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Air pollution and mortality in the Netherlands: are the elderly more at risk?

¹ National Institute of Public Health and the Environment, Centre for Environmental Health Research, Bilthoven, ² Environmental and Occupational Health Group, Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, ³ Municipal Health Service Amsterdam, Dept of Epidemiology and Health Promotion, Amsterdam, ⁴ Municipal Health Service Amsterdam, Environmental Medicine, Amsterdam, the Netherlands

CORRESPONDENCE: P. Fischer, National Institute of Public Health and the Environment, Centre for Environmental Health Research, P.O. Box 1, 3720 Bilthoven, the Netherlands. Fax: 31 302744451. E-mail: p.fischer@rivm.nl

Keywords: air pollutants, elderly, mortality, particles, time series

Received: April 12, 2002
The association between daily mortality and short-term variations in the ambient levels of ozone (O₃), black smoke (BS), sulphur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO) and particulate matter was studied in the Netherlands.

Daily total and cause-specific mortality counts (cardiovascular, chronic obstructive pulmonary disease (COPD) and pneumonia), air quality, temperature, relative humidity and influenza data were obtained from 1986–1994. The relationship between daily mortality and air pollution was modelled using Poisson regression analysis. All pollution mortality associations were adjusted for potential confounding due to long-term trends, seasonal trends, influenza epidemics, ambient temperature, ambient relative humidity, day of the week and holidays, using generalised additive models.

Statistically significant associations were mostly found in the elderly, that is the age categories of 65–74 and 75 yrs for the pollutants PM₁₀ (particles with a 50% cut-off aerodynamic diameter of 10 µm), BS, SO₂, NO₂ and CO. This may partly be due to a better precision of relative risk (RR) estimates for the larger numbers of deaths in these age groups. Significant associations for those <65 yrs were found for O₃ (total and COPD mortality), PM₁₀ (pneumonia), NO₂ (pneumonia) and CO (pneumonia).

RR estimates for deaths between 45–65 yrs tended to be smaller than those in >65 yrs, with the exception of ozone; for cardiovascular mortality the RR for PM₁₀, O₃ and CO were similar in these age groups.

In conclusion, larger relative risks for air pollution were mostly found in the elderly except for ozone and for death-cause pneumonia which showed larger relative risk in younger age groups.

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