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The Temporal Pattern of Mortality Responses to Ambient Ozone in the Aphea Project

Samoli, Evangelia*; Zanobetti, Antonella; Schwartz, Joel; Atkinson, Richard; LeTertre, Alain§; Schindler, Christian; Pérez, Laura**; Cadum, Enio††; Pekkanen, Juha‡‡§§; Paldy, Anna¶¶; Touloumi, Giota*; Katsouyanni, Klea*

doi: 10.1097/01.ede.0000362256.87812.16
Abstracts: ISEE 21st Annual Conference, Dublin, Ireland, August 25–29, 2009: Oral Presentations

*Dept of Hygiene, Epidemiology & Medical Statistics, University of Athens, Athens, Greece; †Harvard School of Public Health, Boston, United States; ‡St George's, University of London, London, United Kingdom; §Environmental Health Unit, National Institute of Public Health Surveillance, Paris, France; ¶Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland; **CREAL, Barcelona, Spain; ††Center for Epidemiology and Environmental Health, Regional Agency for Environmental Protection, Turin, Italy; ‡‡Department of Environmental Health, National Public Health Institute (KTL), Helsinki, Finland; §§School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland; and ¶¶National Institute of Environmental Health, Budapest, Hungary.

Abstracts published in Epidemiology have been reviewed by the organizations of Epidemiology. Affliate Societies at whose meetings the abstracts have been accepted for presentation. These abstracts have not undergone review by the Editorial Board of Epidemiology.


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We investigated the temporal pattern in health effects of exposure to summertime ozone (O3) on total, cardiovascular and respiratory mortality in 21 European cities participating in the APHEA-2 project. The temporal pattern of effects is fundamental in assessing the public health importance of the exposure, as it determines whether air pollution has only a transient effect - bringing forward the date of death in a frail individual by a day or two or whether it is responsible for causing death in subjects that would survive if not exposed.

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The association was examined using hierarchical models implemented in two stages. In the first stage data from each city were analyzed separately using distributed lag models with up to 21 lags. In the second stage the city specific air pollution estimates were regressed on city specific covariates to obtain overall estimates and to explore sources of possible heterogeneity.

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We found stronger associations with respiratory mortality that extend to a period of two weeks. A 10 μg/m3 increase in O3 was associated with 0.36% (95%CI: −0.21, 0.94) increase in respiratory deaths for lag 0 and with 3.35% (95% CI: 1.90, 4.83) for lags 0-20. We also found significant adverse health effects of summer O3 (June-August) on total and cardiovascular mortality that persist up to a week, but are counterbalanced by negative effects thereafter. Thus, there was indication of mortality displacement for total and cardiovascular mortality but not for respiratory.

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Our results indicate that studies on health effects of short term exposure to O3 using single day exposures may have found effects on total and cardiovascular mortality largely due to short term harvesting, whereas they probably underestimated effects on respiratory mortality.

© 2009 Lippincott Williams & Wilkins, Inc.