title: Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project.
abstract: We investigated the short-term effects of air pollution on hospital admissions for chronic obstructive pulmonary disease (COPD) in Europe. As part of a European project (Air Pollution and Health, a European Approach (APHEA)), we analysed data from the cities of Amsterdam, Barcelona, London, Milan, Paris and Rotterdam, using a standardized approach to data eligibility and statistical analysis. Relative risks for daily COPD admissions were obtained using Poisson regression, controlling for: seasonal and other cycles; influenza epidemics; day of the week; temperature; humidity and autocorrelation. Summary effects for each pollutant were estimated as the mean of each city's regression coefficients weighted by the inverse of the variance, allowing for additional between-cities variance, as necessary. For all ages, the relative risks (95% confidence limits (95% CL)) for a 50 microg x m(-3) increase in daily mean level of pollutant (lagged 1-3 days) were (95% CL): sulphur dioxide 1.02 (0.98, 1.06); black smoke 1.04 (1.01, 1.06); total suspended particulates 1.02 (1.00, 1.05), nitrogen dioxide 1.02 (1.00, 1.05) and ozone (8 h) 1.04 (1.02, 1.07). The results confirm that air pollution is associated with daily admissions for chronic obstructive pulmonary disease in European cities with widely varying climates. The results for particles and ozone are broadly consistent with those from North America, though the coefficients for particles are substantially smaller. Overall, the evidence points to a causal relationship but the mechanisms of action, exposure response relationships and pollutant interactions remain unclear.
authors.affiliation: Dept of Public Health Sciences, St. George's Hospital Medical School, London, UK.
authors.forename: H R
authors.initials: HR
authors.lastname: Anderson
authors.forename: C
authors.initials: C
authors.lastname: Spix
authors.forename: S
authors.initials: S
authors.lastname: Medina
authors.forename: J P
authors.initials: JP
authors.lastname: Schouten
authors.forename: J
authors.initials: J
authors.lastname: Castellsague
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: D
authors.initials: D
authors.lastname: Zmirou
authors.forename: G
authors.initials: G
authors.lastname: Touloumi
authors.forename: B
authors.initials: B
authors.lastname: Wojtyniak
authors.forename: A
authors.initials: A
authors.lastname: Ponka
authors.forename: L
authors.initials: L
authors.lastname: Bacharova
authors.forename: J
authors.initials: J
authors.lastname: Schwartz
authors.forename: K
authors.initials: K
authors.lastname: Katsouyanni
mesh_terms: D000397:Air Pollution / Q000706:statistics & numerical data*; D002980:Climate; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D009585:Nitrogen Dioxide / Q000032:analysis; D010126:Ozone / Q000032:analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012044:Regression Analysis; D012306:Risk; D012906:Smoke / Q000032:analysis; D013458:Sulfur Dioxide / Q000032:analysis
chemical_list: D012906:Smoke; D013458:Sulfur Dioxide; D010126:Ozone; D009585:Nitrogen Dioxide