Fine Particulate Matter Constituents and Cardiopulmonary Mortality in a Heavily Polluted Chinese City

BACKGROUND: Although ambient fine particulate matter (PM2.5; particulate matter <= 2.5 mu m in aerodynamic diameter) has been linked to adverse human health effects, the chemical constituents that cause harm are unknown. To our knowledge, the health effects of PM2.5 constituents have not been reported for a developing country. OBJECTIVES: We examined the short-term association between PM2.5 constituents and daily mortality in Xi'an, a heavily polluted Chinese city. METHODS: We obtained daily mortality data and daily concentrations of PM2.5, organic carbon (OC), elemental carbon (EC), and 10 water-soluble ions for 1 January 2004 through 31 December 2008. We also measured concentrations of fifteen elements 1 January 2006 through 31 December 2008. We analyzed the data using overdispersed generalized linear Poisson models. RESULTS: During the study period, the mean daily average concentration of PM2.5 in Xi'an was 182.2 mu g/m(3). Major contributors to PM2.5 mass included OC, EC, sulfate, nitrate, and ammonium. After adjustment for PM2.5 mass, we found significant positive associations of total, cardiovascular, or respiratory mortality with OC, EC, ammonium, nitrate, chlorine ion, chlorine, and nickel for at least one lag period. Nitrate demonstrated stronger associations with total and cardiovascular mortality than PM2.5 mass. For a 1-day lag, interquartile range increases in PM2.5 mass and nitrate (114.9 and 15.4 mu g/m(3), respectively) were associated with 1.8% [95% confidence interval (CI): 0.8%, 2.8%] and 3.8% (95% CI: 1.7%, 5.9%) increases in total mortality, CONCLUSIONS: Our findings suggest that PM2.5 constituents from the combustion of fossil fuel may have an appreciable influence on the health effects attributable to PM2.5 in Xi'an.