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The effects of ambient air pollution on school absenteeism due to respiratory illnesses.

We investigated the relations between ozone (O3), nitrogen dioxide (NO2), and respirable particles less than 10 microm in diameter (PM10) and school absenteeism in a cohort of 4th-grade school children who resided in 12 southern California communities. An active surveillance system ascertained the numbers and types of absences during the first 6 months of 1996. Pollutants were measured hourly at central-site monitors in each of the 12 communities. To examine acute effects of air pollution on absence rates, we fitted a two-stage time-series model to the absence count data that included distributed lag effects of exposure adjusted for long-term pollutant levels. Short-term change in O3, but not NO2 or PM10, was associated with a substantial increase in school absences from both upper and lower respiratory illness. An increase of 20 ppb of O3 was associated with an increase of 62.9% [95% confidence interval (95% CI) = 18.4-124.1%] for illness-related absence rates, 82.9% (95% CI = 3.9-222.0%) for respiratory illnesses, 45.1% (95% CI = 21.3-73.7%) for upper respiratory illnesses, and 173.9% (95% CI = 91.3-292.3%) for lower respiratory illnesses with wet cough. The short-term effects of a 20-ppb change of O3 on illness-related absenteeism were larger in communities with lower long-term average PM10 [223.5% (95% CI = 90.4-449.7)] compared with communities with high average levels [38.1% (95% CI = 8.5-75.8)]. Increased school absenteeism from O3 exposure in children is an important adverse effect of ambient air pollution worthy of public policy consideration.

Absenteeism↗

Pollution and allergic airways disease.

The incidence of allergic diseases has increased dramatically over recent years in most industrialized countries of the world. Air pollution from motor vehicles has been implicated as one of the factors that are responsible for this increase. Epidemiological studies carried out in different geographical regions in the world have shown a significant and consistent association between ambient levels of pollutants and increased asthma and rhinitis symptoms. Recent human and animal exposure studies, as well as laboratory-based studies, have demonstrated that diesel particles, ozone and nitrogen dioxide induce an inflammatory response that involves various inflammatory cells, mediators and adhesion molecules, which could contribute to worsening of the allergic disorders. The present review describes our current understanding of the mechanisms by which pollutants such as diesel exhaust and ozone enhance the underlying allergic inflammatory response, and possibly explain the associations between pollutants and increasing allergic diseases noted in epidemiological studies.

Air Pollutants↗

Bioaccumulation of marine pollutants.

Bioaccumulation of pollutants can occur from sea water, from suspended particles, from sediments and through food chains. The rate at which accumulation occurs in an organism depends not only on the availability of the pollutant but also on a whole range of biological, chemical and environmental factors. The ultimate level which is reached is governed by the ability of the organism to excrete the pollutant or, alternatively, store it. This latter course often leads to the attainment of very high concentrations and sometimes no equilibrium level is ever reached. Two particular topics which are considered are the biological amplification of pollutants along food chains and the development of tolerance which sometimes occurs.

Absorption↗

Long-term exposure to background air pollution related to respiratory and allergic health in schoolchildren.

BACKGROUND: The impact of air pollution on asthma and allergies still remains a debate. OBJECTIVE: Our cross-sectional study was intended to analyse the associations between long-term exposure to background air pollution and atopic and respiratory outcomes in a large population-based sample of schoolchildren. METHODS: Six thousand six hundred and seventy-two children aged 9-11 years recruited from 108 randomly schools in six French cities underwent a clinical examination including a skin prick test (SPT) to common allergens, exercise-induced bronchial reactivity (EIB) and skin examination for flexural dermatitis. The prevalence of asthma, allergic rhinitis (AR) and atopic dermatitis was assessed by a standardized health questionnaire completed by the parents. Three-year-averaged concentrations of air pollutants (NO2, SO2, PM10 and O3) were calculated at children' schools using measurements of background monitoring stations. RESULTS: After adjusting for confounders, EIB, lifetime asthma and lifetime AR were found to be positively related to an increase in the exposure to SO2, PM10 and O3. The adjusted odds ratios (aOR) per increase of 5 microg/m3 of SO2 was 1.39 (95% confidence interval (CI)=1.15-1.66) for EIB and 1.19 (1.00-1.41) for lifetime asthma. The aOR for lifetime AR per increase of 10 microg/m3 of PM10 was 1.32 (CI=1.04-1.68). Moreover, SPT positivity was associated with O3 (aOR=1.34; CI=1.24-1.46). Associations with past year symptoms were consistent, even if not always statistically significant. Results persisted in long-term resident (current address for at least 8 years) children. However, no consistent positive association was found with NO2. CONCLUSIONS: A moderate increase in long-term exposure to background ambient air pollution was associated with an increased prevalence of respiratory and atopic indicators in children.

Air Pollutants↗

Air pollution and sudden infant death syndrome: a literature review.

Although the rate of sudden infant death syndrome (SIDS) has been reduced with the 'Back to Sleep' campaign, SIDS is still a common cause of death in infancy. A range of environmental factors may interact to contribute to the adverse health conditions conducive to SIDS. Nine studies have evaluated the association between exposure to air pollution and the incidence of SIDS. The available evidence is inadequate to come to any conclusion about a relationship between air pollution and SIDS, although the body of evidence appears to suggest that air pollution (especially particles and some gaseous pollutants) may play a certain role in the occurrence of SIDS. We suggest that future studies should focus on the research design, role of indoor air quality and the effect of smaller particles, particularly those in the ultrafine range.

Air Pollutants↗

Air pollution and type 1 diabetes in children.

BACKGROUND: Over the past decade, there has been a worldwide largely unexplained increase in the incidence of type 1 diabetes in young children. This study explores the quantitative role of exposure to specific air pollutants in the development of type 1 diabetes in children. METHODS: A total of 402 children were retrospectively studied. Zip code-related, time-specific birth-to-diagnosis exposure to five ambient air pollutants was obtained for 102 children with type 1 diabetes and 300 healthy children receiving care at a single hospital. Pollution exposure levels were created by summing up zip code-specific pollution data and dividing by months of exposure from birth to diagnosis. Analysis employed chi2, two-tailed independent sample t-test and unconditional logistic regression. RESULTS: Odds ratio (OR) was significantly high for cumulative exposure to ambient ozone (O3) and sulfate (SO4) in cases compared with controls, OR = 2.89 [95% confidence interval (CI) = 1.80-4.62] and OR = 1.65 (CI = 1.20-2.28), respectively, even after adjustment for several potential confounders. Passive smoking was more frequent in children with diabetes (30 vs. 10%, p = 0.001). Attending day care and breast feeding in infancy were less frequent in children with diabetes (14 vs. 23%, p = 0.025; 59 vs. 78%, p = 0.001). Family history of diabetes, autoimmune disease and drug abuse was more frequent in cases (p < 0.01). CONCLUSION: Cumulative exposure to ozone and sulfate in ambient air may predispose to the development of type 1 diabetes in children. Early infant formula feeding and passive smoking in the household may precipitate or accelerate the onset of type 1 diabetes.

Adolescent↗

Influence of air pollution on respiratory health during perinatal development.

The respiratory system is a highly ordered structure composed of over 40 cell types involved in a multitude of functions. Development of the lungs spans from embryogenesis to adult life, passing through several distinct stages of growth. 2. Oxidant gases, airborne particles and environmental tobacco smoke are common air pollutants that could have a significant impact on the lungs during both pre- and postnatal periods of life. Although the specific target cells for exposure to these pollutants are not clearly identified, these cells are likely to affect critical signals or mediators expressed during distinct stages of lung development. 3. Neonatal susceptibility to environmental pollutants may be caused by either direct or indirect hits on several cell types to influence cell differentiation, proliferation and/or maturation. Air pollutants may also alter the normal developmental pattern for metabolic, immune and neurological functions that are constantly changing during in utero and postnatal growth. 4. The sensitivity of neonatal cells to environmental insults is likely to be completely different from these same cell types found in the adult. Delivery of an environmental toxicant to the respiratory system is also dramatically different during the fetal compared with the postnatal period. Passage and interaction of environmental factors through other organ systems and the vasculature, as well as maternal influences, must be taken into consideration when evaluating the impact of an environmental toxicant during early life. 5. To understand the heath outcomes of exposure to a variety of environmental factors in the respiratory system of children requires careful consideration that lung development is a multistep process and cannot be based on studies in adults.

Adult↗

Does air pollution pose a public health problem for New Zealand?

Air pollution is increasingly documented as a threat to public health and a major focus of regulatory activity in developed and developing countries. Air quality indicators suggest New Zealand has clean air relative to many other countries. However, media releases such as 'Christchurch wood fires pump out deadly smog' and 'Vehicle pollution major killer' have sparked public health concern regarding exposure to ambient air pollution, especially in anticipation of increasing emissions and population growth. Recent evidence is presented on the effects of air quality on health, which has been aided by the application of urban airshed models and Geographic Information Systems (GIS). Future directions for research into the effects of air quality on health in New Zealand are discussed, including a national ambient air quality management project: HAPINZ--Health and Air Pollution in New Zealand.

Air Pollutants↗

Pollutant dispersion in a large indoor space: Part 1 -- Scaled experiments using a water-filled model with occupants and furniture.

Scale modeling is a useful tool for analyzing complex indoor spaces. Scale model experiments can reduce experimental costs, improve control of flow and temperature conditions, and provide a practical method for pretesting full-scale system modifications. However, changes in physical scale and working fluid (air or water) can complicate interpretation of the equivalent effects in the full-scale structure. This paper presents a detailed scaling analysis of a water tank experiment designed to model a large indoor space, and experimental results obtained with this model to assess the influence of furniture and people in the pollutant concentration field at breathing height. Theoretical calculations are derived for predicting the effects from losses of molecular diffusion, small scale eddies, turbulent kinetic energy, and turbulent mass diffusivity in a scale model, even without Reynolds number matching. Pollutant dispersion experiments were performed in a water-filled 30:1 scale model of a large room, using uranine dye injected continuously from a small point source. Pollutant concentrations were measured in a plane, using laser-induced fluorescence techniques, for three interior configurations: unobstructed, table-like obstructions, and table-like and figure-like obstructions. Concentrations within the measurement plane varied by more than an order of magnitude, even after the concentration field was fully developed. Objects in the model interior had a significant effect on both the concentration field and fluctuation intensity in the measurement plane. PRACTICAL IMPLICATION: This scale model study demonstrates both the utility of scale models for investigating dispersion in indoor environments and the significant impact of turbulence created by furnishings and people on pollutant transport from floor level sources. In a room with no furniture or occupants, the average concentration can vary by about a factor of 3 across the room. Adding furniture and occupants can increase this spatial variation by another factor of 3.

Air Movements↗

Energy needs versus environmental pollution: a reconciliation?

In this article I have presented, for discussion, a proposed system for energy generation by which the principal sources of environmental pollution by power plants could be eliminated. For stationary power plants the concept appears feasible technically and, according to my " horseback estimates," perhaps economically as well, depending upon the economic value of the by-products of sulfur, CO(2), water, and possibly nitrogen, and upon the price we are willing to pay for a clean environment .Thus, a more thorough engineering and economic analysis to explore these and other factors in greater depth seems warranted. In the case of turbine-driven vehicles, the technical and economic feasibility of widespread distribution and handling of the fuel constitutes a serious question, but one which deserves equally serious consideration before the possibility is discounted. The reports of the cited study panels notwithstanding, the technology required for the proposed system exists today, with one exception. This exception (which is not essential for trial of the system but will be required for its complete fruition) is the development of a nuclear reactor for the prime purpose of delivering process heat for the steam reforming of natural gas and, ultimately, for gas production from coal in a continuous process, such as those discussed by Pieroni et al. (16). Today's intermittent processes of coking and gas production are both archaic and themselves large sources of atmospheric pollution, and a development program aimed at advancing the technology of the coal industry in this regard would seem long overdue. The report of the PSAC Environmental Pollution Panel recommended "demonstration of the feasibility and economy of new developments for abating or controlling pollution through their use at Federal installations" and suggested the coalburning TVA power plants as a likely place for such demonstration. This suggestion is doubly appropriate since the TVA is in a region of subnormal " atmospheric ventilation" (8). By design these plants are adjacent to the AEC's Oak Ridge National Laboratory, and such a location would seem ideal for an experiment on the wedding of nuclear and fossil sources of energy. In comments on a preliminary draft of this article, proponents of "conventional " nuclear power pointed out that such power is hard to beat on the basis of cost, and that dissipation of heat to the air by way of cooling towers can also be accomplished in conventional plants (17). These observations are individually correct but not compatible: the low power costs cited are for very large plants [of the order of 1000 mega-watts lectrical) and larger], and the costs of cooling towers and associated equipment needed to dissipate such large amounts of heat [of the order of 2000 megawatts (thermal)] to air from a closed cycle would offset the power cost advantage of the large plant. In regard to the proposed use of nuclear process heat, Weinberg (20) has expressed doubt that much advantage can be derived from this approach because the temperatures involved are too high for low-cost reactors, and heat transfer from surfaces could involve materials problems. In the case of gas production, this is indeed an anticipated problem-not a technologically insuperable one, but a problem of reducing the cost of the materials required (16). Indeed, Weinberg himself has mentioned this possible use of nuclear heat in a recent publication discussing the steam reforming of coal to liquid fuel(21). Also, an improved process for synthesizing methane from lignitec has recently been reported (22). Since the earlier studies date back a decade, a new look at the problems and costs involved relative to the benefits to be derived (not the least of which could be new vigor for the coal industry) would seem to be in order. In the case of steam reforming of natural gas, the temperature level (about 1500 degrees F) is such that the technology is available today, and a process-heat-reactor design study could be initiated without awaiting further developments.

Air Pollution↗

Toluene-degrading bacteria are chemotactic towards the environmental pollutants benzene, toluene, and trichloroethylene.

The bioremediation of polluted groundwater and toxic waste sites requires that bacteria come into close physical contact with pollutants. This can be accomplished by chemotaxis. Five motile strains of bacteria that use five different pathways to degrade toluene were tested for their ability to detect and swim towards this pollutant. Three of the five strains (Pseudomonas putida F1, Ralstonia pickettii PKO1, and Burkholderia cepacia G4) were attracted to toluene. In each case, the response was dependent on induction by growth with toluene. Pseudomonas mendocina KR1 and P. putida PaW15 did not show a convincing response. The chemotactic responses of P. putida F1 to a variety of toxic aromatic hydrocarbons and chlorinated aliphatic compounds were examined. Compounds that are growth substrates for P. putida F1, including benzene and ethylbenzene, were chemoattractants. P. putida F1 was also attracted to trichloroethylene (TCE), which is not a growth substrate but is dechlorinated and detoxified by P. putida F1. Mutant strains of P. putida F1 that do not oxidize toluene were attracted to toluene, indicating that toluene itself and not a metabolite was the compound detected. The two-component response regulator pair TodS and TodT, which control expression of the toluene degradation genes in P. putida F1, were required for the response. This demonstration that soil bacteria can sense and swim towards the toxic compounds toluene, benzene, TCE, and related chemicals suggests that the introduction of chemotactic bacteria into selected polluted sites may accelerate bioremediation processes.

Alkanes↗

Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Air Pollution and Health: a European Approach.

OBJECTIVES: To carry out a prospective combined quantitative analysis of the associations between all cause mortality and ambient particulate matter and sulphur dioxide. DESIGN: Analysis of time series data on daily number of deaths from all causes and concentrations of sulphur dioxide and particulate matter (measured as black smoke or particles smaller than 10 microns in diameter (PM10)) and potential confounders. SETTING: 12 European cities in the APHEA project (Air Pollution and Health: a European Approach). MAIN OUTCOME MEASURE: Relative risk of death. RESULTS: In western European cities it was found that an increase of 50 micrograms/m3 in sulphur dioxide or black smoke was associated with a 3% (95% confidence interval 2% to 4%) increase in daily mortality and the corresponding figure for PM10 was 2% (1% to 3%). In central eastern European cities the increase in mortality associated with a 50 micrograms/m3 change in sulphur dioxide was 0.8% (-0.1% to 2.4%) and in black smoke 0.6% (0.1% to 1.1%). Cumulative effects of prolonged (two to four days) exposure to air pollutants resulted in estimates comparable with the one day effects. The effects of both pollutants were stronger during the summer and were mutually independent. CONCLUSIONS: The internal consistency of the results in western European cities with wide differences in climate and environmental conditions suggest that these associations may be causal. The long term health impact of these effects is uncertain, but today's relatively low levels of sulphur dioxide and particles still have detectable short term effects on health and further reductions in air pollution are advisable.

Air Pollutants↗

Short term effects of air pollution on health: a European approach using epidemiologic time series data: the APHEA protocol.

BACKGROUND AND OBJECTIVES: Results from several studies over the past five years have shown that the current levels of pollutants in Europe and North America have adverse short term effects on health. The APHEA project aims to quantifying these in Europe, using standardised methodology. The project protocol and analytical methodology are presented here. DESIGN: Daily time series data were gathered for several air pollutants (sulphur dioxide; particulate matter, measured as total particles or as the particle fraction with an aerodynamic diameter smaller than a certain cut off, or as black smoke; nitrogen dioxide; and ozone) and health outcomes (the total and cause specific number of deaths and emergency hospital admissions). The data included fulfilled the quality criteria set by the APHEA protocol. SETTING: Fifteen European cities from 10 different countries with a total population over 25 million. METHODOLOGY: The APHEA collaborative group decided on a specific methodological procedure to control for confounding effects and evaluate the hypothesis. At the same time there was sufficient flexibility to allow local characteristics to be taken into account. The procedure included modelling of all potential confounding factors (that is, seasonal and long term patterns, meteorological factors, day of the week, holidays, and other unusual events), choosing the "best" air pollution models, and applying diagnostic tools to check the adequacy of the models. The final analysis used autoregressive Poisson models allowing for overdispersion. Effects were reported as relative risks contrasting defined increases in the corresponding pollutant levels. Each participating group applied the analyses to their own data. CONCLUSIONS: This methodology enabled results from many different European settings to be considered collectively. It represented the best available compromise between feasibility, comparability, and local adaptibility when using aggregated time series data not originally collected for the purpose of epidemiological studies.

Air Pollutants↗

Short term effects of air pollution on mortality in the city of Lyon, France, 1985-90.

OBJECTIVE: The short term association between daily mortality and ambient air pollution in the city of Lyon, France (population, 410,000) between 1985 and 1990 was assessed using time series analysis. DESIGN: This study followed the standardised design and statistical analysis (Poisson regression) that characterise the APHEA project. METHODS: Four categories of cause of death were studied: total (minus external causes), respiratory, cardiovascular, and digestive causes (as a control condition). RESULTS: No association was found with any cause of death for nitrogen dioxide (NO2) and ozone (O3), nor, for any pollutant, for digestive conditions. Sulphur dioxide (SO2) and, to a much lesser degree, suspended particles (PM13), were significantly related to mortality from respiratory and cardiovascular conditions. The relative risk (RR) of respiratory deaths associated with a 50 micrograms/m3 increment of mean daily SO2 over the whole period was 1.22 (95% CI 1.05, 1.40); the RR for cardiovascular deaths was 1.54 (1.22, 1.96). The corresponding RRs for PM13 were 1.04 (1.00, 1.09) for respiratory mortality and 1.04 (0.99, 1.10) for cardiovascular deaths. CONCLUSIONS: The effects of particulates were slightly increased during the cold season. When particulates concentrations were greater than 60 micrograms/m3, the joint SO2 effect was increased, suggesting some interaction between the two pollution indicators. These results agree with other studies showing an association between particulate pollution and daily mortality; however, they also suggest the noxious effect of SO2.

Air Pollutants↗

Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987-88 and 1991-92.

STUDY OBJECTIVE: To investigate whether air pollution levels in London have short term effects on hospital admissions for respiratory disease. DESIGN: Poisson regression analysis of daily counts of hospital admissions, adjusting for effects of trend, seasonal and other cyclical factors, day of the week, holidays, influenza epidemic, temperature, humidity, and autocorrelation. Pollution variables were particulates (black smoke: BS), sulphur dioxide (SO2), ozone (O3), and nitrogen dioxide (NO2), lagged 0-3 days. SETTING AND PATIENTS: All immediate admissions for respiratory disease (ICD 460-519) to hospitals in London health districts in the five years April 1987 to February 1992 for all ages and the 0-14, 15-64, and 65+ age groups. MAIN RESULTS: O3 (lagged one day) was significantly associated with an increase in daily admissions among all age groups, except the 0-14 group, and this effect was stronger in the "warm" season (April-September). In this season, the relative risks of admission associated with an increase in 8 hour O3 levels of 29 ppb (10th to 90th centile) were 1.0483 (95% CI 1.0246, 1.0726), 1.0294 (0.9930,1.0672), 1.0751 (1.0354,1.1163), and 1.0616 (1.0243,1.1003) for all ages and age groups 0-14, 15-64, and 65+ respectively. Very few significant associations were observed with the other pollutants, though these tended to be positive. Controlling for other pollutants made little difference to the O3 coefficients. There was evidence of a threshold at about 40-60 ppb O3 (maximum hourly or maximum 8 hour). CONCLUSIONS: O3 levels in London have a small but significant effect on hospital admissions for respiratory disease at all ages. The possible role of aerollergen as a confounding factor needs to be examined. Unlike other cities where similar effects have been reported, little or no effect of particulates was observed in London.

Acute Disease↗

Association between ambient air pollution and birth weight in São Paulo, Brazil.

OBJECTIVES: Previous studies have implicated air pollution in increased mortality and morbidity, especially in the elderly population and children. More recently, associations with mortality in infants and with some reproductive outcomes have also been reported. The aim of this study is to explore the association between exposure to outdoor air pollution during pregnancy and birth weight. DESIGN: Cross sectional study using data on all singleton full term live births during a one year period. For each individual birth, information on gestational age, type of delivery, birth weight, sex, maternal education, maternal age, place of residence, and parity was available. Daily mean levels of PM(10), sulphur dioxide, nitrogen dioxide, carbon monoxide, and ozone were also gathered. The association between birth weight and air pollution was assessed in regression models with exposure averaged over each trimester of pregnancy. SETTING: São Paulo city, Brazil. RESULTS: Birth weight was shown to be associated with length of gestation, maternal age and instruction, infant gender, number of antenatal care visits, parity, and type of delivery. On adjusting for these variables negative effects of exposure to PM(10) and carbon monoxide during the first trimester were observed. This effect seemed to be more robust for carbon monoxide. For a 1 ppm increase in mean exposure to carbon monoxide during the first trimester a reduction of 23 g in birth weight was estimated. CONCLUSIONS: The results are consistent in revealing that exposure to air pollution during pregnancy may interfere with weight gain in the fetus. Given the poorer outlook for low birthweight babies on a number of health outcomes, this finding is important from the public health perspective.

Adult↗

Association of ventricular arrhythmias detected by implantable cardioverter defibrillator and ambient air pollutants in the St Louis, Missouri metropolitan area.

BACKGROUND: It has previously been reported that the risk of ventricular arrhythmias is positively associated with ambient air pollution among patients with implantable cardioverter defibrillators (ICD) in Boston. AIMS: To assess the association of community exposures to air pollution with ventricular arrhythmias in a cohort of ICD patients in metropolitan St Louis, Missouri. METHODS: ICD detected episodes reported during clinical follow up were abstracted and reviewed by an electrophysiologist to identify ventricular arrhythmias. A total of 139 ventricular arrhythmias were identified among 56 patients. A case-crossover design was used with control periods matched on weekday and hour of the day within the same calendar month. Conditional logistic regression models were adjusted for temperature, barometric pressure, and relative humidity in the 24 hours preceding the event. RESULTS: There was a significant (24%, 95% CI 7% to 44%) increase in risk of ventricular arrhythmias associated with each 5 ppb increase in mean sulphur dioxide and non-significantly increased risk (22%, 95% CI -6% to 60%; and 18%, 95% CI -7% to 50%) associated with increases in nitrogen dioxide (6 ppb) and elemental carbon (0.5 microg/m3), respectively in the 24 hours before the arrhythmia. CONCLUSIONS: These results provide evidence of an association between ventricular arrhythmias and ambient air pollutants in St Louis. This is consistent with previous results from Boston, although the pollutants responsible for the increased risk are different.

Adult↗

Air pollution and daily mortality in Rome, Italy.

OBJECTIVES: To assess the relation between several daily indicators of air pollution (particulates and gases) and daily mortality in the metropolitan area of Rome and in the central part of the city. METHODS: Time series analysis. The associations between daily concentrations of pollutants (particles, SO2, NO2, CO, O3) recorded by five fixed monitors and daily total mortality in the period from January 1992 to June 1995 were evaluated. The analysis included examination of the pollution effect on mortality by place of residence within the metropolitan area, by season, age, place of death (in and out a hospital), and cause of death (cardiovascular and respiratory disease). The Poisson model included loses smooth functions of the day of study, mean temperature, mean humidity, and indicator variables for day of the week and holidays. RESULTS: The mean daily number of deaths was 56.9 (44.8 among people > or = 65 years old). A mean of 36.3 deaths occurred in the city centre; 37.3 deaths a day were recorded in a hospital. Total mortality was significantly associated with a 10 micrograms/m3 increase in particles (0.4%) on that day (log 0), and with a 10 micrograms/m3 increase in NO2 at lag 1 (0.3%) and lag 2 (0.4%) (1 and 2 days before, respectively). The effect of particles (lag 0) and of NO2 (lag 2) on total mortality was higher among those living in the city centre (0.7% and 0.5%, respectively). The risk estimates were higher in the warmer season (1.0% and 1.1%, respectively), whereas no difference was found for those dying in or out of the hospital. The effect of particles was robust to a sensitivity analysis and to the inclusion of NO2 in the regression model. CONCLUSIONS: Increase in particulates and NO2, generated by the same mobile combustion sources, is associated with a short term increase in mortality in Rome. The effect is more evident among residents in the city centre, where the levels of exposure to pollutants recorded by fixed monitors are probably more reliable indicators of personal exposure.

Air Pollutants↗