Abstract: Exposure to high levels of air pollution can cause a variety of adverse health outcomes. Air quality in developed countries has been generally improved over the last three decades. However, many recent epidemiological studies have consistently shown positive associations between low-level exposure to air pollution and health outcomes. Thus, adverse health effects of air pollution, even at relatively low levels, remain a public concern. This paper aims to provide an overview of recent research development and contemporary methodological challenges in this field and to identify future research directions for air pollution epidemiological studies.

Abstract: Many studies have indicated that ozone is associated with morbidity and mortality. A few studies have reported that the association is heterogeneous across seasons and geographic regions. However, little information is available on whether both temperature and geographic factors simultaneously modify the ozone effect. This study used a Poisson regression model to explore whether temperature modifies the effect of ozone on mortality in the 60 large eastern US communities during April to October, 1987–2000. Results show that temperature modified ozone-mortality associations and that such modification varied across geographic regions. In the northeast region, a 10-ppb increment in ozone was associated with an increase of 2.22% (95% posterior interval [PI]: 1.19%, 3.13%), 3.06% (95% PI: 2.21%, 3.76%) and 6.22% (95% PI: 4.77%, 7.56%) in mortality at low, moderate and high temperature level, respectively, while in the southeast region a 10-ppb increment in ozone was associated with an increase of 1.13% (95% PI:− 1.12%, 3.18%), 1.50% (95% PI: 0.22%, 2.81%) and 1.29% (95% PI:− 0.33%, 2.96%) in mortality, respectively. We concluded that temperature synergistically modified the ozone-mortality association in the northeast region, but such a pattern was not apparent in the southeast region. Thus, both temperature and geographic factors should be considered in the assessment of ozone effects.

Abstract: Objectives: Both ambient ozone and temperature are associated with human health. However, few data are available on whether ozone modifies temperature effects. This study aims to explore whether ozone modified associations between maximum temperature and cardiovascular mortality in the USA. Methods: The authors obtained data from the US National Morbidity, Mortality, and Air Pollution Study (NMMAPS) website. They used two time-series Poisson regression models (a response surface model and a stratification model) to examine whether ozone modified associations between maximum temperature and cardiovascular mortality (CVM) in 95 large US communities during 1987–2000 in summer (June to September). Bayesian meta-analysis was used to pool estimates in each community. Results: The response surface model was used to examine the joint effects of temperature and ozone on CVM in summer. Results indicate that ozone positively modified the temperature-CVM associations across the different regions. The stratification model quantified the temperature-CVM associations across different levels of ozone. Results show that in general the higher the ozone concentration, the stronger the temperature-CVM associations across the communities. A 10 degrees Celsius increase in temperature on the same day was associated with an increase in CVM by 1.17% and 8.31% for the lowest and highest level of ozone concentrations in all communities, respectively. Conclusion: Ozone modified temperature effects in different regions in the USA. It is important to evaluate the modifying role of ozone when estimating temperature-related health impacts and to further investigate the reasons behind the regional variability and mechanism for the interaction between temperature and ozone.

Abstract: A few epidemiological studies have examined whether there was an interactive effect between temperature and ambient particulate matter on cardiorespiratory morbidity and mortality, but the results were inconsistent. The present study used three time-series approaches to explore whether maximum temperature modified the impact of ambient particulate matter less than 10 μm in diameter (PM10) on daily respiratory hospital admissions, cardiovascular hospital admissions, respiratory emergency visits, cardiovascular emergency visits, non-external cause mortality and cardiovascular mortality in Brisbane between 1996 and 2001. The analytical approaches included a bivariate response surface model, a non-stratification parametric model and a stratification parametric model. Results show that there existed a statistically significant interaction between PM10 and temperature on most health outcomes at various lags. PM10 exhibited more adverse health effects on warm days than cold days. The choice of the degree of freedom for smoothers to adjust for confounders and the selection of arbitrary cut-offs for temperature affected the interaction estimates to a certain extent, but did not change the overall conclusion. The results imply that it is important to control and reduce the emission of air particles in Brisbane, particularly when temperature increases.

Abstract: BACKGROUND: A number of studies have shown that both temperature and air pollution are associated with health outcomes. In assessing air pollution effects, temperature is usually considered a confounder. However, only a few recent studies considered air pollution as confounders while assessing temperature effects. Few studies are available on whether or not air pollution modifies the temperature–disease relationship. METHODS: In this study, we used three parallel Poisson generalized additive models to examine whether particulate matter < 10 μm in aerodynamic diameter (PM10) modified the effects of minimum temperature on cardiorespiratory morbidity and mortality in Brisbane, Australia. RESULTS: Results show that PM10 statistically significantly modified the effects of temperature on respiratory and cardiovascular hospital admissions, all nonexternal-cause mortality, and cardiovascular mortality at different lags. The enhanced adverse temperature effects were found at higher levels of PM10, but no clear evidence emerged for interactive effects on respiratory and cardiovascular emergency visits. Three parallel models produced similar results, which strengthened the validity of findings. CONCLUSION: We conclude that it is important to evaluate the modification role of air pollution in the assessment of temperature-related health impacts.