title: Which specific causes of death are associated with short term exposure to fine and coarse particles in Southern Europe? Results from the MED-PARTICLES project.
abstract: We investigated the short-term effects of particles with aerodynamic diameter less than 2.5μm (PM2.5), between 2.5 and 10μm (PM2.5-10) and less than 10μm (PM10) on deaths from diabetes, cardiac and cerebrovascular causes, lower respiratory tract infections (LRTI) and chronic obstructive pulmonary disease (COPD) in 10 European Mediterranean metropolitan areas participating in the MED-PARTICLES project during 2001-2010. In the first stage of the analysis, data from each city were analyzed separately using Poisson regression models, whereas in the second stage, the city-specific air pollution estimates were combined to obtain overall estimates. We investigated the effects following immediate (lags 0-1), delayed (lags 2-5) and prolonged exposure (lags 0-5) and effect modification patterns by season. We evaluated the sensitivity of our results to co-pollutant exposures or city-specific model choice. We applied threshold models to investigate the pattern of selected associations. For a 10μg/m(3) increase in two days' PM2.5 exposure there was a 1.23% (95% confidence interval (95% CI): -1.63%, 4.17%) increase in diabetes deaths, while six days' exposure statistically significantly increased cardiac deaths by 1.33% (95% CI: 0.27, 2.40%), COPD deaths by 2.53% (95% CI: -0.01%, 5.14%) and LRTI deaths by 1.37% (95% CI: -1.94%, 4.78%). PM2.5 results were robust to co-pollutant adjustments and alternative modeling approaches. Stronger effects were observed in the warm season. Coarse particles displayed positive, even if not statistically significant, associations with mortality due to diabetes and cardiac causes that were more variable depending on exposure period, co-pollutant and seasonality adjustment. Our findings provide support for positive associations between PM2.5 and mortality due to diabetes, cardiac causes, COPD, and to a lesser degree to cerebrovascular causes, in the European Mediterranean region, which seem to drive the particles short-term health effects.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece. Electronic address: esamoli@med.uoa.gr.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.affiliation: Department of Epidemiology of Lazio Region, 53 Santa Costanza Str, 00198 Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Rodopoulou
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, C/Doctor Aiguader, 88, E-08003 Barcelona, Spain.
authors.forename: Bart
authors.initials: B
authors.lastname: Ostro
authors.affiliation: Department of Epidemiology of Lazio Region, 53 Santa Costanza Str, 00198 Rome, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Alessandrini
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, C/Doctor Aiguader, 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, 28029 Madrid, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Basagaña
authors.affiliation: Carlos III Institute of Health, 5 Avda. Monforte de Lemos, 28029 Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Díaz
authors.affiliation: Department of Epidemiology of Lazio Region, 53 Santa Costanza Str, 00198 Rome, Italy.
authors.forename: Annunziata
authors.initials: A
authors.lastname: Faustini
authors.affiliation: Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, 9 Pio VII Str, 10127 Turin, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Gandini
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, C/Doctor Aiguader, 88, E-08003 Barcelona, Spain.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Karanasiou
authors.affiliation: Environmental Department, Municipality of Thessaloniki, 7 Paparigopoulou Str, 54630 Thessaloniki, Greece.
authors.forename: Apostolos G
authors.initials: AG
authors.lastname: Kelessis
authors.affiliation: Environmental Health Department, French Institute for Public Health Surveillance (InVS), 12 du Val d'Osne Str, 94415 Saint-Maurice Cedex, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Le Tertre
authors.affiliation: Carlos III Institute of Health, 5 Avda. Monforte de Lemos, 28029 Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Linares
authors.affiliation: Regional Centre for Environment and Health, Regional Agency for Environmental Prevention of Emilia-Romagna, 13 Begarelli Str, 41121 Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranzi
authors.affiliation: Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, 9 Pio VII Str, 10127 Turin, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Scarinzi
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece.
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
authors.affiliation: Department of Epidemiology of Lazio Region, 53 Santa Costanza Str, 00198 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000397:Air Pollution / Q000706:statistics & numerical data*; D002423:Cause of Death; D002947:Cities; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005060:Europe; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008962:Models, Theoretical; D010316:Particle Size; D052638:Particulate Matter; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000401:mortality; D012621:Seasons
chemical_list: D052638:Particulate Matter
keywords: COPD; Cardiac; Cerebrovascular; Coarse particles; Diabetes; Fine particles; Mediterranean; Mortality; Particulate matter; Time series analysis