Effect of the Interaction Between Outdoor Air Pollution and Extreme Temperature on Daily Mortality in Shanghai, China

Background: Both outdoor air pollution and extreme temperature have been associated with daily mortality; however, the effect of their interaction is not known. Methods: This time-series analysis examined the effect of the interaction between outdoor air pollutants and extreme temperature on daily mortality in Shanghai, China. A generalized additive model (GAM) with penalized splines was used to analyze mortality, air pollution, temperature, and covariate data. The effects of air pollutants were stratified by temperature stratum to examine the interaction effect of air pollutants and extreme temperature. Results: We found a statistically significant interaction between PM10/O-3 and extreme low temperatures for both total nonaccidental and cause-specific mortality. On days with "normal" temperatures (15th-85th percentile), a 10-mu g/m(3) increment in PM10 corresponded to a 0.17% (95% CI: 0.03%, 0.32%) increase in total mortality, a 0.23% (0.02%, 0.44%) increase in cardiovascular mortality, and a 0.26% (-0.07%, 0.60%) increase in respiratory mortality. On low-temperature days (< 15th percentile), the estimates changed to 0.40% (0.21%, 0.58%) for total mortality, 0.49% (0.13%, 0.86%) for cardiovascular mortality, and 0.24% (-0.33%, 0.82%) for respiratory mortality. The interaction pattern of O-3 with lower temperature was similar. The interaction between PM10/O-3 and lower temperature remained robust when alternative cut-points were used for temperature strata. Conclusions: The acute health effects of air pollution might vary by temperature level.