title: Chronic air pollution and social deprivation as modifiers of the association between high temperature and daily mortality.
abstract: BACKGROUND
  Heat and air pollution are both associated with increases in mortality. However, the interactive effect of temperature and air pollution on mortality remains unsettled. Similarly, the relationship between air pollution, air temperature, and social deprivation has never been explored.
  
  
  METHODS
  We used daily mortality data from 2004 to 2009, daily mean temperature variables and relative humidity, for Paris, France. Estimates of chronic exposure to air pollution and social deprivation at a small spatial scale were calculated and split into three strata. We developed a stratified Poisson regression models to assess daily temperature and mortality associations, and tested the heterogeneity of the regression coefficients of the different strata. Deaths due to ambient temperature were calculated from attributable fractions and mortality rates were estimated.
  
  
  RESULTS
  We found that chronic air pollution exposure and social deprivation are effect modifiers of the association between daily temperature and mortality. We found a potential interactive effect between social deprivation and chronic exposure with regards to air pollution in the mortality-temperature relationship.
  
  
  CONCLUSIONS
  Our results may have implications in considering chronically polluted areas as vulnerable in heat action plans and in the long-term measures to reduce the burden of heat stress especially in the context of climate change.
authors.affiliation: EHESP School of Public Health, Sorbonne-Paris Cité, Rennes, France. benmarhnia.tarik@ouranos.ca.
authors.forename: Tarik
authors.initials: T
authors.lastname: Benmarhnia
authors.forename: Youssef
authors.initials: Y
authors.lastname: Oulhote
authors.forename: Claire
authors.initials: C
authors.lastname: Petit
authors.forename: Annabelle
authors.initials: A
authors.lastname: Lapostolle
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
authors.forename: Denis
authors.initials: D
authors.lastname: Zmirou-Navier
authors.forename: Séverine
authors.initials: S
authors.lastname: Deguen
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000633:toxicity; D000397:Air Pollution / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009585:Nitrogen Dioxide / Q000633:toxicity; D010297:Paris / Q000453:epidemiology; D012934:Social Isolation; D013696:Temperature
chemical_list: D000393:Air Pollutants; D009585:Nitrogen Dioxide