• Renjie Chen, Peng Yin, Xia Meng, Cong Liu, Lijun Wang, Xiaohui Xu, Jennifer A Ross, Lap A Tse, Zhuohui Zhao, Haidong Kan, and Maigeng Zhou.
• 1 School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health.
• Am. J. Respir. Crit. Care Med. 2017 Jul 1; 196 (1): 73-81.

RationaleEvidence concerning the acute health effects of air pollution caused by fine particulate matter (PM2.5) in developing countries is quite limited.ObjectivesTo evaluate short-term associations between PM2.5 and daily cause-specific mortality in China.MethodsA nationwide time-series analysis was performed in 272 representative Chinese cities from 2013 to 2015. Two-stage Bayesian hierarchical models were applied to estimate regional- and national-average associations between PM2.5 concentrations and daily cause-specific mortality. City-specific effects of PM2.5 were estimated using the overdispersed generalized additive models after adjusting for time trends, day of the week, and weather conditions. Exposure-response relationship curves and potential effect modifiers were also evaluated.Measurements And Main ResultsThe average of annual mean PM2.5 concentration in each city was 56 μg/m3 (minimum, 18 μg/m3; maximum, 127 μg/m3). Each 10-μg/m3 increase in 2-day moving average of PM2.5 concentrations was significantly associated with increments in mortality of 0.22% from total nonaccidental causes, 0.27% from cardiovascular diseases, 0.39% from hypertension, 0.30% from coronary heart diseases, 0.23% from stroke, 0.29% from respiratory diseases, and 0.38% from chronic obstructive pulmonary disease. There was a leveling off in the exposure-response curves at high concentrations in most, but not all, regions. The associations were stronger in cities with lower PM2.5 levels or higher temperatures, and in subpopulations with elder age or less education.ConclusionsThis nationwide investigation provided robust evidence of the associations between short-term exposure to PM2.5 and increased mortality from various cardiopulmonary diseases in China. The magnitude of associations was lower than those reported in Europe and North America.

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