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Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities
  1. A Le Tertre1,
  2. S Medina1,
  3. E Samoli2,
  4. B Forsberg3,
  5. P Michelozzi4,
  6. A Boumghar5,
  7. J M Vonk6,
  8. A Bellini7,
  9. R Atkinson8,
  10. J G Ayres9,
  11. J Sunyer10,
  12. J Schwartz11,
  13. K Katsouyanni2
  1. 1Environmental Health Unit, National Institute of Public Health Surveillance, France
  2. 2Department of Hygiene-Epidemiology, Athens, Greece
  3. 3Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
  4. 4Agency for Public Health Lazio region, Rome, Italy
  5. 5Health Regional Observatory, Paris, France
  6. 6Faculty of Medical Sciences, Department of Epidemiology and Statistics, University of Groningen, Netherlands
  7. 7Local Health Authority, Milan, Italy
  8. 8Department of Public Health Sciences, St George’s Hospital Medical School, London, UK
  9. 9Birmingham Heartlands Hospital, Birmingham, UK
  10. 10Unitat de Recerca Respiratoria i Ambiental, Institut Municipal Investigació Médica (IMIM), Barcelona, Spain
  11. 11Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, USA
  1. Correspondence to:
 Dr A Le Tertre, 12 rue du val d’osne, 94410 Saint-maurice, France;


Study objective: As part of the APHEA project this study examined the association between airborne particles and hospital admissions for cardiac causes (ICD9 390–429) in eight European cities (Barcelona, Birmingham, London, Milan, the Netherlands, Paris, Rome, and Stockholm). All admissions were studied, as well as admissions stratified by age. The association for ischaemic heart disease (ICD9 410–413) and stroke (ICD9 430–438) was also studied, also stratified by age.

Design: Autoregressive Poisson models were used that controlled for long term trend, season, influenza epidemics, and meteorology to assess the short-term effects of particles in each city. The study also examined confounding by other pollutants. City specific results were pooled in a second stage regression to obtain more stable estimates and examine the sources of heterogeneity.

Main results: The pooled percentage increases associated with a 10 μg/m3 increase in PM10 and black smoke were respectively 0.5% (95% CI: 0.2 to 0.8) and 1.1% (95% CI: 0.4 to 1.8) for cardiac admissions of all ages, 0.7% (95% CI: 0.4 to 1.0) and 1.3% (95% CI: 0.4 to 2.2) for cardiac admissions over 65 years, and, 0.8% (95% CI: 0.3 to 1.2) and 1.1% (95% CI: 0.7 to 1.5) for ischaemic heart disease over 65 years. The effect of PM10 was little changed by control for ozone or SO2, but was substantially reduced (CO) or eliminated (NO2) by control for other traffic related pollutants. The effect of black smoke remained practically unchanged controlling for CO and only somewhat reduced controlling for NO2.

Conclusions: These effects of particulate air pollution on cardiac admissions suggest the primary effect is likely to be mainly attributable to diesel exhaust. Results for ischaemic heart disease below 65 years and for stroke over 65 years were inconclusive.

  • cardiovascular disease
  • air pollution

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  • Funding: The APHEA 2 study is supported by the European Commission (EC) Environment and Climate 1994–98 Programme (Contract number ENV4-CT97–0534). The Swedish group had national funding only.

  • Conflicts of interest: none.

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