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Published ahead of print on July 28, 2004, doi:10.1164/rccm.200403-333OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 10, November 2004, 1080-1087

A more recent version of this article appeared on November 15, 2004
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Submitted on March 22, 2004
Accepted on July 20, 2004

Acute Effects of Ozone on Mortality from the "Air Pollution and Health: A European Approach" Project

Alexandros Gryparis1, Bertil Forsberg2, Klea Katsouyanni3*, Antonis Analitis3, Giota Touloumi3, Joel Schwartz4, Evi Samoli3, Sylvia Medina5, Hugh R Anderson6, Emilia M Niciu7, Erich Wichmann8, Bohumir Kriz9, Mitja Kosnik10, Jiri Skorkovsky11, Judith M Vonk12, and Zeynep Dortbudak13

1 Department of Hygiene-Epidemiology, University of Athens Medical School, Athens, Greece; Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA, 2 Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden, 3 Department of Hygiene-Epidemiology, University of Athens Medical School, Athens, Greece, 4 Department of Environmental Health, Harvard School of Public Health, Boston, USA, 5 Institut de Veille Sanitaire, Paris, France, 6 St George's Hospital Medical School, University of London, London, United Kingdom, 7 Department of Environmental Health, Institute of Public Health, Bucharest, Romania, 8 National Research Center for Environment and Health, Munich, Germany, 9 Charles University, Prague, The Czech Republic, 10 Institute of Public Health, Ljubljana, Slovenia, 11 Institute of Hygiene, Teplice, The Czech Republic, 12 Department of Epidemiology and Statistics, University of Groningen, Groningen, The Netherlands, 13 School of Health Sciences, Koc University, Istanbul, Turkey

* To whom correspondence should be addressed. E-mail: kkatsouy{at}med.uoa.gr.

In the APHEA2 (Air Pollution and Health: a European Approach) project, the effects of ambient ozone concentrations on mortality were investigated. Data were collected on daily 1 and 8-hour ozone concentrations, on daily total, respiratory and cardiovascular number of deaths and on confounders and potential effect modifiers from 23 cities/areas. Effect estimates were obtained for each city with city-specific models and 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 1 hour ozone concentration by 10 ug/m3 was associated with a 0.33% (95% 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 8-hour ozone were: 0.31% (0.17-0.52); 0.46% (0.22-0.73); 1.13 (0.74-1.51). The associations with total mortality were independent of SO2 and PM10 but 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 European cities). The dose-response curve of ozone effects on total mortality during the summer did not deviate significantly from linearity.
Key words: Respiratory mortality, Cardiovascular mortality, Time-series




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