title: Associations between fine and coarse particles and mortality in Mediterranean cities: results from the MED-PARTICLES project.
abstract: BACKGROUND
  Few studies have investigated the independent health effects of different size fractions of particulate matter (PM) in multiple locations, especially in Europe.
  
  
  OBJECTIVE
  We estimated the short-term effects of PM with aerodynamic diameter ≤ 10 μm (PM10), ≤ 2.5 μm (PM2.5), and between 2.5 and 10 μm (PM2.5-10) on all-cause, cardiovascular, and respiratory mortality in 10 European Mediterranean metropolitan areas within the MED-PARTICLES project.
  
  
  METHODS
  We analyzed data from each city using Poisson regression models, and combined city-specific estimates to derive overall effect estimates. We evaluated the sensitivity of our estimates to co-pollutant exposures and city-specific model choice, and investigated effect modification by age, sex, and season. We applied distributed lag and threshold models to investigate temporal patterns of associations.
  
  
  RESULTS
  A 10-μg/m3 increase in PM2.5 was associated with a 0.55% (95% CI: 0.27, 0.84%) increase in all-cause mortality (0-1 day cumulative lag), and a 1.91% increase (95% CI: 0.71, 3.12%) in respiratory mortality (0-5 day lag). In general, associations were stronger for cardiovascular and respiratory mortality than all-cause mortality, during warm versus cold months, and among those ≥ 75 versus < 75 years of age. Associations with PM2.5-10 were positive but not statistically significant in most analyses, whereas associations with PM10 seemed to be driven by PM2.5.
  
  
  CONCLUSIONS
  We found evidence of adverse effects of PM2.5 on mortality outcomes in the European Mediterranean region. Associations with PM2.5-10 were positive but smaller in magnitude. Associations were stronger for respiratory mortality when cumulative exposures were lagged over 0-5 days, and were modified by season and age.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece. esamoli@med.uoa.gr
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
authors.forename: Sophia
authors.initials: S
authors.lastname: Rodopoulou
authors.forename: Bart
authors.initials: B
authors.lastname: Ostro
authors.forename: Christophe
authors.initials: C
authors.lastname: Declercq
authors.forename: Ester
authors.initials: E
authors.lastname: Alessandrini
authors.forename: Julio
authors.initials: J
authors.lastname: Díaz
authors.forename: Angeliki
authors.initials: A
authors.lastname: Karanasiou
authors.forename: Apostolos G
authors.initials: AG
authors.lastname: Kelessis
authors.forename: Alain
authors.initials: A
authors.lastname: Le Tertre
authors.forename: Paolo
authors.initials: P
authors.lastname: Pandolfi
authors.forename: Giorgia
authors.initials: G
authors.lastname: Randi
authors.forename: Cecilia
authors.initials: C
authors.lastname: Scarinzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Zauli-Sajani
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000368:Aged; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D016022:Case-Control Studies; D002947:Cities; D018592:Cross-Over Studies; D004781:Environmental Exposure; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008962:Models, Theoretical; D009026:Mortality; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity*; D012621:Seasons
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter