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Published ahead of print on December 3, 2004, doi:10.1164/rccm.200407-933OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 6, March 2005, 627-631

A more recent version of this article appeared on March 15, 2005
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Submitted on July 20, 2004
Accepted on November 29, 2004

How Sensitive is the Association Between Ozone and Daily Deaths to Control for Temperature?

Joel Schwartz1*

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

* To whom correspondence should be addressed. E-mail: jschwrtz{at}hsph.harvard.edu.

Rationale: Air pollution has been associated with changes in daily mortality. Objectives: Generally, studies use Poisson regression, with complicated modelling strategies to control for season and weather, raising concerns that the results may be sensitive to these modelling protocols. For studies of ozone, weather control is a particular problem because high ozone days are generally quite hot. Methods: The case-crossover approach converts this problem into a case-control study, where the control for each person is the same person on a day near in time, when they did not die. It controls for season and individual risk factors by matching. One can also choose the control day to have the same temperature as the event day. Measurements: I have applied this approach to a study of over one million deaths in 14 US cities. Main Results: I found that with matching on temperature, a 10 ppb increase in maximum hourly ozone concentrations was associated with a 0.23% (95% CI 0.01%, 0.44%) increase in the risk of dying. This was indistinguishable from the risk when only matching on season and controlling for temperature with regression splines (0.19% (95% CI.03%, .35%). Control for PM10 did not change this risk. However, the association was restricted to the warm months (0.37% increase, (95% CI 0.11%, 0.62%), with no effect in the cold months. Conclusions: The association between ozone and mortality risk is unlikely to be due to confounding by temperature.
Key words: Ozone, Deaths, Case-Crossover, Air Pollution, Temperature




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