Background Although air pollution is a known fundamental problem in China, few studies have investigated the associations between ambient air pollution and respiratory mortality in non-metropolitan cities of China. The study aimed to investigate a potential relationship between short-term exposure to ambient air pollutants and respiratory mortality in Xi’an, China. Methods Daily averages of PM 2.5 , SO 2 , O 3 , temperature, relative humidity and daily counts of respiratory mortality were obtained (2014–2016). Using a single and multi-pollutant approach in time-series analysis, the generalized additive model with natural splines was used for analysis. Subgroup analysis stratified by gender and age group (≤ 64 years and ≥ 65 years) was conducted. Results Seven thousand nine hundred sixty-five cases of respiratory mortality were assessed, with 62.9, 28.5, and 8.6% of mortality attributed to chronic lower respiratory diseases, influenza and pneumonia, as well as other forms of respiratory diseases, respectively. Observed pollutants were significantly associated with respiratory mortality. In the single pollutant model, 10 μg/m 3 increase in a two-day moving average of PM 2.5 , and SO 2 concentrations were significantly associated with relative risk 1.313(1.032, 1.708) and 1.4020(0.827, 2.854) of respiratory mortality, respectively. The effects of both air pollutants remained statistically significant after adjusting for collinearity in the multi-pollutant model. Ozone was only statistically associated with respiratory mortality in females at lag 0 [RR: 0.964(0.938, 0.991)]. Conclusion This study provided evidence that respiratory mortality in Xi’an was significantly associated with exposure to ambient air pollutants from 2014 to 2016.

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Several studies have reported that air pollution and climatic factors are major contributors to human morbidity and mortality globally. However, the combined interactive effects of air pollution and climatic factors on human health remain largely unexplored. This study aims to investigate the interactive effects of air pollution and climatic factors on circulatory and respiratory mortality in Xi’an, China. Time-series analysis and the distributed lag non-linear model (DLNM) were employed as the study design and core statistical method. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for temperature and Air Quality Index (AQI) interaction on circulatory mortality were 0.973(0.969, 0.977) and −0.055(−0.059, −0.048), respectively; while for relative humidity and AQI interaction, 1.098(1.011, 1.072) and 0.088(0.081, 0.107) respectively, were estimated. Additionally, the IRR and RERI for temperature and AQI interaction on respiratory mortality were 0.805(0.722, 0.896) and −0.235(−0.269, −0.163) respectively, while 1.008(0.965, 1.051) and −0.031(−0.088, 0.025) respectively were estimated for relative humidity and AQI interaction. The interaction effects of climatic factors and AQI were synergistic and antagonistic in relation to circulatory and respiratory mortality, respectively. Interaction between climatic factors and air pollution contributes significantly to circulatory and respiratory mortality.

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Over the past decades, urbanization and industrialization have led to a change in air quality, bringing researchers to a full realization of the damaging effects of human activities on the environment. This study focused on describing air quality during the initial phase of the Novel Coronavirus disease (COVID-19) pandemic (since there were fewer anthropogenic activities) in 10 Chinese mega-cities. Using the independent t-test, the means of air quality index (AQI) scores and individual air pollutants concentration during the outbreak were compared with the means before the outbreak. Cohen’s d was estimated to quantify how much difference was observed. Based on the AQI score, the air quality in these 10 cities ranged from excellent (Shenzhen) to light pollution (Xi’an) with 44.8 μg m−3 and 119.7 μg m−3, respectively. In comparison to the 2019 air quality, Guangzhou and Wuhan noted major differences in air quality during the outbreak. Indicators of traffic pollution, particularly NO2, were significantly lower during the outbreak in all cities. Particulate matter pollution varied, with some cities observing lower concentrations and other higher concentrations during the outbreak. There was a significant decrease in air pollution levels during the outbreak. More researchers should observe changes in air quality during peculiar or major events. Implementation of stringent regulation on vehicle use should be considered in mega-cities. Relevant findings should be employed in emphasizing the detrimental effects of anthropogenic activities and support the need for stringent emission control regulations.