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Background <p>The acute effects of short-term air pollution exposure on human health in regions with low pollution concentrations is not widely explored. This study assesses the risk of mortality and morbidity linked to short-term exposure to NO<sub>2</sub> and PM<sub>2.5</sub> in Baden-Wurttemberg, Germany, a region that broadly complies with European air quality standards and global guidelines.</p> Methods <p>We applied a two-stage time-stratified case-crossover design followed by meta-analyses to estimate the relative risks of mortality (all-cause), hospital admission and sick leave (all-cause and cause-specific). Health outcomes between 2013 and 2022 were collected from the regional public insurance records, and exposures were derived from ensemble air quality models. Effect modification by SARS‑CoV‑2 (COVID-19) years, age, sex and urbanisation were also evaluated.</p> Results <p>Short-term exposure to PM<sub>2.5</sub> and NO<sub>2</sub> was associated with increased risks of several acute health outcomes. Associations were observed for all-cause and cardiovascular-related hospital admissions, as well as sick leave, even at concentrations near the current daily limits set by the European Union. Effect estimates were generally more pronounced for NO<sub>2</sub> and concentrated at immediate lag days. Exposure–response relationships were non-linear across health outcomes, and little evidence of effect modification by demographic or urbanisation characteristics was observed.</p> Conclusion <p>This study provides evidence of acute health risks from short-term exposure to PM<sub>2.5</sub> and NO<sub>2</sub>, even at concentrations below the suggested daily permissible levels, emphasising the need to reassess existing air quality standards.</p>

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Short-term exposure to air pollution and acute health effects in a low-pollution region, Baden-Wurttemberg, Germany

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月24日

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  • Mahakalkar Amruta Umakant,
  • Lorenzo Gianquintieri,
  • Lorenza Gilardi,
  • Thilo Erbertseder,
  • Frank Baier,
  • Simon Dally,
  • Maximilian Leon Arnold,
  • Maxana Baltruweit,
  • Charles R. S. Hatfield,
  • Chelsea Williams Cleary,
  • Enrico Gianluca Caiani

摘要

Background

The acute effects of short-term air pollution exposure on human health in regions with low pollution concentrations is not widely explored. This study assesses the risk of mortality and morbidity linked to short-term exposure to NO2 and PM2.5 in Baden-Wurttemberg, Germany, a region that broadly complies with European air quality standards and global guidelines.

Methods

We applied a two-stage time-stratified case-crossover design followed by meta-analyses to estimate the relative risks of mortality (all-cause), hospital admission and sick leave (all-cause and cause-specific). Health outcomes between 2013 and 2022 were collected from the regional public insurance records, and exposures were derived from ensemble air quality models. Effect modification by SARS‑CoV‑2 (COVID-19) years, age, sex and urbanisation were also evaluated.

Results

Short-term exposure to PM2.5 and NO2 was associated with increased risks of several acute health outcomes. Associations were observed for all-cause and cardiovascular-related hospital admissions, as well as sick leave, even at concentrations near the current daily limits set by the European Union. Effect estimates were generally more pronounced for NO2 and concentrated at immediate lag days. Exposure–response relationships were non-linear across health outcomes, and little evidence of effect modification by demographic or urbanisation characteristics was observed.

Conclusion

This study provides evidence of acute health risks from short-term exposure to PM2.5 and NO2, even at concentrations below the suggested daily permissible levels, emphasising the need to reassess existing air quality standards.