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Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project

¹ Dept Hygiene-Epidemiology, University of Athens, Athens, Greece, ² St. George's Hospital Medical School, London, UK, ³ Environmental Protection Agency of Piemonte, Torino, Italy, ⁴ Umeå University, Umeå, Sweden, ⁵ Dublin Institute of Technology, Dublin, Ireland, ⁶ Tel-Aviv University, Tel-Aviv, Israel, ⁷ Institute of Hygiene, Teplice, Czech Republic, ⁸ Charles University, Prague, Czech Republic, ⁹ Institute of Public Health, Ljubljana, Slovenia, ¹⁰ Institut de Veille Sanitaire, Saint Maurice, France, ¹¹ National Public Health Center, Budapest, Hungary, ¹² University of Basel, Basel, Switzerland, ¹³ Institute Municipal d'Investigacio Medica (IMIM), Barcelona, Spain, ¹⁴ National Public Health Institute, Kuopio, Finland, ¹⁵ National Institute of Hygiene, Warsaw, Poland, ¹⁶ INSERM U420, Nancy, France, ¹⁷ Harvard School of Public Health, Boston, USA

CORRESPONDENCE: K. Katsouyanni, Dept of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias street, 115 27, Athens, Greece. Fax: 30 2107462080. E-mail: kkatsouy@med.uoa.gr

Keywords: ambient particles, elderly, mortality, nitrogen dioxide, time series

Received: April 12, 2002
Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons 65 yrs were investigated.

Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 µm (PM₁₀) and black smoke (BS), as well as the daily number of deaths among persons 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied.

The per cent increase (95% confidence intervals), associated with a 10 µg·m^–3 increase in PM₁₀, in the elderly daily number of deaths was 0.8% (0.7–0.9%) and the corresponding number for BS was 0.6% (0.5–0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects).

These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.