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Am J Respir Crit Care Med. 2017 Jul 1;196(1):73-81. doi: 10.1164/rccm.201609-1862OC.

Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities.

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1 School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health.
2 Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), and.
3 National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing, China.
4 Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
5 Texas A&M School of Public Health, College Station, Texas; and.
6 JC School of Public Health and Primary Care, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
7 Key Lab of Reproduction Regulation of National Population and Family Planning Commission, Shanghai Institute of Planned Parenthood Research, Institute of Reproduction and Development, Fudan University, Shanghai, China.



Evidence concerning the acute health effects of air pollution caused by fine particulate matter (PM2.5) in developing countries is quite limited.


To evaluate short-term associations between PM2.5 and daily cause-specific mortality in China.


A nationwide time-series analysis was performed in 272 representative Chinese cities from 2013 to 2015. Two-stage Bayesian hierarchical models were applied to estimate regional- and national-average associations between PM2.5 concentrations and daily cause-specific mortality. City-specific effects of PM2.5 were estimated using the overdispersed generalized additive models after adjusting for time trends, day of the week, and weather conditions. Exposure-response relationship curves and potential effect modifiers were also evaluated.


The average of annual mean PM2.5 concentration in each city was 56 μg/m3 (minimum, 18 μg/m3; maximum, 127 μg/m3). Each 10-μg/m3 increase in 2-day moving average of PM2.5 concentrations was significantly associated with increments in mortality of 0.22% from total nonaccidental causes, 0.27% from cardiovascular diseases, 0.39% from hypertension, 0.30% from coronary heart diseases, 0.23% from stroke, 0.29% from respiratory diseases, and 0.38% from chronic obstructive pulmonary disease. There was a leveling off in the exposure-response curves at high concentrations in most, but not all, regions. The associations were stronger in cities with lower PM2.5 levels or higher temperatures, and in subpopulations with elder age or less education.


This nationwide investigation provided robust evidence of the associations between short-term exposure to PM2.5 and increased mortality from various cardiopulmonary diseases in China. The magnitude of associations was lower than those reported in Europe and North America.


China; air pollution; fine particulates; mortality; time-series

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