title: Particulate matter and out-of-hospital coronary deaths in eight Italian cities.
abstract: OBJECTIVE
  We evaluated the association between PM(10) concentration and out-of-hospital coronary deaths in eight Italian cities during 1997-2004.
  
  
  METHODS
  16 989 subjects aged >35 years who died out-of-hospital from coronary causes were studied and hospital admissions in the previous 2 years identified. We studied the effect of the mean of current and previous day PM(10) values (lag 0-1). A city-specific case-crossover analysis was applied using a time-stratified approach considering as confounders weather, holidays, influenza epidemics, and summer decrease in population. The pooled percentage increase (95% CI) in mortality per 10 microg/m(3) increase in PM(10) was estimated.
  
  
  RESULTS
  A statistically significant increase in out-of-hospital coronary deaths was related to a 10 microg/m(3) increase in PM(10): 1.46% (95% CI 0.50 to 2.43). Although no statistically significant effect modification by age was found, the effect was stronger among subjects aged >65 years (1.60%, 0.59 to 2.63), particularly those aged 65-74 (3.01%, 0.74 to 5.34). People in the lowest socio-economic category (3.34%, 1.28 to 5.45) had a stronger effect than those in the highest category. No clear effect modification was seen for gender, season or any specific comorbidity. An indication of negative effect modification was seen for previous admission for cardiac dysrhythmias. Subjects without hospital admissions in the previous 2 years were slightly more affected by PM(10) effects (1.91%, 0.28 to 3.47) than those with at least one previous hospital admission (1.44%, 0.09 to 2.82).
  
  
  CONCLUSIONS
  Our results show that short term exposure to PM(10) is associated with coronary mortality especially among the elderly and socio-economically disadvantaged. No clear effect modification by previous hospitalisations was detected except for cardiac dysrhythmias, possibly due to protective treatment.
authors.affiliation: Institute of Clinical Physiology, National Research Council, Lecce, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Serinelli
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Vigotti
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
authors.forename: Giovanna
authors.initials: G
authors.lastname: Berti
authors.forename: Luigi
authors.initials: L
authors.lastname: Bisanti
authors.forename: Sandra
authors.initials: S
authors.lastname: Mallone
authors.forename: Barbara
authors.initials: B
authors.lastname: Pacelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Tessari
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000328:Adult; D000368:Aged; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D002947:Cities / Q000453:epidemiology; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter; D012959:Socioeconomic Factors; D014504:Urban Health
chemical_list: D052638:Particulate Matter