Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities

• Published in: Journal of epidemiology and community health (1979) Vol. 56; no. 10; pp. 773 - 779
• Main Authors: Le Tertre, A, Medina, S, Samoli, E, Forsberg, B, Michelozzi, P, Boumghar, A, Vonk, J M, Bellini, A, Atkinson, R, Ayres, J G, Sunyer, J, Schwartz, J, Katsouyanni, K
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2002; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Aged; Air; Air pollutants; Air Pollutants - adverse effects; Air pollution; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cities; Environmental Exposure; Environmental pollutants toxicology; Estimates; Europe - epidemiology; Funding; Heart; Hospital admissions; Hospitalization - statistics & numerical data; Hospitals; Humans; Medical sciences; Middle Aged; Mortality; Myocardial ischemia; Myocardial Ischemia - epidemiology; Myocardial Ischemia - etiology; Nitrogen dioxide; Particulate matter; Poisson Distribution; Pollutants; Research Report; Short term; Smoke - adverse effects; Statistical variance; Stroke; Stroke - epidemiology; Stroke - etiology; Strokes; Studies; Toxicology; Urban Health - statistics & numerical data; Vehicle Emissions - adverse effects; Europe; United States > US; Netherlands; Vascular disease; Short term; Human; Particle; Toxicology; Ischemia; Hospital admission; Myocardium; Cardiovascular disease; Air pollution; Coronary heart disease; Myocardial disease
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.56.10.773

Study objective: As part of the APHEA project this study examined the association between airborne particles and hospital admissions for cardiac causes (ICD9 390–429) in eight European cities (Barcelona, Birmingham, London, Milan, the Netherlands, Paris, Rome, and Stockholm). All admissions were studied, as well as admissions stratified by age. The association for ischaemic heart disease (ICD9 410–413) and stroke (ICD9 430–438) was also studied, also stratified by age. Design: Autoregressive Poisson models were used that controlled for long term trend, season, influenza epidemics, and meteorology to assess the short-term effects of particles in each city. The study also examined confounding by other pollutants. City specific results were pooled in a second stage regression to obtain more stable estimates and examine the sources of heterogeneity. Main results: The pooled percentage increases associated with a 10 μg/m3 increase in PM10 and black smoke were respectively 0.5% (95% CI: 0.2 to 0.8) and 1.1% (95% CI: 0.4 to 1.8) for cardiac admissions of all ages, 0.7% (95% CI: 0.4 to 1.0) and 1.3% (95% CI: 0.4 to 2.2) for cardiac admissions over 65 years, and, 0.8% (95% CI: 0.3 to 1.2) and 1.1% (95% CI: 0.7 to 1.5) for ischaemic heart disease over 65 years. The effect of PM10 was little changed by control for ozone or SO2, but was substantially reduced (CO) or eliminated (NO2) by control for other traffic related pollutants. The effect of black smoke remained practically unchanged controlling for CO and only somewhat reduced controlling for NO2. Conclusions: These effects of particulate air pollution on cardiac admissions suggest the primary effect is likely to be mainly attributable to diesel exhaust. Results for ischaemic heart disease below 65 years and for stroke over 65 years were inconclusive.