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Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics

Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA

Correspondence to:
Correspondence to:
Dr A Zeka
Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Suite 415 W, PO Box 15677, Boston, MA 02215, USA; azeka{at}hsph.harvard.edu

Background: Consistent evidence has shown increased all-cause mortality, and mortality from broad categories of causes associated with airborne particles. Less is known about associations with specific causes of death, and modifiers of those associations.

Aims: To examine these questions in 20 US cities, between 1989 and 2000.

Methods: Mortality files were obtained from the National Center for Health Statistics. Air pollution data were obtained from the Environmental Protection Agency website. The associations between daily concentrations of particulate matter of aero-diameter 10 µm (PM₁₀) and daily mortality from all-cause and selected causes of death, were examined using a case-crossover design. Temporal effects of PM₁₀ were examined using lag models, in first stage regressions. City specific modifiers of these associations were examined in second stage regressions.

Results: All-cause mortality increased with PM₁₀ exposures occurring both one and two days prior the event. Deaths from heart disease were primarily associated with PM₁₀ on the two days before, while respiratory deaths were associated with PM₁₀ exposure on all three days. Analyses using only one lag underestimated the effects for all-cause, heart, and respiratory deaths. Several city characteristics modified the effects of PM₁₀ on daily mortality. Important findings were seen for population density, percentage of primary PM₁₀ from traffic, variance of summer temperature, and mean of winter temperature.

Conclusions: There was overall evidence of increased daily mortality from increased concentrations of PM₁₀ that persisted across several days, and matching for temperature did not affect these associations. Heterogeneity in the city specific PM₁₀ effects could be explained by differences in certain city characteristics.

Abbreviations: AT, apparent temperature; COPD, chronic obstructive pulmonary disease; HF, heart failure; ICD, International Classification of Diseases; IHD, ischaemic heart disease; MI, myocardial infarction; NMMAPS, National Morbidity and Mortality Air Pollution Study; NO₂, nitrogen dioxide; PM₁₀, particulate matter of aero-diameter equal or less than 10 µm

Keywords: case crossover; cause-specific mortality; daily mortality; effect modification; particulate matter

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