Am. J. Respir. Crit. Care Med., Volume 164, Number 10, November 2001, 1860-1866

Acute Effects of Particulate Air Pollution on Respiratory Admissions
Results from APHEA 2 Project

RICHARD W. ATKINSON, H. ROSS ANDERSON, JORDI SUNYER, JON AYRES, MICHELA BACCINI, JUDITH M. VONK, AZZEDINE BOUMGHAR, FRANCESCO FORASTIERE, BERTIL FORSBERG, GIOTA TOULOUMI, JOEL SCHWARTZ, and KLEA KATSOUYANNI

Department of Public Health Sciences, St. George's Hospital Medical School, London, United Kingdom; Unitat de Recerca Respiratoria i Ambiental, Institut Municipal Investigació Médica (IMIM), Barcelona, Spain; Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, United Kingdom; Department of Statistics, University of Florence, Florence, Italy; Faculty of Medical Sciences, Department of Epidemiology and Statistics, University of Groningen, Groningen, The Netherlands; Health Regional Observatory, Paris, France; Agency for Public Health, Lazio, Italy; Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden; Department of Hygiene-Epidemiolgy, Athens, Greece; and Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts

The APHEA 2 project investigated short-term health effects of particles in eight European cities. In each city associations between particles with an aerodynamic diameter of less than 10 µm (PM₁₀) and black smoke and daily counts of emergency hospital admissions for asthma (0-14 and 15-64 yr), chronic obstructive pulmonary disease (COPD), and all-respiratory disease (65+ yr) controlling for environmental factors and temporal patterns were investigated. Summary PM₁₀ effect estimates (percentage change in mean number of daily admissions per 10 µg/m³ increase) were asthma (0-14 yr) 1.2% (95% CI: 0.2, 2.3), asthma (15-64 yr) 1.1% (0.3, 1.8), and COPD plus asthma and all-respiratory (65+ yr) 1.0% (0.4, 1.5) and 0.9% (0.6, 1.3). The combined estimates for Black Smoke tended to be smaller and less precisely estimated than for PM₁₀. Variability in the sizes of the PM₁₀ effect estimates between cities was also investigated. In the 65+ groups PM₁₀ estimates were positively associated with annual mean concentrations of ozone in the cities. For asthma admissions (0-14 yr) a number of city-specific factors, including smoking prevalence, explained some of their variability. This study confirms that particle concentrations in European cities are positively associated with increased numbers of admissions for respiratory diseases and that some of the variation in PM₁₀ effect estimates between cities can be explained by city characteristics.

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