Статья

Confounding and Effect Modification in the Short-Term Effects of Ambient Particles on Total Mortality: Results from 29 European Cities within the APHEA2 Project

Klea KatsouyanniDepartment of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias Street, 115 27 Athens, GreeceGiota TouloumiDepartment of Hygiene and Epidemiology, University of Athens Medical School, Athens, GreeceEvangelia SamoliDepartment of Hygiene and Epidemiology, University of Athens Medical School, Athens, GreeceAlexandros GryparisDepartment of Hygiene and Epidemiology, University of Athens Medical School, Athens, GreeceAlain Le TertreInstitut de Veille Sanitaire, Paris, FranceYannis MonopolisDepartment of Hygiene and Epidemiology, University of Athens Medical School, Athens, GreeceGiuseppe RossiFisiologia Clinica CNR, Unit of Epidemiology and Biostatistics, Pisa, ItalyDenis ZmirouUniversite Joseph Fourier Public Health Laboratory Medical School Domaine de la Merci, Grenoble, FranceFerrán BallesterEpidemiology and Statistics Unit, Escola Valenciana d’Estudis per a la Salut, Conselleria de Sanitat, Generalitat Valenciana, Valencia, SpainAzedine BoumgharInstitut de Veille Sanitaire, Paris, FranceHugh Ross AndersonDepartment of Public Health Sciences, St. George’s Hospital Medical School, University of London, United KingdomBogdan WojtyniakNational Institute of Hygiene, Department of Medical Statistics, Population Studies Laboratory, Warsaw, PolandAnna PáldyJ. Fodor National Public Health Centre—National Institute of Environmental Health, Division of Environmental Health Assessment, Budapest, HungaryRony BraunsteinDepartment of Epidemiology and Preventive Medicine, Tel Aviv University, IsraelJuha PekkanenChristian SchindlerUniversitat Basel, Institut fur Sozial-und Praventivmedizin, SwitzerlandJoel Schwartz

2001en

ABI

Аннотация

We present the results of the Air Pollution and Health: A European Approach 2 (APHEA2) project on short-term effects of ambient particles on mortality with emphasis on effect modification. We used daily measurements for particulate matter less than 10 microm in aerodynamic diameter (PM10) and/or black smoke from 29 European cities. We considered confounding from other pollutants as well as meteorologic and chronologic variables. We investigated several variables describing the cities' pollution, climate, population, and geography as potential effect modifiers. For the individual city analysis, generalized additive models extending Poisson regression, using a smoother to control for seasonal patterns, were applied. To provide quantitative summaries of the results and explain remaining heterogeneity, we applied second-stage regression models. The estimated increase in the daily number of deaths for all ages for a 10 microg/m3 increase in daily PM10 or black smoke concentrations was 0.6% [95% confidence interval (CI) = 0.4-0.8%], whereas for the elderly it was slightly higher. We found important effect modification for several of the variables studied. Thus, in a city with low average NO2, the estimated increase in daily mortality for an increase of 10 microg/m3 in PM10 was 0.19 (95% CI = 0.00-0.41), whereas in a city with high average NO2 it was 0.80% (95% CI = 0.67-0.93%); in a relatively cold climate the corresponding effect was 0.29% (95% CI = 0.16-0.42), whereas in a warm climate it was 0.82% (95% CI = 0.69-0.96); in a city with low standardized mortality rate it was 0.80% (95% CI = 0.65-0.95%), and in one with a high rate it was 0.43% (95% CI = 0.24-0.62). Our results confirm those previously reported on the effects of ambient particles on mortality. Furthermore, they show that the heterogeneity found in the effect parameters among cities reflects real effect modification, which is explained by specific city characteristics.

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Идентификаторы

DOI: 10.1097/00001648-200109000-00011

Цитирования и источники

Цитирований: 3Использованных источников: 0

Показатели — AkademScholar