title: Acute Effects of Nitrogen Dioxide on Cardiovascular Mortality in Beijing: An Exploration of Spatial Heterogeneity and the District-specific Predictors.
abstract: The exploration of spatial variation and predictors of the effects of nitrogen dioxide (NO2) on fatal health outcomes is still sparse. In a multilevel case-crossover study in Beijing, China, we used mixed Cox proportional hazard model to examine the citywide effects and conditional logistic regression to evaluate the district-specific effects of NO2on cardiovascular mortality. District-specific predictors that could be related to the spatial pattern of NO2effects were examined by robust regression models. We found that a 10 μg/m3increase in daily mean NO2concentration was associated with a 1.89% [95% confidence interval (CI): 1.33-2.45%], 2.07% (95% CI: 1.23-2.91%) and 1.95% (95% CI: 1.16-2.72%) increase in daily total cardiovascular (lag03), cerebrovascular (lag03) and ischemic heart disease (lag02) mortality, respectively. For spatial variation of NO2effects across 16 districts, significant effects were only observed in 5, 4 and 2 districts for the above three outcomes, respectively. Generally, NO2was likely having greater adverse effects on districts with larger population, higher consumption of coal and more civilian vehicles. Our results suggested independent and spatially varied effects of NO2on total and subcategory cardiovascular mortalities. The identification of districts with higher risk can provide important insights for reducing NO2related health hazards.
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.|Centre of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Luo
authors.affiliation: College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China.|State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Science, Beijing 100101, China.
authors.forename: Runkui
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.|Centre of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Li
authors.affiliation: Chinese Research Academy of Environmental Sciences, Beijing 100012, China.
authors.forename: Zongshuang
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.|Centre of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
authors.forename: Xinming
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.|Centre of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
authors.forename: Ruiming
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden.
authors.forename: Xin
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.|Centre of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
authors.forename: Zhenglai
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden.|Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro 70185, Sweden.
authors.forename: Yang
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China.|Centre of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Xu
mesh_terms: D000368:Aged; D000068476:Beijing / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D000066428:Coal Industry; D018592:Cross-Over Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D009585:Nitrogen Dioxide / Q000633:toxicity*; D016016:Proportional Hazards Models; D013997:Time Factors; D001335:Vehicle Emissions
chemical_list: D004785:Environmental Pollutants; D001335:Vehicle Emissions; D009585:Nitrogen Dioxide