Associations of ambient exposure to benzene, toluene, ethylbenzene, and xylene with daily mortality: a multicountry time-series study in 757 global locations
BACKGROUND: The presence of benzene, toluene, ethylbenzene, and xylene isomers (BTEX) in the environment is of increasing concern due to their toxicity and ubiquity. Although the adverse health effects of BTEX exposure have been documented, robust epidemiological evidence from large-scale, multicountry studies using advanced exposure assessment methodologies remains scarce. We aimed to assess the association of short-term ambient exposure to individual BTEX components and their mixture with daily total, cardiovascular, and respiratory mortality on a global scale. METHODS: Daily data on mortality, meteorological factors, and air pollution were collected from 757 locations across 46 countries or regions. Data on individual chemicals (ie, benzene, toluene, xylenes [summation of ethylbenzene, m-xylene, p-xylene, and o-xylene]) and the aggregate mixture (ie, BTEX) were estimated using a chemistry-climate model. We examined the short-term associations of each individual chemical as well as the BTEX mixture with daily total, cardiovascular, and respiratory mortality in a multicountry framework. Using a two-stage time-series design, we first applied generalised additive models with a quasi-Poisson distribution to obtain location-specific associations, which were subsequently pooled using random-effects meta-analysis. Two-pollutant models were used to assess the independent effects of BTEX after adjusting for co-pollutants (PM(2·5), PM(10), nitrogen dioxide, sulphur dioxide, ozone, and carbon monoxide). Additionally, we assessed the overall exposure-response curves with spline terms. FINDINGS: An IQR increment of BTEX concentration on lag 0-2 days (3-day moving average of the present day and the previous 2 days) was associated with increases of 0·57% (95% CI 0·49-0·65), 0·42% (0·30-0·54), and 0·68% (0·50-0·86) in total, cardiovascular, and respiratory mortality, respectively. The corresponding effect estimates for an IQR increment in individual chemicals (benzene, toluene, and xylenes) were 0·38-0·61%, 0·44-0·70%, and 0·41-0·65%, respectively. The associations remained significant after adjusting for co-pollutants, with a general decline in magnitude, except for a slight increase after adjustment for ozone. The shape of the exposure-response curves for all pollutants and causes of death was almost linear, with steeper slopes at low concentrations and no discernible thresholds. INTERPRETATION: This global study provides novel evidence linking short-term exposure to ambient BTEX, both individually and as a mixture, with increased daily total, cardiovascular, and respiratory mortality. Our findings underscore the need for comprehensive air pollution mitigation policies, including stringent controls on BTEX emissions, to protect public health.
Auteur(s) : Zhou Lu, Xiong Ying, Sera Francesco, Vicedo-Cabrera Ana Maria, Abrutzky Rosana, Guo Yuming, Tong Shilu, de Sousa Zanotti Stagliorio Coelho Micheline, Nascimento Saldiva Paulo Hilario, Lavigne Eric, Correa Patricia Matus, Ortega Nicolás Valdés, Osorio Samuel, Roye Dominic, Kyselý Jan, Orru Hans, Maasikmets Marek, Jaakkola Jouni J K, Ryti Niilo, Pascal Mathilde, Huber Veronika, Breitner-Busch Susanne, Schneider Alexandra, Katsouyanni Klea, Samoli Evangelia, Entezari Alireza, Mayvaneh Fatemeh, Goodman Patrick, Zeka Ariana, Raz Raanan, Scortichini Matteo, Stafoggia Massimo, Honda Yasushi, Hashizume Masahiro, Ng Chris Fook Sheng, Alahmad Barrak, Diaz Magali Hurtado, Félix Arellano Eunice Elizabeth, Overcenco Ala, Klompmaker Jochem, Rao Shilpa, Carrasco Gabriel, Seposo Xerxes, Chua Paul Lester Carlos, Pereira da Silva Susana das Neves, Madureira Joana, Holobaca Iulian-Horia, Scovronick Noah, Garland Rebecca M, Kim Ho, Lee Whanhee, Tobias Aurelio, Íñiguez Carmen, Forsberg Bertil, Ragettli Martina S, Guo Yue Leon, Pan Shih-Chun, Li Shanshan, Masselot Pierre, Colistro Valentina, Bell Michelle, Zanobetti Antonella, Schwartz Joel, Dang Tran Ngoc, Van Dung Do, Gasparrini Antonio, Huang Yaoxian, Kan Haidong
Année de publication : 2025
Pages : Online ahead of print
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