Associations between short-term exposure to nitrogen dioxide and mortality in 17 Chinese cities: The China Air Pollution and Health Effects Study (CAPES)

Few multi-city studies in Asian developing countries have examined the acute health effects of ambient nitrogen dioxide (NO2). In the China Air Pollution and Health Effects Study (CAPES), we investigated the short-term association between NO2 and mortality in 17 Chinese cities. We applied two-stage Bayesian hierarchical models to obtain city-specific and national average estimates for NO2. In each city, we used Poisson regression models incorporating natural spline smoothing functions to adjust for long-term and seasonal trend of mortality, as well as other time-varying covariates. We examined the associations by age, gender and education status. We combined the individual-city estimates of the concentration–response curves to get an overall NO2–mortality association in China. The averaged daily concentrations of NO2 in the 17 Chinese cities ranged from 26 μg/m3 to 67 μg/m3. In the combined analysis, a 10-μg/m3 increase in two-day moving averaged NO2 was associated with a 1.63% [95% posterior interval (PI), 1.09 to 2.17], 1.80% (95% PI, 1.00 to 2.59) and 2.52% (95% PI, 1.44 to 3.59) increase of total, cardiovascular, and respiratory mortality, respectively. These associations remained significant after adjustment for ambient particles or sulfur dioxide (SO2). Older people appeared to be more vulnerable to NO2 exposure. The combined concentration–response curves indicated a linear association. Conclusively, this largest epidemiologic study of NO2 in Asian developing countries to date suggests that short-term exposure to NO2 is associated with increased mortality risk.

► Few multi-city studies in Asia have examined the acute health effects of NO2.
► We observed significant effects of NO2 on daily mortality in 17 Chinese cities.
► Age, but not gender or socioeconomic status, may modify the health effects of NO2.