Ambient air pollution, temperature and out-of-hospital coronary deaths in Shanghai, China

Few studies have evaluated the effects of ambient air pollution and temperature in triggering out-of-hospital coronary deaths (OHCDs) in China. We evaluated the associations of air pollution and temperature with daily OHCDs in Shanghai, China from 2006 to 2011. We applied an over-dispersed generalized additive model and a distributed lag nonlinear model to analyze the effects of air pollution and temperature, respectively. A 10 μg/m3 increase in the present-day PM10, PM2.5, SO2, NO2 and CO were associated with increases in OHCD mortality of 0.49%, 0.68%, 0.88%, 1.60% and 0.08%, respectively. A 1 °C decrease below the minimum-mortality temperature corresponded to a 3.81% increase in OHCD mortality on lags days 0-21, and a 1 °C increase above minimum-mortality temperature corresponded to a 4.61% increase over lag days 0-3. No effects were found for in-hospital coronary deaths. This analysis suggests that air pollution, low temperature and high temperature may increase the risk of OHCDs.