Search

Abstract Background Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the presence of reduced renal function. The aim of this study was to analyze the relationship between estimated glomerular filtration rate (eGFR) and cardiovascular mortality in patients hospitalized with infection. Methods This cohort study included all adult, incident patients who were hospitalized at one of four hospitals in China between 2012 and 2015, had a discharge diagnosis of infection, and had a serum creatinine measurement at admission. Patients receiving renal replacement therapy were excluded. Hospital data were linked to death registry data. All-cause and cardiovascular mortality were evaluated according to admission eGFR [≥60 (reference), 30–59 and < 30 mL/min/1.73m2] using multivariable Cox regression and competing risk analyses. Results During a median follow-up period of 2.39 years, 40,524 patients were hospitalized with infection (mean age 61 years, 54.3% female 18.4% diabetic). Of these, 4781 died. Lower admission eGFR was associated with progressively increased risks of cardiovascular mortality (≥60 mL/min/1.73m2 reference; 30–59 mL/min/1.73m2 subdistribution hazard ratio [SHR] 2.15, 95% CI 1.85–2.50, P<.01; <30 mL/min/1.73m2 SHR 3.19, 95% CI 2.68–3.80, P <.01). The proportion of deaths due to cardiovascular disease increased as the eGFR decreased, predominantly due to ischemic heart disease. Conclusions Patients hospitalized with infections and reduced renal function have significantly increased risks of cardiovascular mortality. Heart status should be carefully monitored following infections, especially for those with reduced renal function. Highlights • Infections increase cardiovascular mortality in patients with reduced eGFR. • Cardiovascular death after infections are predominantly due to ischemic heart disease. • Heart status should be monitored following infections, especially for those with reduced eGFR. [ABSTRACT FROM AUTHOR]

The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006–2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), −0.53 % (95 % CI: −0.89 %, −0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure. [Display omitted] • Long-term effect of temperature on health was assessed by a quasi-experiment study. • The decreased summer temperature was associated with decreased mortality risks. • The average winter temperature is negatively correlated with mortality risks. • People with respiratory diseases and the young are more susceptible to temperature. • The temperature risk are more prominent in areas with low socioeconomic status. [ABSTRACT FROM AUTHOR]

Background Daily mean concentration cannot fully address the hourly variations of air pollution within one day. As such, we proposed a new indicator, daily exceedance concentration hours (DECH), to explore the acute cardiovascular effects of ambient PM 2.5 (particles with aerodynamic diameters less than 2.5 μm). The DECH in PM 2.5 was defined as daily total concentration-hours > 25 μg/m 3 . Methods A generalized additive model with a quasi-Poisson link was applied to estimate the associations between day-to-day variation in PM 2.5 DECH and day-to-day variation in cardiovascular mortality in six subtropical cities in Guangdong Province, China. Results The analysis revealed significant associations between PM 2.5 DECHs and cardiovascular mortality. A 500 μg/m 3 ∗ h increase in PM 2.5 DECHs at lag 03 was associated with an increase of 4.55% (95% confidence interval (CI): 3.59%, 5.52%) in cardiovascular mortality, 4.45% (95% CI: 2.81%, 6.12%) in ischemic cardiovascular mortality, 5.02% (95% CI: 3.41%, 6.65%) in cerebrovascular mortality, and 3.00% (95% CI: 1.13%, 4.90%) in acute myocardial infarction mortality. We further observed a greater mortality burden using PM 2.5 DECHs than daily mean PM 2.5 (6478 (95% CI: 5071, 7917) VS 5136 (95% CI: 3990, 6305)). Conclusion This study reveals that PM 2.5 DECH is one important exposure indicator of ambient PM 2.5 to measure its cardiovascular mortality effects in Pearl River Delta region; and that using daily mean concentration could under-estimate the mortality burden compared with this new indicator. [ABSTRACT FROM AUTHOR]

Compared with daily mean concentration of air pollution, hourly peak concentration may be more directly relevant to the acute health effects due to the high concentration levels, however, few have analyzed the acute mortality effects of hourly peak levels of air pollution. We examined the associations of hourly peak concentration of fine particulate matter air pollution (PM 2.5 ) with mortality in six cities in Pearl River Delta, China. We used generalized additive Poisson models to examine the associations with adjustment for potential confounders in each city. We further applied random-effects meta-analyses to estimate the regional overall effects. We further estimated the mortality burden attributable to hourly peak and daily mean PM 2.5 . We observed significant associations between hourly peak PM 2.5 and mortality. Each 10 μg/m3 increase in 4-day averaged (lag 03 ) hourly peak PM 2.5 corresponded to a 0.9% [95% confidence interval (CI): 0.7%, 1.1%] increase in total mortality, 1.2% (95% CI: 1.0%, 1.5%) in cardiovascular mortality, and 0.7% (95% CI: 0.2%, 1.1%) in respiratory mortality. We observed a greater mortality burden using hourly peak PM 2.5 than daily mean PM 2.5 , with an estimated 12915 (95% CI: 9922, 15949) premature deaths attributable to hourly peak PM 2.5 , and 7951 (95% CI: 5067, 10890) to daily mean PM 2.5 in the Pearl River Delta (PRD) region during the study period. This study suggests that hourly peak PM 2.5 might be one important risk factor of mortality in PRD region of China; the finding provides important information for future air pollution management and epidemiological studies. [ABSTRACT FROM AUTHOR]

Background Epidemiological studies have reported significant association between ambient fine particulate matter air pollution (PM 2.5 ) and mortality, however, few studies have investigated the relationship of mortality with PM 2.5 and associated mortality burden in China, especially in a multicity setting. Methods We investigated the PM 2.5 -mortality association in six cities of the Pearl River Delta region from 2013 to 2015. We used generalized additive Poisson models incorporating penalized smoothing splines to control for temporal trend, temperature, and relative humidity. We applied meta-analyses using random-effects models to pool the effect estimates in the six cities. We also examined these associations in stratified analyses by sex, age group, education level and location of death. We further estimated the mortality burden (attributable fraction and attributable mortality) due to ambient PM 2.5 exposures. Results During the study period, a total of 316,305 deaths were recorded in the study area. The analysis revealed a significant association between PM 2.5 and mortality. Specifically, a 10 μg/m 3 increase in 4-day averaged (lag 03 ) PM 2.5 concentration corresponded to a 1.76% (95% confidence interval (CI): 1.47%, 2.06%) increase in total mortality, 2.19% (95% CI: 1.80%, 2.59%) in cardiovascular mortality, and 1.68% (95% CI: 1.00%, 2.37%) in respiratory mortality. The results were generally robust to model specifications and adjustment of gaseous air pollutants. We estimated that 0.56% (95% CI: 0.47%, 0.66%) and 3.79% (95% CI: 3.14%, 4.45%) of all-cause mortalities were attributable to PM 2.5 using China's and WHO's air quality standards as the reference, corresponding to 1661 (95% CI: 1379, 1946) and 11,176 (95% CI: 9261, 13,120) attributable premature mortalities, respectively. Conclusion This analysis adds to the growing body of evidence linking PM 2.5 with daily mortality, and mortality burdens, particularly in one Chinese region with high levels of air pollution. [ABSTRACT FROM AUTHOR]

In 2012, Chinese Environmental Bureau modified its National Ambient Air Quality Standards to include fine particulate matter (PM 2.5 ). Recent air pollution monitoring data shows that numerous locations have exceeded this standard, which may have resulted in avoidable adverse health effects. For example, among the 74 Chinese cities with PM 2.5 monitoring data in 2013, only three cities attained the annual air quality standard (35 μg/m 3 ). This study aimed to quantify the potential short- and long-term health benefits from achieving the Chinese ambient air quality standard and WHO’s air quality objectives. A generalized additive model was used to estimate the short-term association of mortality with changes in daily PM 2.5 concentrations, based on which we estimated the potential premature mortality reduction that would have been achieved during the period of 2012–2015 if the daily air quality standard had been met in Guangzhou, China; we also estimated the avoidable deaths if attaining the annual air quality standard using the relative risk obtained from a previous cohort study. During the study period, there were 160 days exceeding the national daily PM 2.5 standard (75 μg/m 3 ) in Guangzhou, and the annual average concentration (47.7 μg/m 3 ) was higher than the air quality standard of 35 μg/m 3 . Significant associations between PM 2.5 and mortality were observed. An increase of 10 μg/m 3 in PM 2.5 was associated with increases in daily death counts of 0.95% (95% CI: 0.56%, 1.34%) in natural mortality, 1.31% (95% CI: 0.75%, 1.87%) in cardiovascular mortality, and 1.06% (95% CI: 0.19%, 1.94%) in respiratory mortality. The health benefits of attaining the national daily air quality standard of PM 2.5 (75 μg/m 3 ) would have prevented 143 [95% confidence interval (CI): 84, 203] fewer natural deaths, including 84 (95% CI: 48, 121) fewer cardiovascular deaths and 27 (95% CI: 5, 49) fewer respiratory deaths. Had the annual PM 2.5 levels been reduced to 35 μg/m 3 , an estimated 3875 (95% CI: 1852, 6074) natural deaths, 2378 (95% CI: 800, 4230) cardiovascular deaths, and 227 (95% CI: -437, 1033) respiratory deaths could have been prevented. Even greater substantial mortality reductions could be achieved if the WHO’s air quality objectives were met. Our study suggests that air pollution is significantly associated with mortality in Guangzhou, and more stringent air quality standards would significantly reduce air pollution-related premature mortality. [ABSTRACT FROM AUTHOR]

Though increasing evidence supports significant association between particulate matter (PM) air pollution and stroke, it remains unclear what characteristics, such as particle size and chemical constituents, are responsible for this association. A time-series model with quasi-Poisson function was applied to assess the association of PM pollution with different particle sizes and chemical constituents with mortalities from ischemic and hemorrhagic strokes in Guangzhou, China, we controlled for potential confounding factors in the model, such as temporal trends, day of the week, public holidays, meteorological factors and influenza epidemic. We found significant association between stroke mortality and various PM fractions, such as PM10, PM2.5 and PM1, with generally larger magnitudes for smaller particles. For the PM2.5 chemical constituents, we found that organic carbon (OC), elemental carbon (EC), sulfate, nitrate and ammonium were significantly associated with stroke mortality. The analysis for specific types of stroke suggested that it was hemorrhagic stroke, rather than ischemic stroke, that was significantly associated with PM pollution. Our study shows that various PM pollution fractions are associated with stroke mortality, and constituents primarily from combustion and secondary aerosols might be the harmful components of PM2.5 in Guangzhou, and this study suggests that PM pollution is more relevant to hemorrhagic stroke in the study area, however, more studies are warranted due to the underlying limitations of this study. [ABSTRACT FROM AUTHOR]

Abstract: Though increased particulate air pollution has been consistently associated with elevated mortality, evidence regarding whether diminished particulate air pollution would lead to mortality reduction is limited. Citywide air pollution mitigation program during the 2010 Asian Games in Guangzhou, China, provided such an opportunity. Daily mortality from non-accidental, cardiovascular and respiratory diseases was compared for 51 intervention days (November 1–December 21) in 2010 with the same calendar date of baseline years (2006–2009 and 2011). Relative risk (RR) and 95% confidence interval (95% CI) were estimated using a time series Poisson model, adjusting for day of week, public holidays, daily mean temperature and relative humidity. Daily PM10 (particle with aerodynamic diameter less than 10 μm) decreased from 88.64 μg/m3 during the baseline period to 80.61 μg/m3 during the Asian Games period. Other measured air pollutants and weather variables did not differ substantially. Daily mortality from non-accidental, cardiovascular and respiratory diseases decreased from 32, 11 and 6 during the baseline period to 25, 8 and 5 during the Games period, the corresponding RR for the Games period compared with the baseline period was 0.79 (95% CI: 0.73–0.86), 0.77 (95% CI: 0.66–0.89) and 0.68 (95% CI: 0.57–0.80), respectively. No significant decreases were observed in other months of 2010 in Guangzhou and intervention period in two control cities. This finding supports the efforts to reduce air pollution and improve public health through transportation restriction and industrial emission control. [Copyright &y& Elsevier]

Abstract: Background: Heat waves have been reported to be associated with increased mortality; however, fewer studies have examined the effect modification by heat wave characteristics, individual characteristics and community characteristics. Methods: This study investigated the effect of extreme heat on mortality in 2 urban and 2 rural communities in Guangdong Province, China during 2006–2010. The effect of extreme heat was divided into two parts: main effect due to high temperature and added effect due to prolonged heat for several consecutive days. A distributed lag non-linear model was used to calculate the relative risk with consideration of lag days and potential confounding factors. Separate models were further fit by individual characteristics (cause of death, age and gender) and heat wave characteristics (intensity, duration and timing), and potential effect modification of community characteristics was examined using a meta-regression, such as educational levels, percentage of the elderly, Gross Regional Domestic Product (GDP). Results: The overall main effects (ER=8.2%, 95% CI: 3.4%, 13.2%) were greater than the added effects (ER=0.0%, 95% CI: −3.8%, 4.0%) on the current day. The main effect peaked at lag0–2, and was higher for the two rural areas compared to the two cities, for respiratory compared to cardiovascular mortality, for those ≥75years old and for females. The modifying effects of heat wave characteristics and community characteristics on mortality were not statistically significant. Conclusion: This study suggests the effects of extreme heat were mainly driven by high temperature, which can be modified by some individual characteristics. [Copyright &y& Elsevier]

Abstract: Background: Numerous studies have reported the association between ambient temperature and mortality. However, few multicity studies have been conducted in subtropical regions in developing countries. The present study assessed the health effects of temperature on mortality in four subtropical cities of China. Methods: We used “double threshold-natural cubic spline” distributed lag non-linear model (DLNM) to investigate the cold and hot effects on mortality at different lags in four subtropical cities. Then we conducted a meta-analysis to estimate the overall cold and hot effects on mortality at different lag days. Results: A U-shaped relationship between temperature and mortality was found in the four cities. Cold effect was delayed and persisted for about 27days, whereas hot effect was acute and lasted for 3days. In Changsha, Kunming, Guangzhou and Zhuhai, a 1°C decrease of temperature under the low threshold was associated with a lag0–27 cumulative relative risk (RR) of 1.061 (95% confidence interval (CI): 1.023–1.099), 1.044 (95% CI: 1.033–1.056), 1.096 (95% CI: 1.075–1.117) and 1.111 (95% CI: 1.078–1.145) for total mortality, respectively. And RR for 1°C increase of temperature above the hot threshold at the lag0 was 1.020 (95% CI: 1.003–1.037), 1.017 (95% CI: 1.004–1.030), 1.029 (95% CI: 1.020–1.039) and 1.023 (95% CI: 1.004–1.042), respectively. The cold and hot effects were greater among the elderly in Changsha, Guangzhou and Zhuhai. Meta analysis showed that the hot effect decreased gradually with lag days, with the greatest effect at current day (RR=1.023, 95% CI: 1.015–1.031); while the cumulative cold effect increased gradually with lag days, with the highest effect at lag0–27 (RR=1.076, 95% CI: 1.046–1.107). Conclusion: Both low and high temperatures were associated with increased mortality in the four subtropical Chinese cities, and cold effect was more durable and pronounced than hot effect. [Copyright &y& Elsevier]