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Published ahead of print on July 28, 2004, doi:10.1164/rccm.200403-333OC
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American Journal of Respiratory and Critical Care Medicine Vol 170. pp. 1080-1087, (2004)
© 2004 American Thoracic Society
doi: 10.1164/rccm.200403-333OC

Original Article

Acute Effects of Ozone on Mortality from the "Air Pollution and Health

A European Approach" Project

Alexandros Gryparis, Bertil Forsberg, Klea Katsouyanni, Antonis Analitis, Giota Touloumi, Joel Schwartz, Evangelia Samoli, Sylvia Medina, H. Ross Anderson, Emilia Maria Niciu, H.-Erich Wichmann, Bohumir Kriz, Mitja Kosnik, Jiri Skorkovsky, Judith M. Vonk and Zeynep Dörtbudak

Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece; Department of Biostatistics, Department of Public Health and Clinical Medicine, and Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Umeå University, Umeå, Sweden; Institut de Veille Sanitaire, Paris, France; St. George's Hospital Medical School, University of London, London, United Kingdom; Department of Environmental Health, Institute of Public Health, Bucharest, Romania; GSF, National Research Center for Environment and Health, Munich, Germany; Charles University, Prague; Institute of Hygiene, Teplice, Czech Republic; Institute of Public Health, Ljubljana, Slovenia; Department of Epidemiology and Statistics, University of Groningen, Groningen, The Netherlands; and Koç University, School of Health Sciences, Istanbul, Turkey

Correspondence and requests for reprints should be addressed to Klea Katsouyanni, M.Sc., D.Med.Sc., Department of Hygiene and Epidemiology, University of Athens Medical School, 75, Mikras Asias Street, 115 27 Athens, Greece. E-mail: kkatsouy{at}med.uoa.gr

In the Air Pollution and Health: A European Approach (APHEA2) project, the effects of ambient ozone concentrations on mortality were investigated. Data were collected on daily ozone concentrations, the daily number of deaths, confounders, and potential effect modifiers from 23 cities/areas for at least 3 years since 1990. Effect estimates were obtained for each city with city-specific models and were combined using second-stage regression models. No significant effects were observed during the cold half of the year. For the warm season, an increase in the 1-hour ozone concentration by 10 µg/m3 was associated with a 0.33% (95% confidence interval [CI], 0.17–0.52) increase in the total daily number of deaths, 0.45% (95% CI, 0.22–0.69) in the number of cardiovascular deaths, and 1.13% (95% CI, 0.62–1.48) in the number of respiratory deaths. The corresponding figures for the 8-hour ozone were similar. The associations with total mortality were independent of SO2 and particulate matter with aerodynamic diameter less than 10 µm (PM10) but were somewhat confounded by NO2 and CO. Individual city estimates were heterogeneous for total (a higher standardized mortality rate was associated with larger effects) and cardiovascular mortality (larger effects were observed in southern cities). The dose–response curve of ozone effects on total mortality during the summer did not deviate significantly from linearity.

Key Words: cardiovascular mortality • respiratory mortality • time series




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