Interactive Effects Between Temperature and PM(2.5) on Mortality: A Study of Varying Coefficient Distributed Lag Model — Guangzhou, Guangdong Province, China, 2013–2020

INTRODUCTION: There is a large body of epidemiological evidence showing significantly increased mortality risks from air pollution and temperature. However, findings on the modification of the association between air pollution and mortality by temperature are mixed. METHODS: We used a varying coefficient distributed lag model to assess the complex interplay between air temperature and PM(2.5) on daily mortality in Guangzhou City from 2013 to 2020, with the aim of establishing the PM(2.5)-mortality association at different temperatures and exploring synergetic mortality risks from PM(2.5) and temperature on vulnerable populations. RESULTS: We observed near-linear concentration-response associations between PM(2.5) and mortality across different temperature levels. Each 10 μg/m³ increase of PM(2.5) in low, medium, and high temperature strata was associated with increments of 0.73% [95% confidence interval (CI): 0.38%, 1.09%], 0.12% (95% CI: −0.27%, 0.52%), and 0.46% (95% CI: 0.11%, 0.81%) in non-accidental mortality, with a statistically significant difference between low and medium temperatures (P=0.02). There were significant modification effects of PM(2.5) by low temperature for cardiovascular mortality and among individuals 75 years or older. CONCLUSIONS: Low temperatures may exacerbate physiological responses to short-term PM(2.5) exposure in Guangzhou, China.