title: Short-term effects of particulate matter constituents on daily hospitalizations and mortality in five South-European cities: results from the MED-PARTICLES project.
abstract: BACKGROUND
  Few recent studies examined acute effects on health of individual chemical species in the particulate matter (PM) mixture, and most of them have been conducted in North America. Studies in Southern Europe are scarce. The aim of this study is to examine the relationship between particulate matter constituents and daily hospital admissions and mortality in five cities in Southern Europe.
  
  
  METHODS
  The study included five cities in Southern Europe, three cities in Spain: Barcelona (2003-2010), Madrid (2007-2008) and Huelva (2003-2010); and two cities in Italy: Rome (2005-2007) and Bologna (2011-2013). A case-crossover design was used to link cardiovascular and respiratory hospital admissions and total, cardiovascular and respiratory mortality with a pre-defined list of 16 PM10 and PM2.5 constituents. Lags 0 to 2 were examined. City-specific results were combined by random-effects meta-analysis.
  
  
  RESULTS
  Most of the elements studied, namely EC, SO4(2-), SiO2, Ca, Fe, Zn, Cu, Ti, Mn, V and Ni, showed increased percent changes in cardiovascular and/or respiratory hospitalizations, mainly at lags 0 and 1. The percent increase by one interquartile range (IQR) change ranged from 0.69% to 3.29%. After adjustment for total PM levels, only associations for Mn, Zn and Ni remained significant. For mortality, although positive associations were identified (Fe and Ti for total mortality; EC and Mg for cardiovascular mortality; and NO3(-) for respiratory mortality) the patterns were less clear.
  
  
  CONCLUSIONS
  The associations found in this study reflect that several PM constituents, originating from different sources, may drive previously reported results between PM and hospital admissions in the Mediterranean area.
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain. Electronic address: xbasagana@creal.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Basagaña
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; INSERM U1018, CESP-Centre for Research in Epidemiology and Population Health, UMRS U1018, Respiratory and Environmental Epidemiology Team, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif, France; University Paris Sud, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Jacquemin
authors.affiliation: Institute of Environmental Assessment and Water Research (IDAEA-CSIC), C/Jordi Girona 18-26, 08034 Barcelona, Spain.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Karanasiou
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Air Pollution Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay St 16th floor, 94612 Oakland, CA, USA.
authors.forename: Bart
authors.initials: B
authors.lastname: Ostro
authors.affiliation: Institute of Environmental Assessment and Water Research (IDAEA-CSIC), C/Jordi Girona 18-26, 08034 Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Querol
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Agis
authors.affiliation: Department of Epidemiology, Lazio Region Health Service, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Alessandrini
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Center of Research on Environmental Health (CYSMA), University of Huelva, Campus de El Carmen, 21007 Huelva, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Alguacil
authors.affiliation: Departamento de Medio Ambiente, CIEMAT, C/Complutense 40, 28040 Madrid, Spain; CSIC-IDAEA/CIEMAT Associate Unit on Atmospheric Pollution, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Artiñano
authors.affiliation: C.N.R. Institute of Atmospheric Pollution Research, Via Salaria Km 29, 300 Montelibretti, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Catrambone
authors.affiliation: Associate Unit CSIC-University of Huelva "Atmospheric Pollution", Centre of Research of Sustainable Chemistry (CIQSO), Campus of Excellence CEIA3, University of Huelva, Edificio Robert H Grubbs, Campus de El Carmen, 21007 Huelva, Spain.
authors.forename: Jesús D
authors.initials: JD
authors.lastname: de la Rosa
authors.affiliation: National School of Public Health, Carlos III Health Institute, C/Sinesio Delgado 6, 28029 Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Díaz
authors.affiliation: Department of Epidemiology, Lazio Region Health Service, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Annunziata
authors.initials: A
authors.lastname: Faustini
authors.affiliation: Environmental Protection Agency of Emilia-Romagna, Via F. Rocchi, 19, Via Triachini, 17, 40138 Bologna, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Department of Epidemiology, Lazio Region Health Service, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75, Goudi, GR-11527 Athens, Greece.
authors.forename: Klea
authors.initials: K
authors.lastname: Katsouyanni
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain; National School of Public Health, Carlos III Health Institute, C/Sinesio Delgado 6, 28029 Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Linares
authors.affiliation: C.N.R. Institute of Atmospheric Pollution Research, Via Salaria Km 29, 300 Montelibretti, Rome, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Perrino
authors.affiliation: Environmental Protection Agency of Emilia-Romagna, Via F. Rocchi, 19, Via Triachini, 17, 40138 Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranzi
authors.affiliation: Environmental Protection Agency of Emilia-Romagna, Via F. Rocchi, 19, Via Triachini, 17, 40138 Bologna, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Ricciardelli
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75, Goudi, GR-11527 Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.affiliation: Environmental Protection Agency of Emilia-Romagna, Via F. Rocchi, 19, Via Triachini, 17, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zauli-Sajani
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain; IMIM (Hospital del Mar Research Institute), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.affiliation: Department of Epidemiology, Lazio Region Health Service, Via di Santa Costanza 53, 00198 Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
mesh_terms: D000393:Air Pollutants / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002947:Cities / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D019216:Metals, Heavy / Q000032:analysis; D009566:Nitrates / Q000032:analysis; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis*; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000401:mortality*; D013030:Spain / Q000453:epidemiology; D013431:Sulfates / Q000032:analysis
chemical_list: D000393:Air Pollutants; D019216:Metals, Heavy; D009566:Nitrates; D052638:Particulate Matter; D013431:Sulfates
keywords: Chemical constituent; Hospital admissions; Mortality; Particulate matter; Species