{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:10:11Z","timestamp":1773933011716,"version":"3.50.1"},"reference-count":59,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Global Challenges"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Evidence linking short\u2010term exposure to air pollution, particularly PM\n                    <jats:sub>2.5<\/jats:sub>\n                    , PM\n                    <jats:sub>10<\/jats:sub>\n                    , NO\n                    <jats:sub>2<\/jats:sub>\n                    , O\n                    <jats:sub>3<\/jats:sub>\n                    , SO\n                    <jats:sub>2<\/jats:sub>\n                    , and CO, with out\u2010of\u2010hospital cardiac arrest (OHCA) risk remains inconsistent. Large\u2010scale studies using advanced air pollution exposure assessment techniques and spatiotemporal modeling are limited. This study investigates the association between short\u2010term air pollution concentration, derived from satellite data, and OHCA events (2016 \u2010 2019) in Lombardy, Italy, using a time\u2010stratified case\u2010crossover design. A two\u2010stage distributed lag non\u2010linear model, adjusted for meteorological factors, long\u2010term trends, seasonality, intraweek patterns and holidays, is applied across 96 districts to estimate the exposure\u2010lag\u2010response relationship, followed by a regional meta\u2010analysis. Subgroup analyses by age and sex of OHCA patients, with models stratified by urban\u2010rural areas and seasons,\u00a0and interaction with co\u2010pollutants, are conducted. Among 37,613 OHCA cases, significant associations between OHCA and air pollutants are observed: NO\n                    <jats:sub>2<\/jats:sub>\n                    shows a delayed effect at lag 4 per 10\u00a0\u00b5g m\n                    <jats:sup>\u2212<\/jats:sup>\n                    <jats:sup>3<\/jats:sup>\n                    increase (RR: 1.071; 95%CI: 1.029\u20131.114), while PM\n                    <jats:sub>2.5<\/jats:sub>\n                    (RR: 1.029; 95%CI: 1.006\u20131.053), PM\n                    <jats:sub>10<\/jats:sub>\n                    (RR: 1.025; 95%CI: 1.005\u20131.046), and O\n                    <jats:sub>3<\/jats:sub>\n                    (RR: 1.009; 95%CI: 1.001\u20131.016) have immediate effects at lag 0 or lag 1. CO exhibits a modest association per 100\u00a0\u00b5g m\n                    <jats:sup>\u2212<\/jats:sup>\n                    <jats:sup>3<\/jats:sup>\n                    increase (RR: 1.007; 95%CI: 1.000\u20131.013, lag 4). Risks are elevated in summer months, and varied by urban\u2010rural setting. No significant effect modification is detected across age or sex subgroups. Bi\u2010pollutant models reveal notable interaction and confounding patterns.\n                  <\/jats:p>","DOI":"10.1002\/gch2.202500241","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T06:34:44Z","timestamp":1759214084000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Short\u2010Term Effect of Air Pollution on Out of Hospital Cardiac Arrest (OHCA) in Lombardy\u2014A Case\u2010Crossover Spatiotemporal Study"],"prefix":"10.1002","volume":"9","author":[{"given":"Amruta Umakant","family":"Mahakalkar","sequence":"first","affiliation":[{"name":"Department of Electronics Information and Bioengineering Politecnico di Milano  Milan 20133 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico G.","family":"Caiani","sequence":"additional","affiliation":[{"name":"Department of Electronics Information and Bioengineering Politecnico di Milano  Milan 20133 Italy"},{"name":"Istituto Auxologico Italiano IRCCS S. Luca Hospital  Milan 20149 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Stirparo","sequence":"additional","affiliation":[{"name":"Agenzia Regionale Emergenza Urgenza (AREU)  Milan 20126 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Ticozzi","sequence":"additional","affiliation":[{"name":"Agenzia Regionale Emergenza Urgenza (AREU)  Milan 20126 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9658-5749","authenticated-orcid":false,"given":"Lorenzo","family":"Gianquintieri","sequence":"additional","affiliation":[{"name":"Department of Electronics Information and Bioengineering Politecnico di Milano  Milan 20133 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"e_1_2_9_1_1","unstructured":"World Health Organization Preventing noncommunicable diseases (NCDs) by reducing environmental risk factors2017https:\/\/www.who.int\/publications\/i\/item\/WHO\u2010FWC\u2010EPE\u201017.01(accessed: August 2025)."},{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.105876"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-204492"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chemosphere.2024.141495"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10668\u2010024\u201004781\u20105"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2024.120150"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-55"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1817364"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2019.06.065"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.10.053"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000032351"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2021.02.007"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.030456"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181e093db"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-316452"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2013-203116"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/2047487319862063"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2022.104327"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(19)30262-1"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.000027"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.11.100"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13467"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/15481603.2024.2436997"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2020.142706"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atmosenv.2021.118567"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1127\/0941-2948\/2006\/0130"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/past.2024.12848"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chemosphere.2024.141438"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/atmos15060699"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182212154"},{"key":"e_1_2_9_31_1","unstructured":"Copernicus Atmosphere Monitoring Service Copernicus Atmosphere Monitoring Service: CAMS European air quality reanalyses Atmosphere Data Store2021 https:\/\/doi.org\/10.24381\/7cc0465a(accessed: September 2025)."},{"key":"e_1_2_9_32_1","unstructured":"S.Schimanke M.Ridal P. M.Le L.Berggren P.Und\u00e9n R.Randriamampianina et al. present. Copernicus Climate Change Service (C3S) Climate Data Store (CDS)2021 https:\/\/cds.climate.copernicus.eu\/datasets\/reanalysis\u2010cerra\u2010single\u2010levels?tab=overview(accessed: September 2025)"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijgi9110639"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12940-022-00853-z"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyae020"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200103000-00010"},{"key":"e_1_2_9_37_1","unstructured":"R.Lombardia Uso e Copertura del Suolo 2021(Dusaf 7.0) [Internet] https:\/\/www.cartografia.servizirl.it\/arcgis1\/services\/territorio\/dusaf7\/MapServer\/WMSServer?_jsfBridgeRedirect=true(accessed:March 2022)."},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7382.219"},{"key":"e_1_2_9_39_1","unstructured":"Health Effects Institute Revised Analyses of Time\u2010Series Studies of Air Pollution and Health\u2014Special Report.Boston 2003https:\/\/www.healtheffects.org\/publication\/revised\u2010analyses\u2010time\u2010series\u2010studies\u2010air\u2010pollution\u2010and\u2010health(accessed: August 2025)."},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5963"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi157"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.0901485"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP11112"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.3390\/atmos14050775"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht489"},{"key":"e_1_2_9_46_1","volume":"16","author":"Gentile F. R.","year":"2021","journal-title":"PLoS One"},{"key":"e_1_2_9_47_1","first-page":"810","volume":"12","author":"Moderato L.","year":"2023","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn074"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2022.08.010"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt092"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2019.1708518"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq217"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41370-019-0140-7"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.11654"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2023.108258"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/EE9.0000000000000269"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2024.08.014"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19159012"},{"key":"e_1_2_9_59_1","unstructured":"A. G.Yow V.Rajasurya I.Ahmed S.Sharma Sudden Cardiac Death2024 https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507854\/(accessed: September 2025)."}],"container-title":["Global Challenges"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/gch2.202500241","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T06:17:35Z","timestamp":1762841855000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/gch2.202500241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":59,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/gch2.202500241"],"URL":"https:\/\/doi.org\/10.1002\/gch2.202500241","archive":["Portico"],"relation":{},"ISSN":["2056-6646","2056-6646"],"issn-type":[{"value":"2056-6646","type":"print"},{"value":"2056-6646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]},"assertion":[{"value":"2025-05-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00241"}}