ArticleEnvironmental health perspectives2008
Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study.
Article in Environmental health perspectives, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 196 papers, 11 of them syntheses that pooled it.
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Who cites it
196 citing papers in PubMed, 11 syntheses or guidelines pooled it.
- Physical Activity, Air Pollution, and Mortality: A Systematic Review and Meta-analysis.Sports medicine - open · 2025Pooled it
- Ambient gaseous pollutants and emergency ambulance calls for all-cause and cause-specific diseases in China: a multicity time-series study.Environmental science and pollution research international · 2022Pooled it
- Acute effect of multiple ozone metrics on mortality by season in 34 Chinese counties in 2013-2015.Journal of internal medicine · 2018Pooled it
- Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis.Environmental health : a global access science source · 2018Pooled it
- Systematic Review and Meta-Analysis of the Association between Ambient Nitrogen Dioxide and Respiratory Disease in China.International journal of environmental research and public health · 2017Pooled it
- Air pollution, cardiovascular endpoints and susceptibility by stress and material resources: a systematic review of the evidence.Environmental health : a global access science source · 2017Pooled it
- Concentration-Response Relationship between PMBioMed research international · 2017Pooled it
- Association of Exposure to particular matter and Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2015Pooled it
- Who is more affected by ozone pollution? A systematic review and meta-analysis.American journal of epidemiology · 2014Pooled it
- Evidence on vulnerability and susceptibility to health risks associated with short-term exposure to particulate matter: a systematic review and meta-analysis.American journal of epidemiology · 2013Pooled it
- Meta-analysis of adverse health effects due to air pollution in Chinese populations.BMC public health · 2013Pooled it
- Air Pollution Control and Residents' Weight: Empirical Evidence From China's Action Plan.Health economics · 2026Article
- Impact of aircraft CO, NOJournal of global health · 2026Article
- Association between compound PMArchives of public health = Archives belges de sante publique · 2026Article
- Nationwide Study of the Association between Temperature Variability and Sleep Apnea, and the Modifying Role of Air Pollution, in a Moderate-to-Severe Risk OSA Population.Environment & health (Washington, D.C.) · 2026Article
- Separate and combined associations of heatwaves, air pollution, green spaces, and blue spaces with depressive symptoms: a national cohort study.Archives of public health = Archives belges de sante publique · 2026Article
- Short-term effects of haze exposure on clinical and subclinical cardiovascular indicators among adults in Nanjing.Scientific reports · 2026Article
- Long-term ozone exposure and the risk of mortality in sepsis patients in a Chinese cohort.Frontiers in public health · 2026Article
- The effect of air pollution on catastrophic health expenditure among middle-aged and older adults in China.PloS one · 2026Article
- Climate change effects in older people's health: A scoping review.Journal of advanced nursing · 2025Article
136 more citing papers are in PubMed but not listed here.
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8 authors.
Funding
Abstract
backgroundVarious factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries.
objectivesWe conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004).
methodsUsing a natural spline model to analyze the data, we examined effects of air pollution for the warm season (April-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality.
resultsOutdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 mug/m(3) in a 2-day average concentration of PM(10), SO(2), NO(2), and O(3) corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0.58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above).
conclusionsSeason, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.
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