American Journal of Epidemiology Vol. 146, No. 2: 177-185
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Short-term Effects of Ambient Oxidant Exposure on Mortality: A Combined Analysis within the APHEA Project
1Department of Hygiene and Epidemiology, University of Athens Medical School Athens, Greece
2Laboratoire de Santé Publique, Faculté de Medicine, University of Grenoble France
3Harvard School of Public Health Boston, Massachusetts
4GSF-Forschungszentrum Umwelt und Gesundhelt, Institut fur Epidemiologie Neuherberg, Germany
5Department of Public Health Sciences, St. George's Hospital Medical School London, United Kingdom
6Institut Municipal d'investigacio Medica Barcelona, Spain
7Reseau National de Santé Publique Saint Maurice, France
8National Institute of Hygiene Warsaw, Poland
9National Center for Health Promotion Bratislava, Slovakia
10Servizio di Epidemiologia-Regione Lombardia Milano, Italy
11Department of Epidemiology and Statistics, University of Groningen the Netherlands
12Helsinki City Center of the Environment Helsinki, Finland
Reprint requests to Dr. G. Touloumi, Department of Hygiene and Epidemiology, University of Athens Medical School, Mikras Asias 75 (Goudi), 115 27 Athens, Greece
The Air Pollution and Health: a European Approach (APHEA) project is a coordinated study of the short-term effects of air pollution on mortality and hospital admissions using data from 15 European cities, with a wide range of geographic, sociodemographic, climatic, and air quality patterns. The objective of this paper is to summarize the results of the short-term effects of ambient oxidants on daily deaths from all causes (excluding accidents). Within the APHEA project, six cities spanning Central and Western Europe provided data on daily deaths and NO2 and/or O3 levels. The data were analyzed by each center separately following a standardized methodology to ensure comparability of results. Poisson autoregressive models allowing for overdispersion were fitted. Fixed effects models were used to pool the individual regression coefficients when there was no evidence of heterogeneity among the cities and random effects models otherwise. Factors possibly correlated with heterogeneity were also investigated. Significant positive associations were found between daily deaths and both NO2 and O3. Increases of 50 µg/m3 in NO2 (1-hour maximum) or O3 (1-hour maximum) were associated with a 1.3% (95% confidence interval 0.9–1.8) and 2.9% (95% confidence interval 1.0–4.9) increase in the daily number of deaths, respectively. Stratified analysis of NO2 effects by low and high levels of black smoke or O3 showed no significant evidence for an interaction within each city. However, there was a tendency for larger effects of NO2 in cities with higher levels of black smoke. The pooled estimate for the O3 effect was only slightly reduced, whereas the one for NO2 was almost halved (although it remained significant) when two pollutant models including black smoke were applied. The internal validity (consistency across cities) as well as the external validity (similarities with other published studies) of our results on the O3 effect support the hypothesis of a causal relation between O3 and all cause daily mortality. However, the short-term effects of NO2 on mortality may be confounded by other vehicle-derived pollutants. Thus, the issue of independent NO2 effects requires additional investigation. Am J Epidemiol 1997;146:177-85.
air pollution; environmental exposure; environmental illness; environmental pollutants; mortality; nitrogen dioxide; ozone
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