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Respir Res. 2019 Jul 5;20(1):139. doi: 10.1186/s12931-019-1117-8.

Ambient air pollution and respiratory mortality in Xi'an, China: a time-series analysis.

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School of Public Health, Health Science Center, Xi'an Jiaotong University, 76, Yanta West Road, Xi'an, 710061, Shaanxi Province, China.
Department of Life Sciences, Central University of Technology, Free State, Bloemfontein, Free State, 9300, South Africa.
School of Public Health, Health Science Center, Xi'an Jiaotong University, 76, Yanta West Road, Xi'an, 710061, Shaanxi Province, China.
Department of Environmental and Occupational Studies, Cape Peninsula University of Technology, Cape Town, 8000, South Africa.
Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, 710054, Shaanxi, China.



Although air pollution is a known fundamental problem in China, few studies have investigated the associations between ambient air pollution and respiratory mortality in non-metropolitan cities of China. The study aimed to investigate a potential relationship between short-term exposure to ambient air pollutants and respiratory mortality in Xi'an, China.


Daily averages of PM2.5, SO2, O3, temperature, relative humidity and daily counts of respiratory mortality were obtained (2014-2016). Using a single and multi-pollutant approach in time-series analysis, the generalized additive model with natural splines was used for analysis. Subgroup analysis stratified by gender and age group (≤ 64 years and ≥ 65 years) was conducted.


Seven thousand nine hundred sixty-five cases of respiratory mortality were assessed, with 62.9, 28.5, and 8.6% of mortality attributed to chronic lower respiratory diseases, influenza and pneumonia, as well as other forms of respiratory diseases, respectively. Observed pollutants were significantly associated with respiratory mortality. In the single pollutant model, 10 μg/m3 increase in a two-day moving average of PM2.5, and SO2 concentrations were significantly associated with relative risk 1.313(1.032, 1.708) and 1.4020(0.827, 2.854) of respiratory mortality, respectively. The effects of both air pollutants remained statistically significant after adjusting for collinearity in the multi-pollutant model. Ozone was only statistically associated with respiratory mortality in females at lag 0 [RR: 0.964(0.938, 0.991)].


This study provided evidence that respiratory mortality in Xi'an was significantly associated with exposure to ambient air pollutants from 2014 to 2016.


Air pollution; Environmental exposure; Principal component analysis; Public health; Respiration disorders

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