ArticleProceedings of the National Academy of Sciences of the United States of America2021
Spatial variation in the joint effect of extreme heat events and ozone on respiratory hospitalizations in California.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 69 citations in OpenAlex.
- Unraveling the potential of urban greenery for extreme heat and ozone mitigation in Northern Hemisphere cities.National science review · 2026Article
- Spatial Heterogeneity in Synergistic Effects of Extreme Heat and NO 2 Exposures on Cardiorespiratory Hospitalizations in California.Epidemiology (Cambridge, Mass.) · 2026Article
- Protocol for identifying compound heat-danger and ozone-pollution hotspots and their synoptic drivers.STAR protocols · 2026Article
- A climate region classification for California's warm season: apparent temperature clustering to support heat-health epidemiology.International journal of biometeorology · 2026Article
- Aggravated Risks of Emergency Hospitalizations Associated with Temperature amid Elevated Ambient Air Pollution: Evidence from a 20-Year Time-Series Study in Hong Kong.Environmental science & technology · 2025Article
- Semi-confined terrain concurrently amplifies heat stress and ozone pollution in Northern China.iScience · 2025Article
- Integrated risks from air pollution and climate extremes: synergistic effects of ozone, heat, and humidity on cardiovascular mortality.BMC medicine · 2025Article
- Modifying effects of PMScientific reports · 2025Article
- Mortality Risk from Chronic Ischemic Heart Disease Associated with Short-Term Co-Exposure to Summer Heatwave and Ozone.Journal of urban health : bulletin of the New York Academy of Medicine · 2025Article
- The Joint Effects of Exposure to Ambient Long-term Air Pollution and Short-term Heat on Epigenetic Aging in the Health and Retirement Study.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025Article
- Joint Effects of Wildfire Smoke and Extreme Heat on Hospitalizations in California, 2011-2020.GeoHealth · 2025Article
- Climate Change and Respiratory Health: Opportunities to Contribute to Environmental Justice: An Official American Thoracic Society Workshop Report.Annals of the American Thoracic Society · 2025Article
- Heat-related mortality in Mexico: A multi-scale spatial analysis of extreme heat effects and municipality-level vulnerability.Environment international · 2025Article
- Spatial Variation in the Association between Extreme Heat Events and Warm Season Pediatric Acute Care Utilization: A Small-Area Assessment of Multiple Health Conditions and Environmental Justice Implications in California (2005-2019).Environmental health perspectives · 2025Article
- Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality.Global health action · 2024Article
- Association of Ozone and Temperature with Ischemic Heart Disease Mortality Risk: Mediation and Interaction Analyses.Environmental science & technology · 2024Article
- Article
- Sex Differences in Impacts of Early Gestational and Peri-Adolescent Ozone Exposure on Lung Development in Rats: Implications for Later Life Disease in Humans.The American journal of pathology · 2024Article
- Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures.Proceedings of the National Academy of Sciences of the United States of America · 2024Review
- Existing Challenges and Opportunities for Advancing Drought and Health Research.Current environmental health reports · 2024Review
Corrections and comments
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Authors and funding
8 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Extreme heat and ozone are co-occurring exposures that independently and synergistically increase the risk of respiratory disease. To our knowledge, no joint warning systems consider both risks; understanding their interactive effect can warrant use of comprehensive warning systems to reduce their burden. We examined heterogeneity in joint effects (on the additive scale) between heat and ozone at small geographical scales. A within-community matched design with a Bayesian hierarchical model was applied to study this association at the zip code level. Spatially varying relative risks due to interaction (RERI) were quantified to consider joint effects. Determinants of the spatial variability of effects were assessed using a random effects metaregression to consider the role of demographic/neighborhood characteristics that are known effect modifiers. A total of 817,354 unscheduled respiratory hospitalizations occurred in California from 2004 to 2013 in the May to September period. RERIs revealed no additive interaction when considering overall joint effects. However, when considering the zip code level, certain areas observed strong joint effects. A lower median income, higher percentage of unemployed residents, and exposure to other air pollutants within a zip code drove stronger joint effects; a higher percentage of commuters who walk/bicycle, a marker for neighborhood wealth, showed decreased effects. Results indicate the importance of going beyond average measures to consider spatial variation in the health burden of these exposures and predictors of joint effects. This information can be used to inform early warning systems that consider both heat and ozone to protect populations from these deleterious effects in identified areas.
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