Acute effects of ambient ozone on mortality in Europe and North America: results from the APHENA study

Abstract

The “Air Pollution and Health: A Combined European and North American Approach” (APHENA) project is a collaborative analysis of multi-city time-series data on the association between air pollution and adverse health outcomes. The main objective of APHENA was to examine the coherence of findings of time-series studies relating short-term fluctuations in air pollution levels to mortality and morbidity in 125 cities in Europe, the US, and Canada. Multi-city time-series analysis was conducted using a two-stage approach. We used Poisson regression models controlling for overdispersion with either penalized or natural splines to adjust for seasonality. Hierarchical models were used to obtain an overall estimate of excess mortality associated with ozone and to assess potential effect modification. Potential effect modifiers were city-level characteristics related to exposure to other ambient air pollutants, weather, socioeconomic status, and the vulnerability of the population. Regionally pooled risk estimates from Europe and the US were similar; those from Canada were substantially higher. The pooled estimated excess relative risk associated with a 10 μg/m3 increase in 1 h daily maximum O3 was 0.26 % (95 % CI, 0.15 %, 0.37 %). Across regions, there was little consistent indication of effect modification by age or other effect modifiers considered in the analysis. The findings from APHENA on the effects of O3 on mortality in the general population were comparable with previously reported results and relatively robust to the method of data analysis. Overall, there was no indication of strong effect modification by age or ecologic variables considered in the analysis.

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References

  1. Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F (2004) Ozone and short-term mortality in 95 US urban communities, 1987–2000. J Am Med Assoc 292(19):2372–2378

    Article  CAS  Google Scholar 

  2. Bell ML, Peng RD, Dominici F (2006) The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations. Environ Health Perspect 114(4):532–536

    Article  CAS  Google Scholar 

  3. Bell ML, Ebisu K, Peng RD, Dominici F (2009) Adverse health effects of particulate air pollution: modification by air conditioning. Epidemiology 20(5):682–686

    Article  Google Scholar 

  4. Braga AL, Zanobetti A, Schwartz J (2000) Do respiratory epidemics confound the association between air pollution and daily deaths? Eur Respir J 16(4):723–728

    Article  CAS  Google Scholar 

  5. Burnett RT, Cakmak S, Brook JR (1998) The effect of the urban ambient air pollution mix on daily mortality rates in 11 Canadian cities. Can J Public Health 89(3):152–156

    CAS  Google Scholar 

  6. Burnett RT, Stieb D, Brook JR, Cakmak S, Dales R, Raizenne M et al (2004) Associations between short-term changes in nitrogen dioxide and mortality in Canadian cities. Arch Environ Health 59(5):228–236

    Article  CAS  Google Scholar 

  7. Craig L, Brook JR, Chiotti Q, Croes B, Gower S, Hedley A et al (2008) Air pollution and public health: a guidance document for risk managers. J Toxicol Environ Health A 71(9–10):588–698

    Article  CAS  Google Scholar 

  8. Gryparis A, Forsberg B, Katsouyanni K, Analitis A, Touloumi G, Schwartz J et al (2004) Acute effects of ozone on mortality from the “air pollution and health: a European approach” project. Am J Respir Crit Care Med 170(10):1080–1087

    Article  Google Scholar 

  9. Health Effects Institute (2003) Revised analyses of time-series studies of air pollution and health. Health Effects Institute, Cambridge

    Google Scholar 

  10. Health Effects Institute (2010) Public Health and Air Pollution in Asia (PAPA): coordinated studies of short-term exposure to air pollution and daily mortality in four cities. HEI research report 154. Health Effects Institute, Boston

    Google Scholar 

  11. Katsouyanni K, Samet JM, Anderson HR, Atkinson R, Le Tertre A, Medina S et al (2009) Air pollution and health: a European and North American approach (APHENA). Res Rep Health Eff Inst 142:5–90

    CAS  Google Scholar 

  12. Pattenden S, Armstrong B, Milojevic A, Heal MR, Chalabi Z, Doherty R, Barratt B, Kovats RS, Wilkinson P (2010) Ozone, heat and mortality: acute effects in 15 British conurbations. Occup Environ Med 67:699–707

    Article  CAS  Google Scholar 

  13. Peng RD, Dominici F, Louis T (2006) Model choice in multi-site time series studies of air pollution and mortality. J R Stat Soc Ser A 169(2):179–203

    Article  Google Scholar 

  14. Samoli E, Peng R, Ramsay T, Pipikou M, Touloumi G, Dominici F et al (2008) Acute effects of ambient particulate matter on mortality in Europe and North America: results from the APHENA study. Environ Health Perspect 116(11):1480–1486

    Article  Google Scholar 

  15. Speckman P (1988) Kernel smoothing in partial linear models. J R Stat Soc Ser B 50:413–436

    Google Scholar 

  16. Touloumi G, Samoli E, Quenel P, Paldy A, Anderson RH, Zmirou D et al (2005) Short-term effects of air pollution on total and cardiovascular mortality: the confounding effect of influenza epidemics. Epidemiology 16(1):49–57

    Article  Google Scholar 

  17. Touloumi G, Samoli E, Pipikou M, Le Tertre A, Atkinson R, Katsouyanni K (2006) Seasonal confounding in air pollution and health time-series studies: effect on air pollution effect estimates. Stat Med 25(24):4164–4178

    Article  CAS  Google Scholar 

  18. U.S. Environmental Protection Agency. 2006. Air quality criteria for ozone and related photochemical oxidants (final). EPA/600/R-05/004aF-cF. Washington, DC:U.S. Environmental Protection Agency

  19. Wood SN (2004) Stable and efficient multiple smoothing parameter estimation for generalized additive models. J Am Stat Assoc 99(467):673–686

    Article  Google Scholar 

  20. World Health Organization (2006) Air quality guidelines: global ppdate 2005—particulate matter, ozone, nitrogen dioxide and sulfur dioxide. World Health Organization, Copenhagen

    Google Scholar 

Download references

Acknowledgments

Funding was provided through a contract with the Health Effects Institute. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Health Effects Institute (HEI) or its sponsors. The authors state that they have no conflicts of interest.

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Correspondence to Roger D. Peng.

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Peng, R.D., Samoli, E., Pham, L. et al. Acute effects of ambient ozone on mortality in Europe and North America: results from the APHENA study. Air Qual Atmos Health 6, 445–453 (2013). https://doi.org/10.1007/s11869-012-0180-9

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Keywords

  • Ozone
  • Mortality
  • Time-series
  • Multi-city
  • Cardiovascular
  • Respiratory