The present paper introduces a novel approach for investigating the synergistic effect of thermal stress (maximum apparent temperature, Tapp) and air pollutant concentrations (PM, NO, and O) on daily mortality in Thessaloniki, Greece. We examine Tapp effects on all-cause mortality, analyzing variations at low, medium, and high levels of pollutants using a prototype modeling framework capable of accounting for multiple lagged exposures. We find J-shaped Tapp–mortality relationships with increasing pollutant levels, indicating that high thermal stress levels (Tapp > 33 °C) favor pollution build-up, subsequently increasing mortality. Heat effects surpass cold effects, with PM, NO, and O associated with 47.7%, 38.7%, and 32% increases in heat-related mortality, respectively, compared to 13.6%, 19.2%, and 2.1% increases in cold-related mortality. Detailed temporal lag structure analysis, conceptualized and conducted for the first time in the present study, unravels different dose-response patterns for the various predictors. PM shows the highest mortality risk on the exposure day, whereas NO risk is more pronounced a week after exposure. The temporal pattern of O differs significantly, as the risk increases with lag until a threshold, followed by decrease. These outcomes underline the importance of holistic planning for public health mitigation and adaptation measures, especially in cities.

中文翻译：

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评估空气质量和热条件对死亡率的协同影响的综合方法：希腊塞萨洛尼基的案例


本文介绍了一种新方法，用于研究热应力（最高表观温度，Tapp）和空气污染物浓度（PM、NO 和 O）对希腊塞萨洛尼基每日死亡率的协同效应。我们研究了塔普对全因死亡率的影响，使用能够解释多重滞后暴露的原型建模框架来分析低、中和高水平污染物的变化。我们发现 J 形 Tapp 与死亡率之间的关系与污染物水平的增加有关，这表明高热应力水平（Tapp > 33 °C）有利于污染积累，从而增加死亡率。热效应超过冷效应，PM、NO 和 O 分别导致热相关死亡率增加 47.7%、38.7% 和 32%，而冷相关死亡率则分别增加 13.6%、19.2% 和 2.1% 。本研究首次概念化并进行了详细的时间滞后结构分析，揭示了各种预测因子的不同剂量反应模式。 PM 在暴露当天显示出最高的死亡风险，而 NO 风险在暴露一周后更为明显。 O 的时间模式显着不同，因为风险随着滞后而增加，直到阈值，然后减少。这些结果强调了公共卫生缓解和适应措施整体规划的重要性，特别是在城市。