Short-term effects of nitrogen dioxide on mortality: an analysis within the APHEA project

E. Samoli ^1*, E. Aga ², G. Touloumi ¹, K. Nisiotis ¹, B. Forsberg ³, A. Lefranc ⁴, J. Pekkanen ⁵, B. Wojtyniak ⁶, C. Schindler ⁷, E. Niciu ⁸, R. Brunstein ⁹, M. Dodi Fikfak ¹⁰, J. Schwartz ², K. Katsouyanni ¹

¹ Dept of Hygiene and Epidemiology, Uni of Athens, Greece
² Harvard School of Public Health, Boston, USA
³ Dept of Public Health and Clinical Medicine, Umea University, Sweden
⁴ Regional Observatory of Health, Ile-de-France, France
⁵ National Public Health Institute, Unit of Environ Epidem, Finland
⁶ National Institute of Hygiene, Dept of Medical Statistics, Population Studies Laboratory, Poland
⁷ Institute of Social and Preventive Medicine, University of Basel, Switzerland
⁸ Dept of Environmental Health, Institute of Public Health Bucharest, Romania
⁹ Center for Quality & Safety, Hadassah University Hospital, Jerusalem, Israel
¹⁰ Institute of Public Health, Slovenia

^* To whom correspondence should be addressed. E-mail: esamoli{at}med.uoa.gr.

	Abstract

We investigated the short-term effects of nitrogen dioxide (NO₂) on total, cardiovascular and respiratory mortality in 30 European cities participating in the APHEA-2 project.

The association was examined using hierarchical models implemented in two stages. In the first stage data from each city were analyzed separately, whereas in the second stage the city specific air pollution estimates were regressed on city specific covariates to obtain overall estimates and to explore sources of possible heterogeneity.

We found a significant association of NO₂ with total, cardiovascular and respiratory mortality, with stronger effects on cause-specific mortality. There was evidence of confounding in respiratory mortality with black smoke and sulphur dioxide. The effect of NO₂ on total and cardiovascular mortality was observed mainly in western and south European cities and was larger when smoking prevalence was lower and household gas consumption was higher. The effect of NO₂ on respiratory mortality was higher in cities with larger proportion of elderly persons in the population and higher levels of PM₁₀.

The results of this large study are consistent with an independent effect of NO₂ on mortality, but the role of NO₂ as a surrogate of other unmeasured pollutants cannot be completely ruled out.

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