Urban climate modified short-term association of air pollution with pneumonia mortality in Hong Kong

Shengzhi SUN, Linwei TIAN*, Wangnan CAO, Poh Chin LAI, Paulina Pui Yun WONG, Ruby Siu-yin LEE, Tonya G. MASON, Alexander KRÄMER, Chit Ming WONG

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

30 Citations (Scopus)



City is becoming warmer, especially in the process of urbanization and climate change. However, it is largely unknown whether this warming urban climate may modify the short-term effects of air pollution. 


To test whether warmer urban climates intensify the acute mortality effects of air pollution on pneumonia in Hong Kong. 


Participants who died of pneumonia from a prospective Chinese elderly cohort between 1998 and 2011 were selected as cases. Urban climatic (UC) classes of cases were determined by an established Urban Climatic Map according to their residential addresses. UC classes were first dichotomized into cool and warm climates and case-crossover analysis was used to estimate the short-term association of pneumonia mortality with air pollution. We further classified UC classes into climate quartiles and used case-only analysis to test the trend of urban climate modification on the short-term association of pneumonia mortality with air pollution. 


Among 66,820 elders (≥65 years), 2208 pneumonia deaths (cases) were identified during the 11–14 years of follow-up. The effects of air pollution for cases residing in the warm climate were statistically significant (p < 0.05) higher than those living in the cool climate. There was an increasing linear trend of urban climate modification on the association of pneumonia mortality with NO2 (nitrogen dioxide) (p for trend = 0.035). Compared to climate Quartile 1 (the lowest), deaths resided in climate Quartile 2, 3, and 4 (the highest) were associated with an additional percent change of 9.07% (0.52%, 17.62%), 12.89% (4.34%, 21.43%), and 8.45% (−0.10%, 17.00%), respectively. 


Warmer urban climate worsened the acute mortality effects of pneumonia associated with air pollutants in Hong Kong. Our findings suggest that warmer urban climate introduced by climate change and urbanization may increase the risks of air pollution-related pneumonia.

Original languageEnglish
Pages (from-to)618-624
Number of pages7
JournalScience of the Total Environment
Issue number2018
Early online date23 Jul 2018
Publication statusPublished - 1 Jan 2019

Bibliographical note

This work was supported by the Hong Kong Research Grants Council [grant number GRF 780512]. We thank Hong Kong Department of Health (Elderly Health Service) for providing the cohort and mortality data, and Environmental Protection Department for the air pollution data.


  • Air pollution
  • Case-crossover study
  • Case-only study
  • Nested case-control study
  • Pneumonia
  • Urban climate map
  • Prospective Studies
  • Air Pollution/statistics & numerical data
  • Humans
  • Mortality
  • Hong Kong/epidemiology
  • Environmental Exposure/statistics & numerical data
  • Pneumonia/mortality
  • Air Pollutants/analysis
  • Aged
  • Cities


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