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Associations of ambient exposure to benzene, toluene, ethylbenzene, and xylene with daily mortality: a multicountry time-series study in 757 global locations
Author(s)
Xiong Ying
Francesco Sera
Ana Maria Vicedo-Cabrera
Rosana Abrutzky
Yuming Guo
Shilu Tong
Micheline de Sousa Zanotti Stagliorio Coêlho
Paulo Hilario Nascimento Saldiva
Éric Lavigne
Patricia Matus Correa
Nicolás Valdés Ortega
Samuel Osorio
Dominic Royé
Jan Kyselý
Hans Orru
Marek Maasikmets
Jouni J. K. Jaakkola
Niilo Ryti
Mathilde Pascal
Veronika Huber
Susanne Breitner-Busch
Alexandra Schneider
Klea Katsouyanni
Evangelia Samoli
Alireza Entezari
Fatemeh Mayvaneh
Patrick Goodman
Ariana Zeka
Raanan Raz
Matteo Scortichini
Massimo Stafoggia
Yasushi Honda
Masahiro Hashizume
Chris Fook Sheng Ng
Barrak Alahmad
Magali Hurtado‐Díaz
Eunice Elizabeth Félix Arellano
Ala Overcenco
Jochem O. Klompmaker
Shilpa Rao
Gabriel Carrasco‐Escobar
Xerxes Seposo
Paul Lester Chua
Susana Pereira Silva
Joana Madureira
Iulian‐Horia Holobâcă
Noah Scovronick
Rebecca M. Garland
Ho Kim
Whanhee Lee
Aurelio Tobı́as
Carmen Íñiguez
Bertil Forsberg
Martina S. Ragettli
Yue Leon Guo
Shih‐Chun Pan
Shanshan Li
Pierre Masselot
Valentina Colistro
Michelle L. Bell
Antonella Zanobetti
Joel Schwartz
Trần Ngọc Đăng
Do Van Dung
Antonio Gasparrini
Yaoxian Huang
Haidong Kan
Date Issued
1 de septiembre de 2025
Type
Article
Volume
9
Issue
9
Start Page
101306
End Page
101306
Abstract
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 25 , 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 057% (95% CI 049-065), 042% (030-054), and 068% (050-086) in total, cardiovascular, and respiratory mortality, respectively.The corresponding effect estimates for an IQR increment in individual chemicals (benzene, toluene, and xylenes) were 038-061%, 044-070%, and 041-065%, 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 exposureresponse 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.
Keywords