Identification of Health Effects of Complex Air Pollution in China.

After the Chinese government introduced a series of policies to strengthen the control of air pollution, the concentration of particulate matter has decreased, but the concentration of ozone has increased, and the problem of complex air pollution still exists, posing a serious threat to public health. Therefore, disentangling the health effect of multi-pollutants has been a long-discussed challenge in China. To evaluate the adverse effects of complex air pollution, a generalized additive model was used to assess the health risks of different pollution types in eight metropolises in different climates in China from 2013 to 2016. Instead of directly introducing multiple pollutant concentrations, we integrated the concentration levels of PM, NO, and O into a set of predictors by grouping methods and divided air pollution into three high single-pollutant types and four high multi-pollutant types to calculate mortality risk in different types. The comprehensive results showed that the impact of high multi-pollutant types on mortality risk was greater than that of high single-pollutant types. Throughout the study period, the high multi-pollutant type with high PM, NO, and O and the high multi-pollutant type with high PM and NO were more associated with death, and the highest RRs were 1.129 (1.080, 1.181) and 1.089 (1.066, 1.113), respectively. In addition, the pollution types that most threaten people are different in different cities. These differences may be related to different pollution conditions, pollutant composition, and indoor-outdoor activity patterns in different cities. Seasonally, the risk of complex air pollution is greater in most cities in the warm season than in the cold season. This may be caused by the modifying effects of high temperature on pollutants in addition to different indoor-outdoor activity patterns in different seasons. The results also show that calculating the effect of individual air pollutants separately and adding them together may lead to an overestimation of the combined effect. It further highlights the urgency and need for air pollution health research to move towards a multi-pollutant approach that considers air pollution as a whole in the context of atmospheric abatement and global warming.