High resolution exposure modelling of heat and air pollution and the impact on mortality

Background: Elevated temperature and air pollution have been associated with increased mortality. Exposure to heat and air pollution, as well as the density of vulnerable groups varies within cities. The objective was to investigate the extent of neighbourhood differences in mortality risk due to heat and air pollution in a city with a temperate maritime climate. Methods: A case-crossover design was used to study associations between heat, air pollution and mortality. Different thermal indicators and air pollutants (PM10, NO2, O-3) were reconstructed at high spatial resolution to improve exposure classification. Daily exposures were linked to individual mortality cases over a 15 year period. Results: Significant interaction between maximum air temperature (Ta-max) and PM10 was observed. During "summer smog" days (Ta-max > 25 degrees C and PM10 > 50 mu g/m(3)), the mortality risk at lag 2 was 7% higher compared to the reference (Ta-max 15 degrees C and PM10 15 mu g/m(3)). Persons above age 85 living alone were at highest risk. Conclusion: We found significant synergistic effects of high temperatures and air pollution on mortality. Single living elderly were the most vulnerable group. Due to spatial differences in temperature and air pollution, mortality risks varied substantially between neighbourhoods, with a difference up to 7%. (C) 2016 Elsevier Ltd. All rights reserved.