Confounding and effect modification in the short-term effects of ambient particles on total mortality: Results from 29 European cities within the APHEA2 project
Confounding and effect modification in the short-term effects of ambient particles on total mortality: Results from 29 European cities within the APHEA2 project
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DOI：
10.1097/00001648-200109000-00011
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发表时间：
2001-09-01
期刊：
影响因子：
5.4
通讯作者：
Schwartz, J
中科院分区：
文献类型：
--
作者：
Katsouyanni, K;Touloumi, G;Schwartz, J
我们提出的结果空气污染和健康：欧洲的方法（APHEA-2，）项目的短期影响，环境颗粒物对死亡率的影响修改的重点。我们对29个欧洲城市的空气动力学直径小于10微米的颗粒物（PM10）和/或黑烟进行了每日测量。我们考虑了其他污染物以及气象和年代学变量的混杂。我们调查了几个变量，描述了城市的污染，气候，人口和地理作为潜在的影响因素。对于单个城市的分析，广义加性模型扩展泊松回归，使用平滑控制的季节性模式，被应用。为了提供结果的定量总结并解释剩余的异质性，我们应用了第二阶段回归模型。每日PM10或黑烟浓度每增加10 mug/m3，所有年龄段的每日死亡人数估计增加0.6% [95%置信区间（CI）= 0.4-0.8%]，而老年人的死亡人数则略高。我们发现重要的影响修改的几个变量的研究。因此，在一个平均NO2浓度较低的城市，PM10浓度每增加10 mug/m3，每日死亡率估计增加0.19（95%CI = 0.00-0.41），而在一个城市的高平均NO2为0.80%（95%CI = 0.67-0.93%）;在相对寒冷的气候中，相应的影响为0.29%（95%CI = 0.16-0.42），而在温暖气候中为0.82%（95%可信区间= 0.69-0.96）;标化死亡率低的城市为0.80%（95% CI = 0.65-0.95%），标化死亡率高的城市为0.43%（95% CI = 0.24-0.62）。我们的研究结果证实了以前报道的环境颗粒对死亡率的影响。此外，他们表明，在城市之间的效果参数中发现的异质性反映了真实的效果修改，这是由特定的城市特征解释。
We present the results of the Air Pollution and Health: A European Approach (APHEA-2,) project on short-term effects of ambient particles on mortality with emphasis on effect modification. We used daily measurements for particulate matter less than 10 mum in aerodynamic diameter (PM10) and/or black smoke from 29 European cities. We considered confounding from other pollutants as well as meteorologic and chronologic variables. We investigated several variables describing the cities' pollution, climate, population, and geography as potential effect modifiers. For the individual city analysis, generalized additive models extending Poisson regression, using a smoother to control for seasonal patterns, were applied. To provide quantitative summaries of the results and explain remaining heterogeneity, we applied second-stage regression models. The estimated increase in the daily number of deaths for all ages for a 10 mug/m(3) increase in daily PM10 or black smoke concentrations was 0.6% [95% confidence interval (CI) = 0.4-0.8%], whereas for the elderly it was slightly higher. We found important effect modification for several of the variables studied. Thus, in a city with low average NO2, the estimated increase in daily mortality for an increase of 10 mug/m(3) in PM10 was 0.19 (95% CI = 0.00-0.41), whereas in a city with high average NO2 it was 0.80% (95% CI = 0.67-0.93%); in a relatively cold climate the corresponding effect was 0.29% (95% CI = 0.16-0.42), whereas in a warm climate it was 0.82% (95% CI = 0.69-0.96); in a city with low standardized mortality rate it was 0.80% (95% CI = 0.65-0.95%), and in one with a high rate it was 0.43% (95% CI = 0.24-0.62). Our results confirm those previously reported on the effects of ambient particles on mortality. Furthermore, they show that the heterogeneity found in the effect parameters among cities reflects real effect modification, which is explained by specific city characteristics.