educational attainment in both urban and suburban areas. • Implies different patterns of temperature impact between developed and developing countries. [ABSTRACT FROM AUTHOR]