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Background and Objective Methods Results Conclusion Evidence of short‐term exposure to particulate matter with an aerodynamic diameter ≤1 μm (PM1) on hospital admission for respiratory diseases (RDs) is limited. We aimed to estimate the associated risk of PM1 on hospital admissions for RDs.In this time‐stratified case‐crossover study, we assigned cases who had been admitted to hospital for RDs in Guangdong, China between 2016 and 2019. Exposure to PM1 was assigned on the basis of the patient's residence for each case day and its control days. Conditional logistic regression models and distributed lag nonlinear models were used to quantify the association of PM1 exposure with hospital admission for RDs at lag 0–1 days.A total of 408, 658 hospital admissions for total RDs were recorded in the study period. Each 10 μg/m3 increase in PM1 was significantly associated with a 1.39% (95% confidence interval [CI]: 0.87%–1.91%), 1.97% (95% CI: 1.06%–2.87%) and 1.69% (95% CI: 0.67%–2.71%) increase in odds of hospital admissions for total RDs, chronic obstructive pulmonary disease (COPD) and pneumonia. The excess fraction of hospital admission for total RDs attributable to PM1 exposure was 6.03%, while 6.59% for COPD and 7.48% for pneumonia. Besides, higher excess fractions were more pronounced for hospital admission of total RDs in older patients (>75 years).Our results support that PM1 is associated with increased risks of hospital admissions for RDs. It emphasizes the needs to pay attention to the effects of PM1 on respiratory health, especially among elderly patients. [ABSTRACT FROM AUTHOR]

Exposure to ambient ozone (O3) is linked to increased mortality risks from various diseases, but epidemiological investigations delving into its potential implications for cancer mortality are limited. We aimed to examine the association between short‐term O3 exposure and site‐specific cancer mortality and investigate vulnerable subgroups in Brazil. In total 3,459,826 cancer death records from 5570 Brazilian municipalities between 2000 and 2019, were included. Municipal average daily O3 concentration was calculated from a global estimation at 0.25°×0.25° spatial resolution. The time‐stratified case‐crossover design was applied to assess the O3‐cancer mortality association. Subgroup analyses by age, sex, season, time‐period, region, urban hierarchy, climate classification, quantiles of GDP per capita and illiteracy rates were performed. A linear and non‐threshold exposure‐response relationship was observed for short‐term exposure to O3 with cancer mortality, with a 1.00% (95% CI: 0.79%–1.20%) increase in all‐cancer mortality risks for each 10‐μg/m3 increment of three‐day average O3. Kidney cancer was most strongly with O3 exposure, followed by cancers of the prostate, stomach, breast, lymphoma, brain and lung. The associated cancer risks were relatively higher in the warm season and in southern Brazil, with a decreasing trend over time. When restricting O3 concentration to the national minimum value during 2000–2019, a total of 147,074 (116,690–177,451) cancer deaths could be avoided in Brazil, which included 17,836 (7014–28,653) lung cancer deaths. Notably, these associations persisted despite observed adaptation within the Brazilian population, highlighting the need for a focus on incorporating specific measures to mitigate O3 exposure into cancer care recommendations. [ABSTRACT FROM AUTHOR]

Associations between air pollution and the acute exacerbations (AEs) of COPD have been established primarily in time-series studies in which exposure and health data were at the aggregate level, limiting the identification of susceptible populations. Are air pollutants associated with the onset of AEs of COPD in China? Who is more susceptible to the effects of air pollutants? Data regarding AEs of COPD were obtained from the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Registry (ACURE) study, and air pollution data were assigned to individuals based on their residential address. We adopted a time-stratified case-crossover study design combined with conditional logistic regression models to estimate the associations between six air pollutants and AEs of COPD. Stratified analyses were performed by individual characteristics, disease severity, COPD types, and the season of exacerbations. A total of 5,746 patients were included. At a 2-day lag, for each interquartile range increase in fine particulate matter and inhalable particulate matter concentrations, ORs for AEs of COPD were 1.054 (95% CI, 1.012-1.097) and 1.050 (95% CI, 1.009-1.092), respectively. The associations were more pronounced in participants who were younger than 65 years, who had experienced at least one severe AE of COPD in the past year, who had received a diagnosis of COPD between 20 and 50 years of age, and who had experienced AEs of COPD in the cool seasons. By contrast, significant associations for nitrogen dioxide, sulfur dioxide, and carbon monoxide lost significance when excluding patients collected before 2020 or with greater distance from the monitoring station, and no significant association was observed for ozone. This study provides robust evidence that short-term exposure to fine particulate matter and inhalable particulate matter was associated with higher odds of AEs of COPD onset. Individuals who are young, have severe COPD, or whose first diagnosis of COPD was made when they were between 20 and 50 years of age and experience an exacerbation during the cooler seasons may be particularly susceptible. ClinicalTrials.gov; No.: NCT2657525; URL: www.clinicaltrials.gov [ABSTRACT FROM AUTHOR]

Stock volatility constitutes an adverse psychological stressor, but few large-scale studies have focused on its impact on major adverse cardiovascular events (MACEs) and suicide. Here, we conducted an individual-level time-stratified case-crossover study to explore the association of daily stock volatility (daily returns and intra-daily oscillations for three kinds of stock indices) with MACEs and suicide among more than 12 million individual decedents from all counties in the mainland of China between 2013 and 2019. For daily stock returns, both stock increases and decreases were associated with increased mortality risks of all MACEs and suicide. There were consistent and positive associations between intra-daily stock oscillations and mortality due to MACEs and suicide. The excess mortality risks occurred at the current day (lag 0 d), persisted for two days, and were greatest for suicide and hemorrhagic stroke. Taking the present-day Shanghai and Shenzhen 300 Index as an example, a 1% decrease in daily returns was associated with 0.74%–1.04% and 1.77% increases in mortality risks of MACEs and suicide, respectively; the corresponding risk increments were 0.57%–0.85% and 0.92% for a 1% increase in daily returns and 0.67%–0.77% and 1.09% for a 1% increase in intra-daily stock oscillations. The excess risks were more pronounced among individuals aged 65–74 years, males, and those with lower education levels. Our findings revealed considerable health risks linked to sociopsychological stressors, which are helpful for the government and general public to mitigate the immediate cardiovascular and mental health risks associated with stock market volatility.

Abstract Objectives This study aimed to establish the exposure-lag-response effect between daily maximum temperature and stroke-related emergency department visits and to project heat-induced stroke impacts under global warming levels (GWL) of 2 °C and 4 °C. Methods Stroke-related emergency department visits in Taiwan from 2001 to 2020 were identified using the National Health Insurance Research Database (NHIRD). The study population consisted of 1,100,074 initial stroke cases matched with 2,200,148 non-stroke controls. We employed Distributed Lag Nonlinear Models (DLNM) in a case-crossover study to investigate the association between temperature and stroke. Generalized Estimating Equations (GEE) models with a Poisson function were used to correlate high-temperature exposure with annual stroke incidence rates. Projections were made under two global warming scenarios, GWL 2.0 °C and 4.0 °C, using Coupled General Circulation Model (GCMs). Baseline data from 1995 to 2014 were transformed for spatial distribution at the township level. Geographic Information System (GIS) spatial analysis was performed using Quantum GIS 3.2.0 software. Results DLNM exposure-lag-response effect revealed that daily maximum temperature exceeding 34 °C significantly increased the risk of stroke-related emergency department visits, particularly for ischemic stroke. Under the 2 °C GWL scenario, the frequency of days with temperatures surpassing 34 °C is projected to rise substantially by the median year of 2042, with a further increase to 92.6 ± 18.0 days/year by 2065 under the 4 °C GWL scenario. Ischemic stroke showed the highest increase in temperature-related incidence rates, notably rising from 7.80% under the GWL 2 °C to 36.06% under the GWL 4 °C. Specifically, the annual temperature-related incidence rate for ischemic stroke is expected to increase significantly by 2065. Regions such as Taichung, Hsinchu, Yilan, and Taitung demonstrated pronounced changes in heat-related ischemic stroke incidence under the GWL 4 °C. Conclusions The findings emphasize the importance of addressing temperature-related stroke risks, particularly in regions projected to experience significant temperature increases. Effective mitigation strategies are crucial to reduce the impact of rising temperatures on stroke incidence and safeguard public health.

The short-term adverse effects of ambient fine particulate matter (PM 2.5) and ozone (O 3) on anxiety disorders (ADs) remained inconclusive. We applied an individual-level time-stratified case-crossover study, which including 126,112 outpatient visits for ADs during 2019–2021 in Guangdong province, China, to investigate the association of short-term exposure to PM 2.5 and O 3 with outpatient visits for ADs, and estimate excess outpatient visits in South China. Daily residential air pollutant exposure assessments were performed by extracting grid data (spatial resolution: 1 km × 1 km) from validated datasets. We employed the conditional logistic regression model to quantify the associations and excess outpatient visits. The results of the single-pollutant models showed that each 10 μg/m3 increase of PM 2.5 and O 3 exposures was significantly associated with a 3.14 % (95 % confidence interval: 2.47 %, 3.81 %) and 0.88 % (0.49 %, 1.26 %) increase in odds of outpatient visits for ADs, respectively. These associations remained robust in 2-pollutant models. The proportion of outpatient visits attributable to PM 2.5 and O 3 exposures was up to 7.20 % and 8.93 %, respectively. Older adults appeared to be more susceptible to PM 2.5 exposure, especially in cool season, and subjects with recurrent outpatient visits were more susceptible to O 3 exposure. As our study subjects were from one single hospital in China, it should be cautious when generalizing our findings to other regions. Short-term exposure to ambient PM 2.5 and O 3 was significantly associated with a higher odds of outpatient visits for ADs, which can contribute to considerable excess outpatient visits. • Exposure to ambient PM 2.5 and O 3 was associated with an increased odds of outpatient visits for anxiety disorders. • PM 2.5 and O 3 exposures were attributable to considerable excess outpatient visits. • Older adults were more susceptible to PM 2.5 exposure, especially in cool season. • Subjects with recurrent outpatient visits were more susceptible to O 3 exposure. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to establish the exposure-lag-response effect between daily maximum temperature and stroke-related emergency department visits and to project heat-induced stroke impacts under global warming levels (GWL) of 2 °C and 4 °C. Methods: Stroke-related emergency department visits in Taiwan from 2001 to 2020 were identified using the National Health Insurance Research Database (NHIRD). The study population consisted of 1,100,074 initial stroke cases matched with 2,200,148 non-stroke controls. We employed Distributed Lag Nonlinear Models (DLNM) in a case-crossover study to investigate the association between temperature and stroke. Generalized Estimating Equations (GEE) models with a Poisson function were used to correlate high-temperature exposure with annual stroke incidence rates. Projections were made under two global warming scenarios, GWL 2.0 °C and 4.0 °C, using Coupled General Circulation Model (GCMs). Baseline data from 1995 to 2014 were transformed for spatial distribution at the township level. Geographic Information System (GIS) spatial analysis was performed using Quantum GIS 3.2.0 software. Results: DLNM exposure-lag-response effect revealed that daily maximum temperature exceeding 34 °C significantly increased the risk of stroke-related emergency department visits, particularly for ischemic stroke. Under the 2 °C GWL scenario, the frequency of days with temperatures surpassing 34 °C is projected to rise substantially by the median year of 2042, with a further increase to 92.6 ± 18.0 days/year by 2065 under the 4 °C GWL scenario. Ischemic stroke showed the highest increase in temperature-related incidence rates, notably rising from 7.80% under the GWL 2 °C to 36.06% under the GWL 4 °C. Specifically, the annual temperature-related incidence rate for ischemic stroke is expected to increase significantly by 2065. Regions such as Taichung, Hsinchu, Yilan, and Taitung demonstrated pronounced changes in heat-related ischemic stroke incidence under the GWL 4 °C. Conclusions: The findings emphasize the importance of addressing temperature-related stroke risks, particularly in regions projected to experience significant temperature increases. Effective mitigation strategies are crucial to reduce the impact of rising temperatures on stroke incidence and safeguard public health. [ABSTRACT FROM AUTHOR]

Although the risk of dental procedures as a cause of bacteremia has been recognized, evidence regarding the association between dental procedures and late periprosthetic joint infection (LPJI) is scarce. We sought to determine whether dental procedures are associated with an increased risk of LPJI. The study was conducted under a case-crossover design using a large claims database in Japan. We identified adult patients who had undergone dental procedures and were hospitalized for LPJI between April 2014 and September 2021. Exposure to dental procedures was assessed during a case period of 1–4 weeks, with two control periods of 9–12 weeks and 17–20 weeks, preceding LPJI hospital admission. Conditional logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of LPJI associated with dental procedures in the case period compared with the two control periods. In total, 241 patients with LPJI were included in the case-crossover study. At least one dental procedure was performed in 46 patients (19.1%) in the hazard period and in 75 patients (31.1%) in the control periods. The OR for LPJI with dental procedures was 0.96 (95% CI, 0.61–1.53; p = 0.88). Findings were robust in several sensitivity analyses, including stratification by whether the dental procedure included antibiotic prophylaxis. This study suggests that dental procedures are not associated with increased risk of LPJI, and will raise questions about the recommendation for antibiotic prophylaxis before dental procedures. [ABSTRACT FROM AUTHOR]

The impact of short-term exposure to air pollutants on the morbidity of schizophrenia, particularly in low- and middle-income countries, remains inadequately explored. The objective of this research was to investigate the relationship between short-term exposure to ambient air pollutants and the risk of schizophrenia hospitalization in Jingmen, China. We performed a time-stratified case-crossover study using daily records of hospital admissions due to schizophrenia in Jingmen Mental Health Center from 2015 to 2017. Environmental exposures to air pollutants and meteorological conditions on case and control days were estimated on the basis of measurements from ground monitoring stations. To investigate the relationship between short-term exposure to ambient air pollutants and the risk of hospitalization for schizophrenia, a conditional logistic regression model was employed. We performed subgroup analyses stratified according to sex, age groups, and season. In total, 4079 schizophrenia hospitalizations were recorded during the designated period. Increased risk of schizophrenia was merely associated with short-term exposure to SO2 and NO2. The estimated odds per interquartile range (IQR) increase in exposure was 1.112 (95% confidence interval (CI): 1.033, 1.196) for SO2 (IQR = 12 µg/m3) and 1.112 (95% CI: 1.033, 1.197) for NO2 (IQR = 18 µg/m3) on lag-0 day. Greater air pollution-schizophrenia associations were observed among middle-aged and older adults (over 45 years of age) and during the cold season. This study added case-crossover evidence indicating that short-term exposure to ambient air pollution, specifically SO2 and NO2, is linked to a higher risk of hospital admissions for schizophrenia. These findings contribute to a better understanding of the detrimental effects of air pollution on neuropsychiatric health conditions. [ABSTRACT FROM AUTHOR]

Abstract Background The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19. Methods Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay. Results The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259–39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03–1.55, p = 0.027). Conclusion This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).

Background: The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19. Methods: Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay. Results: The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259–39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03–1.55, p = 0.027). Conclusion: This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264). [ABSTRACT FROM AUTHOR]

Gout attacks are treated with uric-lowering and anti-inflammatory drugs. In patients with gout, non-steroidal anti-inflammatory drugs (NSAIDs) could be both cardiovascular beneficial, due to their anti-inflammatory actions, and cardiovascular hazardous, due to their prothrombotic, hypertensive, and proarrhythmic side effects. We, therefore, examined the risk of cardiovascular events associated with NSAID use in patients with gout. We conducted a nationwide, population-based case-crossover study of all Danes ≥ 18 years of age with first-time gout during 1997–2020, who experienced a cardiovascular event (myocardial infarction, ischemic stroke, congestive heart failure, atrial fibrillation/flutter, or cardiovascular death) (n = 59,150). The exposure was use of NSAIDs, overall and according to type (ibuprofen, naproxen, or diclofenac). We used the dates 300, 240, 180, and 120 before the outcome date as reference dates. We used the Mantel–Haenszel method to calculate odds ratios (ORs) with 95% confidence intervals (CIs) of the association between NSAID use and cardiovascular events. NSAID use was overall associated with 12% decreased odds of a cardiovascular event (OR = 0.88, 95% CI: 0.85–0.91). This decreased odds ratio was observed for the use of ibuprofen (OR = 0.92, 95% CI: 0.88–0.97) and naproxen (OR = 0.85, 95% CI: 0.74–0.97), but not for the use of diclofenac (OR = 0.97, 95% CI: 0.90–1.05). Overall, use of NSAIDs was associated with decreased odds of all the individual components of the composite outcome. NSAIDs were not associated with an increased cardiovascular event rate when used in gout patients. Ibuprofen and naproxen appeared to have better cardiovascular risk profiles than diclofenac. [ABSTRACT FROM AUTHOR]

Summary: Background: Short-term exposure to particulate matter air pollution has been associated with the exacerbations of COPD, but its association with COPD mortality was not fully elucidated. We aimed to assess the association between short-term particulate matter exposure and the risk of COPD mortality in China using individual-level data. Methods: We derived 2.26 million COPD deaths from a national death registry database in Chinese mainland between 2013 and 2019. Exposures to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) were assessed by satellite-based models of a 1 × 1 km resolution and assigned to each individual based on residential address. The associations of PM2.5 and PM2.5-10 with COPD mortality were examined using a time-stratified case-crossover design and conditional logistic regressions with distributed lag models. We further conducted stratified analyses by age, sex, education level, and season. Findings: Short-term exposures to both PM2.5 and PM2.5-10 were associated with increased risks of COPD mortality. These associations appeared and peaked on the concurrent day, attenuated and became nonsignificant after 5 or 7 days, respectively. The exposure-response curves were approximately linear without discernible thresholds. An interquartile range increase in PM2.5 and PM2.5-10 concentrations was associated with 4.23% (95% CI: 3.75%, 4.72%) and 2.67% (95% CI: 2.18%, 3.16%) higher risks of COPD mortality over lag 0–7 d, respectively. The associations of PM2.5 and PM2.5-10 attenuated slightly but were still significant in the mutual-adjustment models. A larger association of PM2.5-10 was observed in the warm season. Interpretation: This individual-level, nationwide, case-crossover study suggests that short-term exposure to PM2.5 and PM2.5-10 might act as one of the environmental risk factors for COPD mortality. Funding: This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.2-YQ31), and the Science and Technology Commission of Shanghai Municipality (21TQ015).

The changing climate poses a growing challenge to the population health. The objective of this study was to assess the association between ambient temperature and cause-specific mortality in Suzhou. Based on the non-accidental mortality data collected during 2008–2022 in Suzhou, China, this study utilized an individual-level case-crossover design to evaluate the associations of temperature with cause-specific mortality. We applied a distributed lag nonlinear model with a maximum lag of 14 days to account for lag effects. Mortality risk due to extreme cold (97.5th percentile) was analyzed. A total of 634,530 non-accidental deaths were analyzed in this study. An inverse J-shaped exposure-response relationship was observed between ambient temperature and non-accidental mortality, with the minimum mortality temperature (MMT) at 29.1℃. The relative risk (RR) of mortality associated with extreme cold (2.5th percentile) was 1.37 [95 % confidence interval (CI): 1.30, 1.44], higher than estimate of 1.09 (95 %CI: 1.07, 1.11) for extreme heat (97.5th percentile) relative to the MMT. Heat effect lasted for 2–3 days, while cold effect could persist for almost 14 days. Higher mortality risk estimates were observed for cardiorespiratory deaths compared to total deaths, with statistically significant between-group differences. Consequently, this study provides first-hand evidence on the associations between ambient temperatures and mortality risks from various causes, which could help local government and policy-makers in designing targeted strategies and public health measures against the menace of climate change.

Background and objectives: Many studies suggested that short-term exposure to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5–10) was linked to elevated risk of cerebrovascular disease. However, little is known about the potentially differential effects of PM2.5 and PM2.5–10 on various types of cerebrovascular disease. Methods: We collected individual cerebrovascular death records for all residents in Shanghai, China from 2005 to 2021. Residential daily air pollution data were predicted from a satellite model. The associations between particulate matters (PM) and cerebrovascular mortality were investigated by an individual-level, time-stratified, case-crossover design. The data was analyzed by the conditional logistic regression combined with the distributed lag model with a maximum lag of 7 days. Furthermore, we explored the effect modifications by sex, age and season. Results: A total of 388,823 cerebrovascular deaths were included. Monotonous increases were observed for mortality of all cerebrovascular diseases except for hemorrhagic stroke. A 10 μg/m3 rise in PM2.5 was related to rises of 1.35% [95% confidence interval (CI): 1.04%, 1.66%] in mortality of all cerebrovascular diseases, 1.84% (95% CI: 1.25%, 2.44%) in ischemic stroke, 1.53% (95% CI: 1.07%, 1.99%) in cerebrovascular sequelae and 1.56% (95% CI: 1.08%, 2.05%) in ischemic stroke sequelae. The excess risk estimates per each 10 μg/m3 rise in PM2.5–10 were 1.47% (95% CI: 1.10%, 1.84%), 1.53% (95% CI: 0.83%, 2.24%), 1.93% (95% CI: 1.38%, 2.49%) and 2.22% (95% CI: 1.64%, 2.81%), respectively. The associations of both pollutants with all cerebrovascular outcomes were robust after controlling for co-pollutants. The associations were greater in females, individuals > 80 years, and during the warm season. Conclusions: Short-term exposures to both PM2.5 and PM2.5–10 may independently increase the mortality risk of cerebrovascular diseases, particularly of ischemic stroke and stroke sequelae.

BackgroundNitrogen dioxide (NO2), a crucial component of traffic pollutants, has been shown in studies to exert toxic effects on the nervous system. However, there is a limited body of research examining the relationship between NO2 exposure and neurological disorders in children. ObjectiveTo explore the impact of short-term NO2 exposure on the outpatient visits due to pediatric neurological diseases in Shijiazhuang. MethodsFrom 2013 to 2021, we collected outpatient data related to neurological diseases at the Children's Hospital in Shijiazhuang, Hebei Province. We also collected air pollution data and meteorological data of the same city. The air pollution data included daily average concentrations of inhalable particles (PM10), fine particulate matter (PM2.5), sulfur dioxide (SO2), NO2, carbon monoxide (CO), and daily maximum 8-hour average concentration of ozone (O3). The meteorological data comprised daily average atmospheric pressure, temperature, relative humidity, wind speed, and sunshine duration. Employing a time-stratified case-crossover design, we used conditional logistic regression models to analyze the association between NO2 and pediatric outpatient visits for neurological diseases. Stratification analyses were conducted based on gender (male, female) and age groups (0-6 years, 7-14 years). ResultsThe study included a total of 154348 valid pediatric outpatient visits for neurological diseases. The daily average concentration of NO2 was 49.3 μg·m−3 for the study period. The results from the single-pollutant model indicated that NO2 increased the risk of pediatric neurological outpatient visits, with the highest association observed at lag0. Specifically, for every 10 μg·m⁻³ increase in atmospheric NO2 exposure, there was a 1.40% increase (95%CI: 1.05%, 1.74%) in pediatric neurological outpatient visits. The stratification analyses revealed that increased atmospheric NO2 exposure was associated with an elevated risk of neurological outpatient visits for girls (ER=1.54, 95%CI: 1.01, 2.08) and children aged 7-14 years (ER=2.35, 95%CI: 1.68, 3.02). Even after introducing PM2.5 (ER=1.96, 95%CI: 1.49, 2.43), SO2 (ER=2.09, 95%CI: 1.62, 2.55), and O3 (ER=1.40, 95%CI: 1.06, 1.74) to the models, the impact of NO2 exposure on pediatric neurological outpatient visits remained statistically significant. The results of the multi-pollutant model also indicated a significant association (ER=2.53, 95%CI: 1.97, 3.08). ConclusionThe effect of short-term exposure to atmospheric NO2 on the outpatient visits of children with neurological diseases in Shijiazhuang is acute and independent, especially for children aged 7-14.

Abstract Pregnant women might have an increased risk of SARS-COV-2 infection. Although evidence towards the efficacy and safety of COVID-19 is growing still there is room for improvement on the knowledge towards pregnancy adverse events, such as miscarriage. We explored the association of COVID-19 vaccine with the risk of miscarriages using the Real-World. We identified a cohort of vaccinated pregnancies using the BIFAP database which contains systematically recorded data on care patients in Spain (N = 4054). We then restricted it to those women who had a miscarriage using a validated algorithm (N = 607). Among them, we performed a case-crossover design to evaluate the effect of intermittent exposures on the risk of miscarriage. Adjusted Odds Ratio with their confidence intervals were calculated using two analytical approaches: conditional logistic regression and Generalized Linear Mixed-Effects Models. A total of 225 (37.1%) were aged 35–39 years. The most common comorbidities were asthma, migraine, gastritis, and hypothyroidism. A total of 14.7% received only one dose of COVID-19 and 85.3% two doses, respectively. A total of 36.8% of women with one dose and 27.6% with two doses received the vaccine 7 days prior to the miscarriage. Corresponding adjusted estimates for the risk of miscarriage using the conditional logistic regression where as follows: 1.65 (95% CI 0.85–3.23) when using as the sum of 3 control moments among women with one dose, 1.02 (95% CI 0.72–1.46) among women with two doses and 1.03 (95% CI 0.72, 1.46) using the whole study population. Very similar results were obtained when conducting the Generalized Linear Mixed-Effects Models. There was no overall increased risk of miscarriage onset associated with COVID-19 vaccine although contradictory results were found according to the number of doses. Further studies are required with larger sample sizes to assess this association.

Background The effect of exposure to extreme temperature events (ETEs) on dementia mortality remains largely unknown. We aimed to quantify the association of ETE exposure with dementia mortality. Methods We conducted a population-based, case-crossover study among 57 791 dementia deaths in Jiangsu province, China, during 2015–20. Daily mean temperatures were extracted from a validated grid dataset at each subject's residential address, and grid-specific exposures to heat wave and cold spell were assessed with a combination of their intensity and duration. We applied conditional logistic regression models to investigate cumulative and lag effects for ETE exposures. Results Exposure to ETE with each of all 24 definitions was associated with an increased odds of dementia mortality, which was higher when exposed to heat wave. Exposure to heat wave (daily mean temperature ≥95th percentile, duration ≥3 days (d); P95_3d) and cold spell (≤5th percentile, duration ≥3 d; P5_3d) was associated with a 75% (95% CI: 61%, 90%) and 30% (19%, 43%) increase in odds of dementia mortality, respectively. Definitions with higher intensity were generally associated with a higher odds of dementia mortality. We estimated that 6.14% of dementia deaths were attributable to exposure to heat wave (P90_2d) and cold spell (P10_2d). No effect modifications were observed by sex or age, except that the association for heat wave was stronger among women. Conclusions Exposure to both heat wave and cold spell was associated with an increased odds of dementia mortality. Our findings highlight that reducing individual ETE exposures may be helpful in preventing deaths from dementia, especially among women in summer. [ABSTRACT FROM AUTHOR]

ObjectivesThe impact of climate change, especially extreme temperatures, on health outcomes has become a global public health concern. Most previous studies focused on the impact of disease incidence or mortality, whereas much less has been done on road traffic injuries (RTIs). This study aimed to explore the effects of ambient temperature, particularly extreme temperature, on road traffic deaths in Jinan city.MethodsDaily data on road traffic deaths and meteorological factors were collected among all residents in Jinan city during 2011–2020. We used a time-stratified case-crossover design with distributed lag nonlinear model to evaluate the association between daily mean temperature, especially extreme temperature and road traffic deaths, and its variation in different subgroups of transportation mode, adjusting for meteorological confounders.ResultsA total of 9,794 road traffic deaths were collected in our study. The results showed that extreme temperatures were associated with increased risks of deaths from road traffic injuries and four main subtypes of transportation mode, including walking, Bicycle, Motorcycle and Motor vehicle (except motorcycles), with obviously lag effects. Meanwhile, the negative effects of extreme high temperatures were significantly higher than those of extreme low temperatures. Under low-temperature exposure, the highest cumulative lag effect of 1.355 (95% CI, 1.054, 1.742) for pedal cyclists when cumulated over lag 0 to 6 day, and those for pedestrians, motorcycles and motor vehicle occupants all persisted until 14 days, with ORs of 1.227 (95% CI, 1.102, 1.367), 1.453 (95% CI, 1.214, 1.740) and 1.202 (95% CI, 1.005, 1.438), respectively. Under high-temperature exposure, the highest cumulative lag effect of 3.106 (95% CI, 1.646, 5.861) for motorcycle occupants when cumulated over lag 0 to 12 day, and those for pedestrian, pedal cyclists, and motor vehicle accidents all peaked when persisted until 14 days, with OR values of 1.638 (95% CI, 1.281, 2.094), 2.603 (95% CI, 1.695, 3.997) and 1.603 (95% CI, 1.066, 2.411), respectively.ConclusionThis study provides evidence that ambient temperature is significantly associated with the risk of road traffic injuries accompanied by obvious lag effect, and the associations differ by the mode of transportation. Our findings help to promote a more comprehensive understanding of the relationship between temperature and road traffic injuries, which can be used to establish appropriate public health policies and targeted interventions.

Abstract Background Satellite-based PM2.5 predictions are being used to advance exposure science and air-pollution epidemiology in developed countries; including emerging evidence about the impacts of PM2.5 on acute health outcomes beyond the cardiovascular and respiratory systems, and the potential modifying effects from individual-level factors in these associations. Research on these topics is lacking in low and middle income countries. We aimed to explore the association between short-term exposure to PM2.5 with broad-category and cause-specific mortality outcomes in the Mexico City Metropolitan Area (MCMA), and potential effect modification by age, sex, and SES characteristics in such associations. Methods We used a time-stratified case-crossover study design with 1,479,950 non-accidental deaths from the MCMA for the period of 2004–2019. Daily 1 × 1 km PM2.5 (median = 23.4 μg/m3; IQR = 13.6 μg/m3) estimates from our satellite-based regional model were employed for exposure assessment at the sub-municipality level. Associations between PM2.5 with broad-category (organ-system) and cause-specific mortality outcomes were estimated with distributed lag conditional logistic models. We also fit models stratifying by potential individual-level effect modifiers including; age, sex, and individual SES-related characteristics namely: education, health insurance coverage, and job categories. Odds ratios were converted into percent increase for ease of interpretation. Results PM2.5 exposure was associated with broad-category mortality outcomes, including all non-accidental, cardiovascular, cerebrovascular, respiratory, and digestive mortality. A 10-μg/m3 PM2.5 higher cumulative exposure over one week (lag06) was associated with higher cause-specific mortality outcomes including hypertensive disease [2.28% (95%CI: 0.26%–4.33%)], acute ischemic heart disease [1.61% (95%CI: 0.59%–2.64%)], other forms of heart disease [2.39% (95%CI: -0.35%–5.20%)], hemorrhagic stroke [3.63% (95%CI: 0.79%–6.55%)], influenza and pneumonia [4.91% (95%CI: 2.84%–7.02%)], chronic respiratory disease [2.49% (95%CI: 0.71%–4.31%)], diseases of the liver [1.85% (95%CI: 0.31%–3.41%)], and renal failure [3.48% (95%CI: 0.79%–6.24%)]. No differences in effect size of associations were observed between age, sex and SES strata. Conclusions Exposure to PM2.5 was associated with non-accidental, broad-category and cause-specific mortality outcomes beyond the cardiovascular and respiratory systems, including specific death-causes from the digestive and genitourinary systems, with no indication of effect modification by individual-level characteristics.

Background: The disease burden of parkinsonism is extremely costly in the United States. Unlike Parkinson's disease, drug‐induced parkinsonism (DIP) is acute and reversible; exploring the causative drug is important to prevent DIP in patients at high‐risk of parkinsonism. Objective: To examine whether the use of gastrointestinal (GI) prokinetics is associated with an increased risk of parkinsonism. Methods: We conducted a case‐crossover study using nationally representative data. We included patients who were newly diagnosed with parkinsonism (ICD‐10 G20, G21.1, G25.1) between January 1, 2007 and December 1, 2015. The first prescription date of G20, G21.1, or G25.1 diagnoses was defined as the index date (0 day). Patients with prior extrapyramidal and movement disorders or brain tumors were excluded. We assessed the exposure within the risk (0–29 days) and control periods (60–89 days), before or on the index date. Conditional logistic regression estimated the adjusted odds ratio (aOR) for parkinsonism. Results: Overall, 2268 and 1674 patients were exposed to GI prokinetics during the risk and control periods, respectively. The use of GI prokinetics significantly increased the occurrence of parkinsonism (aOR = 2.31; 95% Confidence Interval [CI], 2.06–2.59). The use of GI prokinetics was associated with a higher occurrence of parkinsonism in elderly patients (≥65 years old; aOR = 2.69; 95% CI, 2.30–3.14) than in younger patients (aOR = 1.90; 95% CI, 1.59–2.27). Conclusions: The use of GI prokinetics was significantly associated with higher occurrences of parkinsonism, necessitating close consideration when using GI prokinetics. [ABSTRACT FROM AUTHOR]

Existing evidence suggested that short-term exposure to fine particulate matter (PM 2.5) may increase the risk of death from myocardial infarction (MI), while PM 2.5 constituents responsible for this association has not been determined. We collected 12,927 MI deaths from 32 counties in southern China during 2011–2013. County-level exposures of ambient PM 2.5 and its 5 constituents (i.e., elemental carbon (EC), organic carbon (OC), sulfate (SO 4 2-), ammonium (NH 4 +), and nitrate (NO 3 -)) were aggregated from gridded datasets predicted by Community Multiscale Air Quality Modeling System. We employed a space-time-stratified case-crossover design and conditional logistic regression models to quantify the association of MI mortality with short-term exposure to PM 2.5 and its constituents across various lag days. Over the study period, the daily mean PM 2.5 mass concentration was 77.8 (standard deviation (SD) = 72.7) µg/m3. We estimated an odds ratio of 1.038 (95% confidence interval (CI): 1.003–1.074), 1.038 (1.013–1.063) and 1.057 (1.023–1.097) for MI mortality associated with per interquartile range (IQR) increase in the 3-day moving-average exposure to PM 2.5 (IQR = 76.3 µg/m3), EC (4.1 µg/m3) and OC (9.1 µg/m3), respectively. We did not identify significant association between MI death and exposure to water-soluble ions (SO 4 2-, NH 4 + and NO 3 -). Likelihood ratio tests supported no evident violations of linear assumptions for constituents-MI associations. Subgroup analyses showed stronger associations between MI death and EC/OC exposure in the elderly, males and cold months. Short-term exposure to PM 2.5 constituents, particularly those carbonaceous aerosols, was associated with increased risks of MI mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Satellite-based PM2.5 predictions are being used to advance exposure science and air-pollution epidemiology in developed countries; including emerging evidence about the impacts of PM2.5 on acute health outcomes beyond the cardiovascular and respiratory systems, and the potential modifying effects from individual-level factors in these associations. Research on these topics is lacking in low and middle income countries. We aimed to explore the association between short-term exposure to PM2.5 with broad-category and cause-specific mortality outcomes in the Mexico City Metropolitan Area (MCMA), and potential effect modification by age, sex, and SES characteristics in such associations. Methods: We used a time-stratified case-crossover study design with 1,479,950 non-accidental deaths from the MCMA for the period of 2004–2019. Daily 1 × 1 km PM2.5 (median = 23.4 μg/m3; IQR = 13.6 μg/m3) estimates from our satellite-based regional model were employed for exposure assessment at the sub-municipality level. Associations between PM2.5 with broad-category (organ-system) and cause-specific mortality outcomes were estimated with distributed lag conditional logistic models. We also fit models stratifying by potential individual-level effect modifiers including; age, sex, and individual SES-related characteristics namely: education, health insurance coverage, and job categories. Odds ratios were converted into percent increase for ease of interpretation. Results: PM2.5 exposure was associated with broad-category mortality outcomes, including all non-accidental, cardiovascular, cerebrovascular, respiratory, and digestive mortality. A 10-μg/m3 PM2.5 higher cumulative exposure over one week (lag06) was associated with higher cause-specific mortality outcomes including hypertensive disease [2.28% (95%CI: 0.26%–4.33%)], acute ischemic heart disease [1.61% (95%CI: 0.59%–2.64%)], other forms of heart disease [2.39% (95%CI: -0.35%–5.20%)], hemorrhagic stroke [3.63% (95%CI: 0.79%–6.55%)], influenza and pneumonia [4.91% (95%CI: 2.84%–7.02%)], chronic respiratory disease [2.49% (95%CI: 0.71%–4.31%)], diseases of the liver [1.85% (95%CI: 0.31%–3.41%)], and renal failure [3.48% (95%CI: 0.79%–6.24%)]. No differences in effect size of associations were observed between age, sex and SES strata. Conclusions: Exposure to PM2.5 was associated with non-accidental, broad-category and cause-specific mortality outcomes beyond the cardiovascular and respiratory systems, including specific death-causes from the digestive and genitourinary systems, with no indication of effect modification by individual-level characteristics. [ABSTRACT FROM AUTHOR]

The impact of short-term exposure to air pollutants on the morbidity of schizophrenia, particularly in low- and middle-income countries, remains inadequately explored. The objective of this research was to investigate the relationship between short-term exposure to ambient air pollutants and the risk of schizophrenia hospitalization in Jingmen, China. We performed a time-stratified case-crossover study using daily records of hospital admissions due to schizophrenia in Jingmen Mental Health Center from 2015 to 2017. Environmental exposures to air pollutants and meteorological conditions on case and control days were estimated on the basis of measurements from ground monitoring stations. To investigate the relationship between short-term exposure to ambient air pollutants and the risk of hospitalization for schizophrenia, a conditional logistic regression model was employed. We performed subgroup analyses stratified according to sex, age groups, and season. In total, 4079 schizophrenia hospitalizations were recorded during the designated period. Increased risk of schizophrenia was merely associated with short-term exposure to SO2 and NO2. The estimated odds per interquartile range (IQR) increase in exposure was 1.112 (95% confidence interval (CI): 1.033, 1.196) for SO2 (IQR = 12 µg/m3) and 1.112 (95% CI: 1.033, 1.197) for NO2 (IQR = 18 µg/m3) on lag-0 day. Greater air pollution-schizophrenia associations were observed among middle-aged and older adults (over 45 years of age) and during the cold season. This study added case-crossover evidence indicating that short-term exposure to ambient air pollution, specifically SO2 and NO2, is linked to a higher risk of hospital admissions for schizophrenia. These findings contribute to a better understanding of the detrimental effects of air pollution on neuropsychiatric health conditions.

Summary: Background: It remains unknown how ambient temperature impact pneumonia of various infectious causes. Methods: Based on the national death registry covering all counties in Chinese mainland, we conducted an individual-level case-crossover study in China from 2013 to 2019. Exposures were assigned at residential addresses for each decedent. Conditional logistic regression model combined with distributed lag non-linear models were used to estimate the exposure-response associations. The attributable fractions due to non-optimum temperature were calculated after accounting for spatial and temporal patterns for the excess risks. Findings: The exposure-response curves were inversely J-shaped with both low and high temperature increasing the risks, and the effect of low temperature was stronger. Extremely low temperature was associated with higher magnitude of influenza-related pneumonia [relative risk (RR): 2.46, 95% confidence interval (CI): 1.62–3.74], than viral pneumonia (RR: 1.89, 95% CI: 1.55–2.30) and bacterial pneumonia (RR: 1.81, 95% CI: 1.56–2.09). The magnitudes of RRs associated with extremely high temperature were similar among the three categories of pneumonia. The mortality attributable fraction for influenza-related pneumonia (29.78%) was the highest. The effects were stronger in people of low education level or residence in the north. Interpretation: This nationwide study presents findings on the varied risk and burden of pneumonia mortality of various infectious causes, and highlights the susceptibility of influenza-related pneumonia to ambient low temperature. Funding: This study is supported by the National Key Research and Development Program (2022YFC3702701), the Shanghai Municipal Science and Technology Commission (21TQ015) and Shanghai International Science and Technology Partnership Project (21230780200).

Although several studies provided evidence on the epidemiology of drug-induced Parkinsonism (DIP) and its causative drugs, it is still limited in pediatrics. This study aimed to investigate the prevalence and risk of DIP in pediatrics. We used the Health Insurance Review and Assessment Service–Pediatric Patients Sample in Korea between 2010 and 2017 to estimate the annual prevalence of DIP and causative drug use using a cross-sectional design. The risk of DIP associated with causative drugs was evaluated using a case-crossover design. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated using a conditional logistic regression. A total of 2925 pediatric patients had diagnosed with DIP from 2010 to 2017. Most patients were aged between 12 and19 years old, and 99.8% had any diagnosis of mental health disorder (MHD). During the study period, the prevalence of DIP increased by 10.0-fold from 2010 to 2017. All causative drugs showed a corresponding increase in their use, with atypical antipsychotics being the most prominent (increase ratio, 2.07). For both in the prevalence of DIP and atypical antipsychotic use, the increment was much bigger in patients with non-psychotic MHD than that in patients with psychotic MHD. In the case-crossover study, antipsychotics showed the largest aOR with DIP. Risperidone among antipsychotics showed the highest risk for DIP (aOR = 7.09, 95% CI = 3.83–13.09), followed by aripiprazole (aOR = 5.03, 95% CI = 2.88–8.80). This study suggests that the increase in DIP prevalence in pediatric patients might be because of the increased use of atypical antipsychotics. [ABSTRACT FROM AUTHOR]

Carbon loading in airway cells has shown to worsen function of antimicrobial peptides, permitting increased survival of pathogens in the respiratory tract; however, data on the impacts of carbon particles on childhood acute respiratory infection (ARI) is limited. We assembled daily health data on outpatient visits for ARI (bronchitis, pneumonia, and total upper respiratory infection [TURI]) in children aged 0–14 years between 2015 and 2019 in Beijing, China. Anthropogenic carbons, including black carbon (BC) and its emission sources, and wood smoke particles (delta carbon, ultra‐violet absorbing particulate matter, and brown carbon) were continuously monitored. Using a time‐stratified case‐crossover approach, conditional logistic regression was performed to derive risk estimates for each outcome. A total of 856,899 children were included, and a wide range of daily carbon particle concentrations was observed, with large variations for BC (0.36–20.44) and delta carbon (0.48–57.66 μg/m3). Exposure to these particles were independently associated with ARI, with nearly linear exposure‐response relationships. Interquartile range increases in concentrations of BC and delta carbon over prior 0–8 days, we observed elevation of the odd ratio of bronchitis by 1.201 (95% confidence interval, 1.180, 1.221) and 1.048 (95% CI, 1.039, 1.057), respectively. Stronger association was observed for BC from traffic sources, which increased the odd ratio of bronchitis by 1.298 (95% CI, 1.273, 1.324). Carbon particles were also associated with elevated risks of pneumonia and TURI, and subgroup analyses indicated greater risks among children older than 6 years. Our findings suggested that anthropogenic carbons in metropolitan areas may pose a significant threat to clinical manifestations of respiratory infections in vulnerable populations. Plain Language Summary: Carbon air pollution has been linked to potential biological mechanisms responsible for respiratory diseases, but its impact on childhood respiratory infection remain sparse. In this study, we examined the associations of carbon particles with childhood hospital visits for acute respiratory infection in the megacity Beijing. The results indicated that recent exposure to ambient black carbon and wood smoke‐related particles (delta carbon, ultra‐violet absorbing particulate matter, and brown carbon) was associated with heightened risks of upper and lower respiratory tract infections in children. Greater detrimental respiratory effects were observed for carbon particles from traffic. Up to date, the global pandemic of pediatric respiratory infection and air pollution episodes occurs frequently under the context of climate crisis, our findings highlighted the importance of discerning adverse respiratory effects caused by source‐specific carbon particles in real‐world settings, particularly at the extreme levels of anthropogenic carbon exposures faced by billions of children living in urban areas worldwide today. Key Points: Extremely high levels of ambient black carbon and wood smoke‐related particles were found during the study periodCarbon particles, particularly from traffic, were associated with increased risks of childhood respiratory infectionsGreater risks were found among children older than 6 years [ABSTRACT FROM AUTHOR]

The adverse effects of ambient temperature on human health are receiving increasing attention, yet evidence of its impact on intracerebral hemorrhage (ICH) onset is limited. Here, the relationship between ambient temperature and ICH was evaluated. A time-stratified case-crossover analysis was performed based on 4051 ICH patients admitted to five stroke units in Tianjin between January 2014 and December 2020. Conditional logistic regression was applied to evaluate the associations between the daily mean temperature (Tm) or daily temperature range (DTR) and ICH onset. We found a negative association between Tm and ICH onset (OR = 0.977, 95% CI 0.968–0.987) but not between DTR and ICH onset. In stratified analyses, men and individuals aged ≥ 60 years were more susceptible to low-ambient temperature effects; corresponding adjusted ORs were 0.970 (95% CI 0.956–0.983) and 0.969 (95% CI 0.957–0.982), respectively. Tm significantly affected patients with deep ICH (OR = 0.976, 95% CI 0.965–0.988), but had no effect on lobar ICH. There was also seasonal heterogeneity in the effect of Tm on ICH onset, with Tm being negatively associated with ICH onset only in the warm season (OR = 0.961, 95% CI 0.941–0.982). Results suggest that the low-ambient temperature might trigger ICH onset, especially for the male and elderly population, providing important health guidance to prevent cold exposure–induced ICH. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although residing in lower surrounding greenness and transient exposure to air pollution are independently associated with higher risk of adverse health outcomes, little is known about their interactions. OBJECTIVES: We examine whether residential neighborhood greenness modifies the short-term association between air pollution and respiratory mortality among the participants of Chinese Elderly Health Service Cohort in Hong Kong. METHODS: We estimated residential surrounding greenness by measuring satellite-derived normalized difference vegetation index (NDVI) from Landsat within catchments of residential addresses of participants who died of respiratory diseases between 1998 and 2011. We first dichotomized NDVI into low and high greenness and used a time-stratified case-crossover approach to estimate the percent excess risk of respiratory mortality associated with fine particulate matter (PM2.5), respirable particulate matter (PM10), nitrogen dioxide (NO2), and ozone (O3). We further classified NDVI into greenness quartiles and introduced an interaction term between air pollution and the assigned median values of the NDVI quartiles into the models to assess the trend of greenness modification on the air pollution and respiratory mortality associations. RESULTS: Among 3159 respiratory deaths during the follow-up, 2058 were from pneumonia and 947 from chronic obstructive pulmonary disease. Elders living in the low greenness areas were associated with a higher risk of pneumonia mortality attributed to NO2 (p = 0.049) and O3 (p = 0.025). The mortality risk of pneumonia showed a decreasing trend for NO2 (p for trend = 0.041), O3 (p for trend = 0.006), and PM2.5 (p for trend = 0.034) with greenness quartiles increasing from Quartile 1 (lowest) to Quartile 4 (highest). CONCLUSIONS: Our findings suggest that elders living in higher greenness areas are less susceptible to pneumonia mortality associated with air pollution, which provides evidence for optimizing allocation, siting, and quality of urban green space to minimize detrimental health effects of air pollution.

Abstract Background Long-term exposure to air pollution has been associated with the onset and progression of kidney diseases, but the association between short-term exposure to air pollution and mortality of kidney diseases has not yet been reported. Methods A nationally representative sample of 101,919 deaths from kidney diseases was collected from the Chinese Center for Disease Control and Prevention from 2015 to 2019. A time-stratified case-crossover study was applied to determine the associations. Satellite-based estimates of air pollution were assigned to each case and control day using a bilinear interpolation approach and geo-coded residential addresses. Conditional logistic regression models were constructed to estimate the associations adjusting for nonlinear splines of temperature and relative humidity. Results Each 10 µg/m3 increment in lag 0–1 mean concentrations of air pollutants was associated with a percent increase in death from kidney disease: 1.33% (95% confidence interval [CI]: 0.57% to 2.1%) for PM1, 0.49% (95% CI: 0.10% to 0.88%) for PM2.5, 0.32% (95% CI: 0.08% to 0.57%) for PM10, 1.26% (95% CI: 0.29% to 2.24%) for NO2, and 2.9% (95% CI: 1.68% to 4.15%) for SO2. Conclusions Our study suggests that short-term exposure to ambient PM1, PM2.5, PM10, NO2, and SO2 might be important environmental risk factors for death due to kidney diseases in China.

Few national studies have systemically examined the effects of criteria air pollutants on cardiovascular morbidity. This study aimed to investigate the associations between all criteria air pollutants and hospitalization of cause-specific cardiovascular diseases (CVD) in China. We obtained data on CVD hospitalization events of four major categories and 12 specific diseases from 153 hospitals distributed in 20 provincial-level regions from 2013 to 2020. We adopted a time-stratified case-crossover study design using individual cases to capture the effect of short-term exposure to six criteria air pollutants on CVD hospitalizations, using conditional logistic regression models. More than 1.1 million CVD hospitalization events were included. The lag pattern exploration demonstrated the largest effect for six air pollutants on lag 0–1 day. PM2.5, PM10, NO2, and CO were significantly associated with increased hospitalization from ischemic heart diseases, cerebrovascular diseases, other heart diseases, and five specific causes of CVD. The effect estimates of NO2 were the most robust when adjusting for co-pollutants. The concentration-response curves were positive and linear for most pollutant–endpoint pairs (except for O3), and these positive associations remained even below the 24-h levels recommended by WHO Air Quality Guidelines and China Air Quality Standards. This nationwide case-crossover study in China demonstrated that short-term exposure to multiple ambient air pollutants may significantly increase the risk of cause-specific CVD hospitalizations even under the most stringent air quality regulations, striking an alert for potential CVD patients against these environmental risk factors.

Background The associations between fine and coarse particulate matter (PM2.5 and PM2.5–10) air pollution and hospital admissions for full-spectrum respiratory diseases were rarely investigated, especially for age-specific associations. We aim to estimate the age-specific associations of short-term exposures to PM2.5 and PM2.5–10 with hospital admissions for full-spectrum respiratory diseases in China. Methods We conducted an individual-level case-crossover study based on a nationwide hospital-based registry including 153 hospitals across 20 provincial regions in China in 2013–20. We applied conditional logistic regression models and distributed lag models to estimate the exposure- and lag-response associations. Results A total of 1 399 955 hospital admission records for various respiratory diseases were identified. The associations of PM2.5 and PM2.5–10 with total respiratory hospitalizations lasted for 4 days, and an interquartile range increase in PM2.5 (34.5 μg/m3) and PM2.5–10 (26.0 μg/m3) was associated with 1.73% [95% confidence interval (95% CI): 1.34%, 2.12%)] and 1.70% (95% CI: 1.31%, 2.10%) increases, respectively, in total respiratory hospitalizations over lag 0–4 days. Acute respiratory infections (i.e. pneumonia, bronchitis and bronchiolitis) were consistently associated with PM2.5 or PM2.5–10 exposure across different age groups. We found the disease spectrum varied by age, including rarely reported findings (i.e. acute laryngitis and tracheitis, and influenza) among children and well-established associations (i.e. chronic obstructive pulmonary disease, asthma, acute bronchitis and emphysema) among older populations. Besides, the associations were stronger in females, children and older populations. Conclusions This nationwide case-crossover study provides robust evidence that short-term exposure to both PM2.5 and PM2.5–10 was associated with increased hospital admissions for a wide range of respiratory diseases, and the spectra of respiratory diseases varied by age. Females, children and older populations were more susceptible. [ABSTRACT FROM AUTHOR]

Background Due to climate change, days with high temperatures are becoming more frequent. Although the effect of high temperature on the kidneys has been reported in research from Central and South America, Oceania, North America and Europe, evidence from Asia is still lacking. This study aimed to examine the association between short-term exposure to high temperatures and acute kidney injury (AKI) in a nationwide study in South Korea. Methods We used representative sampling data from the 2002–2015 National Health Insurance Service–National Sample Cohort in South Korea to link the daily mean temperatures and AKI cases that occurred in the summer. We used a bidirectional case-crossover study design with 0–7 lag days before the emergency room visit for AKI. In addition, we stratified the data into six income levels to identify the susceptible population. Results A total of 1706 participants were included in this study. The odds ratio (OR) per 1°C increase at 0 lag days was 1.051, and the ORs per 1°C increase at a lag of 2 days were both 1.076. The association between exposure to high temperatures and AKI was slightly greater in the low-income group (OR = 1.088; 95% CI: 1.049–1.128) than in the high-income group (OR = 1.065; 95% CI: 1.026–1.105). Conclusions In our study, a relationship between exposure to high temperatures and AKI was observed. Precautions should be taken at elevated temperatures to minimize the risk of negative health effects. [ABSTRACT FROM AUTHOR]

Abstract Carbon loading in airway cells has shown to worsen function of antimicrobial peptides, permitting increased survival of pathogens in the respiratory tract; however, data on the impacts of carbon particles on childhood acute respiratory infection (ARI) is limited. We assembled daily health data on outpatient visits for ARI (bronchitis, pneumonia, and total upper respiratory infection [TURI]) in children aged 0–14 years between 2015 and 2019 in Beijing, China. Anthropogenic carbons, including black carbon (BC) and its emission sources, and wood smoke particles (delta carbon, ultra‐violet absorbing particulate matter, and brown carbon) were continuously monitored. Using a time‐stratified case‐crossover approach, conditional logistic regression was performed to derive risk estimates for each outcome. A total of 856,899 children were included, and a wide range of daily carbon particle concentrations was observed, with large variations for BC (0.36–20.44) and delta carbon (0.48–57.66 μg/m3). Exposure to these particles were independently associated with ARI, with nearly linear exposure‐response relationships. Interquartile range increases in concentrations of BC and delta carbon over prior 0–8 days, we observed elevation of the odd ratio of bronchitis by 1.201 (95% confidence interval, 1.180, 1.221) and 1.048 (95% CI, 1.039, 1.057), respectively. Stronger association was observed for BC from traffic sources, which increased the odd ratio of bronchitis by 1.298 (95% CI, 1.273, 1.324). Carbon particles were also associated with elevated risks of pneumonia and TURI, and subgroup analyses indicated greater risks among children older than 6 years. Our findings suggested that anthropogenic carbons in metropolitan areas may pose a significant threat to clinical manifestations of respiratory infections in vulnerable populations.

Background Surgery is a major transient risk factor for venous thromboembolism (VTE). However, the impact of major surgery as a VTE trigger has been scarcely investigated using a case-crossover design.

Abstract Background Ambient air pollution is related to the onset and progression of ocular disease. However, the effect of air pollutants on the acute glaucoma remains unclear. Objective To investigate the effect of air pollutants on the incidence of acute glaucoma (acute angle closure glaucoma and glaucomatocyclitic crisis) among adults. Methods We conducted a time-stratified case-crossover study based on the data of glaucoma outpatients from January, 2015 to Dec, 2021 in Shanghai, China. A conditional logistic regression model combined with a polynomial distributed lag model was applied for the statistical analysis. Each case serves as its own referent by comparing exposures on the day of the outpatient visit to the exposures on the other 3–4 control days on the same week, month and year. To fully capture the delayed effect of air pollution, we used a maximum lag of 7 days in main model. Results A total of 14,385 acute glaucoma outpatients were included in this study. We found exposure to PM2.5, PM10, nitrogen dioxide (NO2) and carbon monoxide (CO) significantly increased the odds of outpatient visit for acute glaucoma. Wherein the odds of acute glaucoma related to PM2.5 and NO2 were higher and more sustained, with OR of 1.07 (95%CI: 1.03–1.11) and 1.12 (95% CI: 1.08–1.17) for an IQR increase over lag 0–3 days, than PM10 and CO over lag 0–1 days (OR:1.03; 95% CI: 1.01–1.05; OR: 1.04; 95% CI: 1.01–1.07). Conclusions This case-crossover study provided first-hand evidence that air pollutants, especially PM2.5 and NO2, significantly increased risk of acute glaucoma.

Background: The relationship between air pollution and stroke has been extensively studied, however, the evidence regarding the association between air pollution and hospitalization due to stroke and its subtypes in coastal areas of China is limited. Objective: To estimate the associations between air pollution and hospitalizations of stroke and its subtypes in the Beibu Gulf Region of China. Methods: We conducted a time-stratified case-crossover study in 15 cities in Beibu Gulf Region in China from 2013 to 2016. Exposures to PM1, PM2.5, PM10, SO2, NO2, O3, and CO on the case and control days were assessed at residential addresses using bilinear interpolation. Conditional logistic regressions were constructed to estimate city-specific associations adjusting for meteorological factors and public holidays. Meta-analysis was further conducted to pool all city-level estimates. Results: There were 271,394 case days and 922,305 control days. The odds ratios (ORs) for stroke hospitalizations associated with each interquartile range (IQR) increase in 2-day averages of SO2 (IQR: 10.8 µg/m3), NO2 (IQR: 11.2 µg/m3), and PM10 (IQR: 37 µg/m3) were 1.047 (95 % CI [confidence interval]: 1.015–1.080), 1.040 (95 % CI: 1.027–1.053), and 1.018 (95 % CI: 1.004–1.033), respectively. The associations with hospitalizations of ischemic stroke were significant for all seven pollutants, while the association with hemorrhagic stroke was significant only for CO. The associations of SO2, NO2, and O3 with stroke hospitalization were significantly stronger in the cool season. Conclusions: Short-term increase in SO2, NO2, and PM10 might be important triggers of stroke hospitalization. All seven air pollutants were associated with ischemic stroke hospitalization, while only CO was associated with hemorrhagic stroke hospitalization. These results should be considered in public health policy.

Many studies have proven the relationship between air pollutants and respiratory diseases, but few studies have assessed the impacts of air particulate matter exposure on older patients with pneumonia. This study aimed to reveal the impacts of short-term exposure to air particulate matter on the daily number of older adult patients hospitalized due to pneumonia and calculate the economic costs attributable to this exposure. We collected inpatient data from 9 city hospitals in Sichuan Province, China, from January 1, 2018, to December 31, 2019, and calculated odds ratios and 95% confidence intervals using a time-stratified case-crossover study design and an attributable risk model to calculate the economic burden due to particulate matter pollution. It was found that for every 10 μg/m3 increase in PM2.5 and PM10 concentrations, the daily number of older adult pneumonia inpatients increased by 1.5% (95% CI: 1.010–1.021) and 1.0% (95% CI: 1.006–1.014), respectively. Those 65 ~ 79 years old were more susceptible to air particulate pollutants (P < 0.05). During the study period, the total hospitalization costs and out-of-pocket expenses attributable to PM2.5 and PM10 exposure were 44.60 million CNY (6.22%) and 16.03 million CNY (6.21%), respectively, with PM2.5 being the primary influencing factor. This study revealed the relationship between particulate matter pollution and pneumonia among older adults. The role of policies to limit particulate matter concentrations in reducing disease burden among older adults can be further explored. [ABSTRACT FROM AUTHOR]

Background: Studies have estimated the associations of short-term exposure to ambient air pollution with ischemic stroke. However, the joint associations of ischemic stroke with air pollution as a mixture remain unknown. Methods: We employed a time-stratified case–crossover study to investigate 824,808 ischemic stroke patients across China. We calculated daily mean concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), maximum 8-h average for O3 (MDA8 O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) across all monitoring stations in the city where the IS patients resided. We conducted conditional logistic regression models to estimate the exposure–response associations. Results: Results from single-pollutant models showed positive associations of hospital admission for ischemic stroke with PM2.5 (excess risk [ER] = 0.38%, 95% confidence interval [CI]: 0.29% to 0.47%, for 10 μg/m3), MDA8 O3 (ER = 0.29%, 95% CI: 0.18% to 0.40%, for 10 μg/m3), NO2 (ER = 1.15%, 95% CI: 0.92% to 1.39%, for 10 μg/m3), SO2 (ER = 0.82%, 95% CI: 0.53% to 1.11%, for 10 μg/m3) and CO (ER = 3.47%, 95% CI: 2.70% to 4.26%, for 1 mg/m3). The joint associations (ER) with all air pollutants (for interquartile range width increases in each pollutant) estimated by the single-pollutant model was 8.73% and was 4.27% by the multipollutant model. The joint attributable fraction of ischemic stroke attributable to air pollutants based on the multipollutant model was 7%. Conclusions: Short-term exposures to PM2.5, MDA8 O3, NO2, SO2, and CO were positively associated with increased risks of hospital admission for ischemic stroke. The joint associations of air pollutants with ischemic stroke might be overestimated using single-pollutant models. See video abstract at, http://links.lww.com/EDE/C8. [ABSTRACT FROM AUTHOR]

Background: Long-term exposure to air pollution has been associated with the onset and progression of kidney diseases, but the association between short-term exposure to air pollution and mortality of kidney diseases has not yet been reported. Methods: A nationally representative sample of 101,919 deaths from kidney diseases was collected from the Chinese Center for Disease Control and Prevention from 2015 to 2019. A time-stratified case-crossover study was applied to determine the associations. Satellite-based estimates of air pollution were assigned to each case and control day using a bilinear interpolation approach and geo-coded residential addresses. Conditional logistic regression models were constructed to estimate the associations adjusting for nonlinear splines of temperature and relative humidity. Results: Each 10 µg/m3 increment in lag 0–1 mean concentrations of air pollutants was associated with a percent increase in death from kidney disease: 1.33% (95% confidence interval [CI]: 0.57% to 2.1%) for PM1, 0.49% (95% CI: 0.10% to 0.88%) for PM2.5, 0.32% (95% CI: 0.08% to 0.57%) for PM10, 1.26% (95% CI: 0.29% to 2.24%) for NO2, and 2.9% (95% CI: 1.68% to 4.15%) for SO2. Conclusions: Our study suggests that short-term exposure to ambient PM1, PM2.5, PM10, NO2, and SO2 might be important environmental risk factors for death due to kidney diseases in China. [ABSTRACT FROM AUTHOR]

The influence of specific local land-use activities (continuously redistributing elements across environments) and environmental conditions (altering the chemical composition of airborne particulate matter) on the intrinsic health risk of PM 2.5 exposure is sparsely reported. To fill this gap, we employed a novel integrated approach to address the influence of short-term changes in source-specific PM 2.5 composition on the exposure-response risk, while controlling for weather conditions. We combine receptor-based source apportionment with conditional logistic regression in a space-time-stratified case-crossover design. This approach is different from previous studies as it: i) controls the impact of spatiotemporal variations in air pollution and human mobility using multilocation-specific fixed and disjointed space-time strata ii) addresses the spatial heterogeneity of personal exposure separating its variable effect from other predictors by allowing different baseline hazards for each space-time stratum; iii) aligns case/control periods with strong/regular episodes of source-specific PM-multipollutant fingerprint contributions rather than health outcomes. This enabled comprehensive examination of the association between source-specific PM 2.5 -bound species and cardiorespiratory disease hospitalizations. The epidemiological findings were that primary anthropogenic emissions [industrial (ORs 2.5 – 4.8)] were associated with higher 1-day moving average PM-induced risks. Natural-related sources [fresh / aged sea salt aerosol, dust, soil resuspension] and secondary sulfate formation were consistently associated with higher health risks (ORs 1.0 – 1.54) after 1 to 5-days since exposure. The results emphasize the importance of source-specific air quality management in complex areas and our research provides an adaptable universal tool to support targeted place-based policy interventions to mitigate air pollution impacts on health. [Display omitted] • Anthropogenic activities reallocate elements and chemically transform the atmosphere. • Combined receptor modeling with logistic regression to analyze PM 2.5 impacts. • A case-crossover design to assess the health risks of source-specific PM 2.5 exposure. • PM 2.5 from tainted natural sources is linked to increases in hospital admissions > 50 %. • Place-based air quality policies are needed to tackle hazardous sources and hidden risks. [ABSTRACT FROM AUTHOR]

The heightened vulnerability of individuals with HIV to environmental stressors is well-recognized, yet the role of air pollution in exacerbating HIV-related mortality remains underexplored. In this nationwide, individual-level case-crossover study conducted from 2013 to 2019, we investigated the association between short-term exposure to criteria air pollutants and HIV-related mortality. Our analysis of 38,510 HIV-related deaths revealed significant associations between exposure to PM 2.5 , PM 10 , NO 2 , and CO and increased mortality risk. The effects of PM 2.5 and PM 10 persisted for two days, whereas NO 2 and CO had immediate, same-day impacts. Vulnerability was heightened in individuals under 65 years, males, those with lower educational attainment, and unmarried individuals. Among causes of death, HIV-related malignant neoplasms exhibited the highest sensitivity to particulate matter. Our findings provide novel insights into the relationship between short-term air pollution exposure and HIV-related mortality, emphasizing the increased susceptibility of this immunocompromised population. The results underscore the need for targeted public health interventions to reduce pollution exposure, particularly for the most at-risk demographic groups. This study contributes to a deeper understanding of environmental health risks faced by individuals living with HIV and informs evidence-based policy recommendations. [Display omitted] • Significant associations were identified between PM 2.5 , PM 10 , NO 2 , CO, and HIV mortality. • Individuals under 65, males, and the unmarried showed higher vulnerability to air pollutants. • Malignant neoplasms related to HIV had the highest mortality risk from particulate matter. • This study offers novel insights into the environmental risks faced by people living with HIV. [ABSTRACT FROM AUTHOR]

• CS prescription acquisition in the 7 days prior to OOD was associated with approximately an 79 % increase in the odds of an OOD event. • Both opioid and benzodiazepine prescription acquisition in the 7 days prior to OOD was associated with approximately a 120 % increase in the odds of an OOD event. • Combined opioid, benzodiazepine, and carisoprodol prescription acquisition in the 7 days prior to OOD was associated with approximately a 150 % increase in the odds of an OOD event. • The recent acquisition of a CS prescription, particularly opioids combined with carisoprodol and/or benzodiazepines, can behave as a trigger for OOD. Background: The role of prescribed opioids and benzodiazepines as risk factors for opioid overdose are well established, however, their role as potential 'triggers' of opioid overdose has not been formally investigated. O bjective: The objective of this study was to evaluate the temporal relationship between controlled substance acquisition and opioid overdose utilizing a case-crossover design. Methods: This study utilized Arkansas statewide data between 2014 and 2020. Prescription Drug Monitoring Program (PDMP) data were used to assess controlled substance acquisition and fatal and non-fatal opioid overdose were assessed using linked death certificate, inpatient discharge, and emergency department (ED) data. All persons residing in Arkansas who experienced an opioid overdose or had ≥ 1 Arkansas PDMP prescription fill(s) were included. Controlled substance characteristics were described in the 7 days prior to overdose and compared to the controlled substance characteristics in 11 weekly (7-day) control windows prior to overdose. Binary controlled substance variables indicating presence or absence of: any controlled substance, opioid, benzodiazepine, stimulant, sedative, carisoprodol, opioid and benzodiazepine, and opioid and benzodiazepine and carisoprodol were created. Additionally, total morphine milliequivalents were calculated for each time window. Conditional logistic regression models were estimated and adjusted odds ratios for each controlled substance characteristic after accounting for other controlled substance, and prior overdose, and clinical characteristics derived from ED and inpatient data are reported. Results: A total of 2,818,135 individuals with ≥1 Arkansas PDMP record(s) (45.10 % male; 39.94 mean age) were included, of which 28,670 (1.02 %) experienced ≥1 opioid overdose. There was a significant association between opioid overdose and the acquisition of a controlled substance (OR=1.785; p < 0.001), opioid (OR=1.992; p < 0.001), benzodiazepine (OR=1.379; p < 0.001), carisoprodol (OR=1.744; p < 0.001), opioid and benzodiazepine (OR=2.203; p < 0.001), and opioid and benzodiazepine and carisoprodol (OR=2.503; p < 0.001), in the 7 days prior to an opioid overdose event. Conclusion: Controlled substance prescription acquisition, particularly opioids in combination with carisoprodol and/or benzodiazepines, are potential triggers of opioid overdose. [ABSTRACT FROM AUTHOR]

Emerging evidence supports that brain dysfunction may be attributable to environmental factors. This study aims to examine associations of ambient temperature and temperature variability (TV) with seizure incidence in children, which has not been explored. Data on 2718 outpatient visits due to seizure were collected in Shanghai, China, from 2018 to 2023. Exposure to ambient temperature was estimated at children's residential addresses using spatial-temporal models. A time-stratified case-crossover design with a distributed lag non-linear model (DLNM) was conducted to assess the association between seizure incidence and daily average of ambient temperature over a period of 21 days prior to a case date of disease onset. For a given case date, we selected all dates falling on the same day of the week within the same month as control dates. We calculated a composite index of intra-day and inter-day TV, which was the standard deviation of the daily minimum and maximum temperatures, respectively, over 7 days preceding a case date. We then assessed the association between TV and seizure incidence. Stratified analyses were conducted by age (73.51% < 5 years old and 26.49 % ≥ 5 years old), sex (41.83% female), presence of fever (69.72%), and diagnosis of epilepsy (27.63%). We observed inversed J-shaped temperature-response curves. Lower temperatures had a significant and prolonged effect than higher temperatures. Using 20 °C (with the minimum effect) as the reference, the cumulative odds ratios (ORs) for over 0–21 days preceding the onset at the 5th percentile of the temperature (3 °C) and at the 95th percentile (29 °C) were 3.17 (95% CI: 1.77, 5.68) and 1.54 (95% CI: 0.97, 2.44), respectively. In addition, per 1 °C increases in TV 0 – 7 was associated with OR of 1.08 (95% CI: 1.01, 1.15). Older children and those experiencing seizure with fever exhibited a higher risk of seizure onset at both lower and higher ambient temperatures. Both low and high temperatures can contribute to the morbidity related to pediatric seizure. Lower temperatures, however, exerted a longer period of effect prior to seizure onset than higher temperatures. An increased risk for incident seizure was significantly associated with temperature variability during preceding 7 days. • The associations between temperature and pediatric incident seizure were inverted J-shaped pattern. • Both low and high temperatures might be important risk factors for seizure onset. • Lower temperatures exert a greater effect size on seizure onset compared to higher temperatures. [ABSTRACT FROM AUTHOR]

BackgroundUnder the background of global climate change, temperature has increased dramatically. Most studies about association between temperature and human health are conducted in low-altitude areas, but rarely focus on plateau areas.ObjectiveTo examine the association between temperature and non-accidental mortality risk in Tibet Plateau, China and to identify vulnerable populations for formulating targeted policies of climate change adaptation.MethodsThe mortality data, meteorological data, and pollutant data of Tibet area between 2013 to 2019 were collected. Based on time-stratified case-crossover design, conditional logistic regression models were used to analyze the exposure-response relationship between temperature and cause-specific mortality, which was linearized to obtain excess risk for 1 ℃ change; attributable fraction was calculated for assessing burden attributable to temperature; and stratified analyses were further conducted by gender, age (＜65 years old, ≥65 years old), and causes of death (cardiovascular diseases, cerebrovascular diseases, and respiratory diseases). Sensitivity analyses were conducted by adjusting model parameters and variables.ResultsA total of 26 045 non-accidental deaths were collected in Tibet during 2013 and 2019, and the P50 of temperature was 5.0 ℃. The non-accidental mortality risk increased as temperature become colder. A 1 ℃ decrease in temperature was associated with a 2.01% (95%CI: 0.94%-3.07%) increase in total non-accidental mortality, while the association changed to 2.05% (95%CI: 0.62%-3.47%) for male and 1.96% (95%CI: 0.34%-3.56%) for female, both of statistial significance; 1.45% (95%CI: −0.10%-2.98%) for the people