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American Journal of Epidemiology Advance Access originally published online on April 2, 2009
American Journal of Epidemiology 2009 169(10):1201-1208; doi:10.1093/aje/kwp032
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Are the Short-term Effects of Air Pollution Restricted to Cardiorespiratory Diseases?

Sophie Larrieu, Agnès Lefranc, Gaëlle Gault, Edouard Chatignoux, Franck Couvy, Bernard Jouves and Laurent Filleul

Correspondence to Dr. Sophie Larrieu, French Institute of Public Health Surveillance (InVS), Cire Aquitaine, Espace Rodesse, 103 bis rue Belleville, BP952, 33063 Bordeaux Cedex, France (e-mail: sophie.larrieu{at}sante.gouv.fr).

Received for publication July 18, 2008. Accepted for publication January 26, 2009.

Short-term effects of air pollution on common morbidity are largely unknown. The authors explored links between daily levels of air pollution (nitrogen dioxide, ozone, and particulate matter less than 10 µm in diameter (PM10)) and medical home visits made for diverse reasons in Bordeaux, France, during 2000–2006. Daily numbers of visits were obtained from a network of general practitioners. The excess relative risk (ERR) of a visit for each indicator associated with increased pollutant levels was estimated by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. Positive and significant associations were found between air pollution and most health indicators. A 10-µg/m3 increase in PM10 levels was associated with increases in visits for upper and lower respiratory diseases (ERRs were 1.5% (95% confidence interval (CI): 0.3, 2.7) and 2.5% (95% CI: 0.5, 4.4), respectively), headache and asthenia (ERR = 3.5%, 95% CI: 1.3, 5.9), and skin rash and conjunctivitis (ERR = 3.2%, 95% CI: –0.2, 6.8). Significant associations were also found between nitrogen dioxide and ozone and several health indicators. Distributed-lag models showed no harvesting effect, and some effects persisted up to 15 days after exposure increased. These results suggest that considering only the most severe effects of air pollution leads to underestimation of its impact on public health.

air pollution; asthenia; conjunctivitis; exanthema; headache; primary health care; respiratory tract diseases

Abbreviations: CI, confidence interval; ERPURS, Evaluation des Risques de la Pollution Urbaine sur la Santé; ERR, excess relative risk; PM10, particulate matter less than 10 µm in diameter


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