The temporal pattern of respiratory and heart disease mortality in response to air pollution.
Short-term changes in ambient particulate matter with aerodynamic diameters < 10 micro m (PM10) have been associated with short-term fluctuations in mortality or morbidity in many studies. In this study, we tested whether those deaths are just advanced by a few days or weeks using a multicity hierarchical modeling approach for all-cause, respiratory, and cardiovascular deaths, for all ages and stratifying by age groups, within the APHEA-2 (Air Pollution and Health: A European Approach) project. We fit a Poisson regression and used an unconstrained distributed lag to model the effect of PM10 exposure on deaths up to 40 days after the exposure. In baseline models using PM10 the day of and day before the death, we found that the overall PM10 effect (per 10 micro g/m3) was 0.74% [95% confidence interval (95% CI), -0.17 to 1.66] for respiratory deaths and 0.69% (95% CI, 0.31-1.08) for cardiovascular deaths. In unrestricted distributed lag models, the effect estimates increased to 4.2% (95% CI, 1.08-7.42) for respiratory deaths and to 1.97% (95% CI, 1.38-2.55) for cardiovascular deaths. Our study confirms that most of the effect of air pollution is not simply advanced by a few weeks and that effects persist for more than a month after exposure. The effect size estimate for PM10 doubles when we considered longer-term effects for all deaths and for cardiovascular deaths and becomes five times higher for respiratory deaths. We found similar effects when stratifying by age groups. These larger effects are important for risk assessment.
Zanobetti
Antonella
A
Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA. azanob@sparc6a.harvard.edu
Schwartz
Joel
J
Samoli
Evi
E
Gryparis
Alexandros
A
Touloumi
Giota
G
Peacock
Janet
J
Anderson
Ross H
RH
Le Tertre
Alain
A
Bobros
Janos
J
Celko
Martin
M
Goren
Ayana
A
Forsberg
Bertil
B
Michelozzi
Paola
P
Rabczenko
Daniel
D
Hoyos
Santiago Perez
SP
Wichmann
H Erich
HE
Katsouyanni
Klea
K
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D016021:Epidemiologic Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends*; D018570:Risk Assessment; D013997:Time Factors; D014505:Urban Population
D000393:Air Pollutants