Synergistic Effects of Ambient PM_2.5 and O₃ with Natural Temperature Variability on Non-Accidental and Cardiovascular Mortality: A Historical Time Series Analysis in Urban Taiyuan, China

Climate change and air pollution are associated with a range of health outcomes, including cardiovascular and respiratory disease. Evaluation of the synergic effects of air pollution and increasing natural temperature on mortality is important for understanding their potential joint health effects. In this study, the modification effects of air temperature on the short-term association of ambient fine particulate matter (PM_2.5) and ozone (O₃) with non-accidental death (NAD) and cardiovascular disease (CVD) mortality were evaluated by using the generalized additive model (GAM) combined with the distributed lag nonlinear model (DLNM) in urban areas of Taiyuan, a representative of energy and heavy industrial cities in Northern China. The data on the daily cause-specific death numbers, air pollutants concentrations, and meteorological factors were collected from January 2013 to December 2019, and the temperature was divided into low (<25th percentile), medium (25–75th percentile), and high (>75th percentile) categories. Significant associations of PM_2.5 and O₃ with NAD and CVD mortality were observed in single-effect analysis. A statistically significant increase in the effect estimates of PM_2.5 and O₃ on NAD and CVD mortality was also observed on high-temperature days. But the associations of those were not statistically significant on medium- and low-temperature days. At the same temperature level, the effects of PM_2.5 and O₃ on the CVD mortality were larger than those on NAD (1.74% vs. 1.21%; 1.67% vs. 0.57%), and the elderly and males appeared to be more vulnerable to both higher temperatures and air pollution. The results suggest that the acute effect of PM_2.5 and O₃ on NAD and CVD mortality in urban Taiyuan was enhanced by increasing temperatures, particularly for the elderly and males. It highlights the importance of reducing PM_2.5 and O₃ exposure in urban areas to reduce the public health burden under the situation of global warming.