title: Short-term effects of particulate matter on mortality during forest fires in Southern Europe: results of the MED-PARTICLES Project.
abstract: BACKGROUND
  An association between occurrence of wildfires and mortality in the exposed population has been observed in several studies with controversial results for cause-specific mortality. In the Mediterranean area, forest fires usually occur during spring-summer, they overlap with Saharan outbreaks, are associated with increased temperature and their health effects are probably due to an increase in particulate matter.
  
  
  OBJECTIVE
  We analysed the effects of wildfires and particulate matter (PM10) on mortality in 10 southern European cities in Spain, France, Italy and Greece (2003-2010), using satellite data for exposure assessment and Poisson regression models, simulating a case-crossover approach.
  
  
  RESULTS
  We found that smoky days were associated with increased cardiovascular mortality (lag 0-5, 6.29%, 95% CIs 1.00 to 11.85). When the effect of PM10 (per 10 µg/m(3)) was evaluated, there was an increase in natural mortality (0.49%), cardiovascular mortality (0.65%) and respiratory mortality (2.13%) on smoke-free days, but PM10-related mortality was higher on smoky days (natural mortality up to 1.10% and respiratory mortality up to 3.90%) with a suggestion of effect modification for cardiovascular mortality (3.42%, p value for effect modification 0.055), controlling for Saharan dust advections.
  
  
  CONCLUSIONS
  Smoke is associated with increased cardiovascular mortality in urban residents, and PM10 on smoky days has a larger effect on cardiovascular and respiratory mortality than on other days.
authors.affiliation: Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
authors.forename: Annunziata
authors.initials: A
authors.lastname: Faustini
authors.affiliation: Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
authors.forename: Ester R
authors.initials: ER
authors.lastname: Alessandrini
authors.affiliation: Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona, Spain Aix Marseille Université, CNRS, Marseille, France.
authors.forename: Jorge
authors.initials: J
authors.lastname: Pey
authors.affiliation: Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona, Spain.
authors.forename: Noemi
authors.initials: N
authors.lastname: Perez
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samoli
authors.affiliation: Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Querol
authors.affiliation: Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Cadum
authors.affiliation: Institute of Atmospheric Pollution, National Research Council, Rome, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Perrino
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Bart
authors.initials: B
authors.lastname: Ostro
authors.affiliation: Regional Centre for Environment and Health, Regional Agency for Environmental Protection of Emilia-Romagna, Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranzi
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.affiliation: Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Stafoggia
authors.affiliation: Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects*; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002947:Cities; D004391:Dust; D004781:Environmental Exposure / Q000009:adverse effects; D005060:Europe / Q000453:epidemiology; D005390:Fires; D065928:Forests; D006801:Humans; D019083:Mediterranean Region / Q000453:epidemiology; D052638:Particulate Matter; D012140:Respiratory Tract Diseases / Q000401:mortality*; D012621:Seasons; D012906:Smoke / Q000009:adverse effects*
chemical_list: D000393:Air Pollutants; D004391:Dust; D052638:Particulate Matter; D012906:Smoke