title: Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities.
abstract: OBJECTIVE
  As part of the APHEA project this study examined the association between airborne particles and hospital admissions for cardiac causes (ICD9 390-429) in eight European cities (Barcelona, Birmingham, London, Milan, the Netherlands, Paris, Rome, and Stockholm). All admissions were studied, as well as admissions stratified by age. The association for ischaemic heart disease (ICD9 410-413) and stroke (ICD9 430-438) was also studied, also stratified by age.
  
  
  METHODS
  Autoregressive Poisson models were used that controlled for long term trend, season, influenza epidemics, and meteorology to assess the short-term effects of particles in each city. The study also examined confounding by other pollutants. City specific results were pooled in a second stage regression to obtain more stable estimates and examine the sources of heterogeneity.
  
  
  RESULTS
  The pooled percentage increases associated with a 10 micro g/m(3) increase in PM(10) and black smoke were respectively 0.5% (95% CI: 0.2 to 0.8) and 1.1% (95% CI: 0.4 to 1.8) for cardiac admissions of all ages, 0.7% (95% CI: 0.4 to 1.0) and 1.3% (95% CI: 0.4 to 2.2) for cardiac admissions over 65 years, and, 0.8% (95% CI: 0.3 to 1.2) and 1.1% (95% CI: 0.7 to 1.5) for ischaemic heart disease over 65 years. The effect of PM(10) was little changed by control for ozone or SO(2), but was substantially reduced (CO) or eliminated (NO(2)) by control for other traffic related pollutants. The effect of black smoke remained practically unchanged controlling for CO and only somewhat reduced controlling for NO(2).
  
  
  CONCLUSIONS
  These effects of particulate air pollution on cardiac admissions suggest the primary effect is likely to be mainly attributable to diesel exhaust. Results for ischaemic heart disease below 65 years and for stroke over 65 years were inconclusive.
authors.affiliation: Environmental Health Unit, National Institute of Public Health Surveillance, France. a.letertre@invs-sante.fr
authors.forename: A
authors.initials: A
authors.lastname: Le Tertre
authors.forename: S
authors.initials: S
authors.lastname: Medina
authors.forename: E
authors.initials: E
authors.lastname: Samoli
authors.forename: B
authors.initials: B
authors.lastname: Forsberg
authors.forename: P
authors.initials: P
authors.lastname: Michelozzi
authors.forename: A
authors.initials: A
authors.lastname: Boumghar
authors.forename: J M
authors.initials: JM
authors.lastname: Vonk
authors.forename: A
authors.initials: A
authors.lastname: Bellini
authors.forename: R
authors.initials: R
authors.lastname: Atkinson
authors.forename: J G
authors.initials: JG
authors.lastname: Ayres
authors.forename: J
authors.initials: J
authors.lastname: Sunyer
authors.forename: J
authors.initials: J
authors.lastname: Schwartz
authors.forename: K
authors.initials: K
authors.lastname: Katsouyanni
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D004781:Environmental Exposure; D005060:Europe / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D016012:Poisson Distribution; D012906:Smoke / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014504:Urban Health / Q000706:statistics & numerical data*; D001335:Vehicle Emissions / Q000009:adverse effects
chemical_list: D000393:Air Pollutants; D012906:Smoke; D001335:Vehicle Emissions