Associations between Mortality and Air Pollution in Central Europe.Increased mortality has been observed in association with elevated concentrations of air pollutants pollutants see environmental pollution. in European cities and in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . We reassessed the effects of particulate matter particulate matter n. Abbr. PM Material suspended in the air in the form of minute solid particles or liquid droplets, especially when considered as an atmospheric pollutant. Noun 1. in Central Europe Central Europe is the region lying between the variously and vaguely defined areas of Eastern and Western Europe. In addition, Northern, Southern and Southeastern Europe may variously delimit or overlap into Central Europe. . Mortality and air pollution data were obtained for a highly polluted pol·lute tr.v. pol·lut·ed, pol·lut·ing, pol·lutes 1. To make unfit for or harmful to living things, especially by the addition of waste matter. See Synonyms at contaminate. 2. region of the Czech Republic Czech Republic, Czech Česká Republika (2005 est. pop. 10,241,000), republic, 29,677 sq mi (78,864 sq km), central Europe. It is bordered by Slovakia on the east, Austria on the south, Germany on the west, and Poland on the north. and a rural region in Germany. Poisson regression In statistics, the Poisson regression model attributes to a response variable Y a Poisson distribution whose expected value depends on a predictor variable x, typically in the following way: caused 500,000 deaths in U.S. alone (1918–1919). [Am. Hist.: Van Doren, 403] See : Disease as confounders in both a parametric See parametric modeling, parametric symbol and PTC. and a nonparametric approach. The Czech Republic had a 3.8% increase in mortality [95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. (CI), 0.8-6.9%] in association with 100 [micro]g/[m.sup.3] total suspended sus·pend v. sus·pend·ed, sus·pend·ing, sus·pends v.tr. 1. To bar for a period from a privilege, office, or position, usually as a punishment: suspend a student from school. particles (TSP TSP - travelling salesman problem ) (lagged 2 days) for the time period 1982-1994. During the last 2 year,t of study, 68% of the TSP consisted of particulate matter [is less than or equal to] 10 [micro]m in aerodynamic diameter Drug particles for pulmonary delivery are typically characterized by aerodynamic diameter rather than geometric diameter. The velocity at which the drug settles is proportional to the aerodynamic diameter, da. ([PM.sub.10]). An increase of 100 [micro]g/[m.sup.3] TSP (lagged 1 day) was associated with a 9.5% increase in mortality (CI, 1.2-18.5%) and 100 [micro]g/[m.sup.3] [PM.sub.10] (lagged 1 day) showed a 9.8% increase in mortality (CI, 0.7-19.7%). We found no evidence for an association between mortality and particulate matter in the rural area in Germany at the Czech border. Data from the coal basin in the Czech Republic suggested an increase in mortality associated with the concentration of particulate matter in a highly polluted setting in Central Europe that is consistent with the associations observed in other western European cities and in the United States. Key words: air pollution, epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , mortality, particulate par·tic·u·late adj. Of or occurring in the form of fine particles. n. A particulate substance. particulate composed of separate particles. pollution, sulfur dioxide sulfur dioxide, chemical compound, SO2, a colorless gas with a pungent, suffocating odor. It is readily soluble in cold water, sparingly soluble in hot water, and soluble in alcohol, acetic acid, and sulfuric acid. . Environ en·vi·ron tr.v. en·vi·roned, en·vi·ron·ing, en·vi·rons To encircle; surround. See Synonyms at surround. [Middle English envirounen, from Old French environner Health Perspect 108:283-287 (2000). [Online 14 February 2000] http://ehpnet1.niehs.nih.gov/docs/2000/108p283-287peters/abstract.html Acute exposure to particulate air pollution has been associated with adverse health effects (1-3). In particular, increases in mortality have been observed in association with particulate matter. Associations between mortality and air pollution were studied in 12 locations in 9 European countries as part of the Air Pollution and Health - a European Approach (APHEA APHEA Australasian and Pacific Hansard Editors Association ) project (4). The study periods ranged from the mid-1970s to the end of the 1980s, when sulfur dioxide concentrations and total suspended particles (TSP) were still relatively high in Europe. The study confirmed the association between air pollution and mortality in combined analyses (5). Surprisingly, stronger associations between air pollutants and mortality were observed in the western European cities than in the eastern European cities, where local air pollution standards were frequently exceeded in the 1980s (5). This paper reports data from a highly polluted area in the Czech Republic and a rural area in Germany during the time period 1982-1994. We analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. a different data set from central Europe and evaluated the possibility that the air pollution effects seen consistently throughout the western world (1-3) are reduced in central Europe despite high exposures in the 1980s. The Czech Republic study region is the coal basin in the northwest of the country. The area is highly industrialized in·dus·tri·al·ize v. in·dus·tri·al·ized, in·dus·tri·al·iz·ing, in·dus·tri·al·iz·es v.tr. 1. To develop industry in (a country or society, for example). 2. based on its rich resources in brown coal. Large power plants provide [is greater than] 70% of the electric energy consumed in the Czech Republic. The comparison region consists of four districts in northern Bavaria, a rural German area at the Czech border. The main sources of pollution are local combustion combustion, rapid chemical reaction of two or more substances with a characteristic liberation of heat and light; it is commonly called burning. The burning of a fuel (e.g., wood, coal, oil, or natural gas) in air is a familiar example of combustion. , traffic, and regional transport. Methods Data acquisition. The coal basin includes the districts Chomutov, Most, Teplice, Usti n.L., and Decin. These districts have approximately 630,000 inhabitants
The game is based loosely on the concepts from SameGame. in an area of approximately 700 [km.sup.2]. The Bavarian study region includes the districts Hof, Landkreis Hof, Wunsiedel, and Tirschenreuth. The Bavarian districts have approximately 250,000 inhabitants in an area of approximately 1,000 [km.sup.2.]. Mortality data from state authorities were obtained in both locations. For the Czech Republic, the cause of death, age, and sex were available for each death record. We calculated daily counts of all-cause mortality [International Classification of Diseases, 9th revision (ICD-9); World Health Organization, Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. ; code [is less than] 800], mortality caused by cardiovascular diseases Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease (ICD-9 code 390-459), respiratory diseases Noun 1. respiratory disease - a disease affecting the respiratory system respiratory disorder, respiratory illness adult respiratory distress syndrome, ARDS, wet lung, white lung - acute lung injury characterized by coughing and rales; inflammation of the (ICD-9 code 460-519), and cancer (ICD-9 code 140-239). For the Bavarian region only daily counts of all-cause mortality (ICD-9 code [is less than] 800) and mortality caused by cardiovascular diseases (ICD-9 code 390-459) were released from the local authorities. Air pollution data were obtained through local air hygiene units. The data were checked for plausibility plau·si·ble adj. 1. Seemingly or apparently valid, likely, or acceptable; credible: a plausible excuse. 2. Giving a deceptive impression of truth or reliability. 3. and correlations between stations by year were taken as guidance to assess the quality of the measurements. Averaged 24-hr concentrations per study region were calculated. When values were missing, we calculated the average based on the remaining stations adjusted for season and year as suggested for the APHEA project (4). Coal basin measurements were taken at seven to nine measurement stations in each district. Automated au·to·mate v. au·to·mat·ed, au·to·mat·ing, au·to·mates v.tr. 1. To convert to automatic operation: automate a factory. 2. air monitoring stations were mounted in each district at a background site in the town centers beginning in 1992. Data measured at the five district Institutes of Hygiene were used for the time period between 1982 and 1991. These measurement stations were maintained on a daily basis and they were located in the center of the towns. Thereafter, data from the automated stations were used. The [SO.sub.2] and the TSP concentrations of the district Chomutov were only poorly correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. with the four other locations (the correlation coefficients Correlation Coefficient A measure that determines the degree to which two variable's movements are associated. The correlation coefficient is calculated as: varied from year to year and ranged between 0.1 and 0.6 as compared to the mean of the other four stations), whereas the temperature measured at Chomutov was correlated perfectly with mean of the other four stations (r = 0.99). Chomutov is on the west side of the coal basin and hosts four large brown-coal power plants, which should have contributed to the pollution in the same way that the industrial facilities contributed in the other four districts. Therefore, air pollution data from Chomutov were not used in the calculation of the average air pollution concentrations. Analyses were repeated with and without data from Chomutov. Slightly smaller estimates were obtained when we considered measurements from Chomutov, suggesting that these measurements might not characterize exposures in Chomutov as well as the mean of the other four stations. Particulate matter [is less than or equal to] 10 [micro]m in aerodynamic diameter ([PM.sub.10]) and particulate matter [is less than or equal to] 2.5 [micro]m in aerodynamic diameter ([PM.sub.2.5]) were measured with a versatile air pollution sampler sampler, sample piece of needlework or embroidery, of silk, cotton, or worsted, for the preservation of some pattern or as an example of the ability of a child or a beginner. In museums and private collections there are samplers dating from as early as 1643. , as previously described (6). In Bavaria, there were three stations in small towns along the Czech border, and there were two others within the district of Hof. All five stations showed good correlation between their measurements and were therefore considered for the analyses (r [is greater than] 0.75). Data on acute respiratory infections Noun 1. respiratory infection - any infection of the respiratory tract respiratory tract infection infection - the pathological state resulting from the invasion of the body by pathogenic microorganisms were available for the Czech Republic from the National Institute of Health (Prague, Czech Republic) indicating influenza epidemics in 1983, 1986, 1987, 1989, 1991, 1992, and 1994. Unfortunately no data on influenza epidemics were available for the Bavarian study region during the study period. We attempted to use the data from the Czech Republic, the former German Democratic Republic (GDR GDR See Global Depositary Receipt (GDR). ), and The Netherlands, but they revealed large temporal Having to do with time. Contrast with "spatial," which deals with space. differences between the putative Alleged; supposed; reputed. A putative father is the individual who is alleged to be the father of an illegitimate child. A putative marriage is one that has been contracted in Good Faith and pursuant to ignorance, by one or both parties, that certain influenza epidemics, probably caused by the restrictions on travel during the Cold War era. Data analyses. We first applied the APHEA methodology (7). We calculated Poisson regression models approximated by logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analyses and assessed an overall trend with a cubic function In mathematics, a cubic function is a function of the form where a is nonzero; or in other words, a polynomial of degree three. . We assessed seasonal variation by sine and cosine cosine: see trigonometry. See sine. COSINE - Cooperation for Open Systems Interconnection Networking in Europe. A EUREKA project. functions with periods between 1 year and one-sixth of a year. We considered temperature a quadratic function A quadratic function, in mathematics, is a polynomial function of the form  , where  . , modeled cold and warm temperatures separately, and
considered relative humidity relative humidityn. The ratio of the amount of water vapor in the air at a specific temperature to the maximum amount that the air could hold at that temperature, expressed as a percentage. , influenza epidemics, and day of the week as additional confounders. We used periodograms and partial autocorrelation Autocorrelation The correlation of a variable with itself over successive time intervals. Sometimes called serial correlation. plots to assess the model fit, and we also used graphical presentations of the fitted values and the residuals. Although a good model fit was obtained for the data from the Czech Republic, the Bavarian data were an imperfect imperfect: see tense. fit. In particular, increases in mortality during the winter were observed in those winters, whereas in The Netherlands, the Netherlands, The officially Kingdom of The Netherlands byname Holland Country, northwestern Europe. Area: 16,034 sq mi (41,528 sq km). Population (2005 est.): 16,300,000. Capital: Amsterdam. Seat of government: The Hague. Most of the people are Dutch. former GDR, or the Czech Republic, we found evidence for possible influenza epidemics. Therefore, we conducted additional analyses using robust Poisson regression models in the framework of generalized additive models In statistics, the generalized additive model (or GAM) is a statistical model developed by Trevor Hastie and Rob Tibshirani blending properties of multiple regression (a special case of general linear model) with additive models. (8). Natural splines with 3 degrees of freedom (df) for each study year were used to fit a semiparametric seasonal function. Temperature and relative humidity were fitted with a natural spline In computer graphics, a smooth curve that runs through a series of given points. The term is often used to refer to any curve, because long before computers, a spline was a flat, pliable strip of wood or metal that was bent into a desired shape for drawing curves on paper. See Bezier and B-spline. of 4 df. We considered temperature on the same day and as a 3-day mean of the current day and the previous 2 days. The association between the air pollutants and mortality was checked for linearity using locally weighted least squares Weighted least squares is a method of regression, similar to least squares in that it uses the same minimization of the sum of the residuals: Term yielded by regression analysis that indicates the sensitivity of the dependent variable to a particular independent variable. See: Parameter. regression coefficient were expressed as relative risks and 95% confidence intervals (CI) were calculated. Results In the coal basin, 18.2 persons died/day on average (Table 1). Fifty-seven percent of all deaths were attributable to cardiovascular disease, 25% to cancer, and 5% to respiratory diseases. On average, 12.0 persons died/day in the Bavarian study region; 53% of these had an underlying diagnosis of cardiovascular disease. Table 1. Distribution of daily deaths in the two study regions between 1982 and 1994. Distribution Mean SD Minimum Coal basin Total mortality(a) 18.2 4.7 3 Cardiovascular diseases(a) 10.4 3.5 0 Respiratory diseases(a) 0.9 1.0 0 Cancer 4.6 2.2 0 Northeast Bavaria Total mortality(b) 412.0 3.7 2 Cardiovascular diseases(b) 6.4 2.6 0 Distribution Median Maximum Coal basin Total mortality(a) 18 41 Cardiovascular diseases(a) 10 29 Respiratory diseases(a) 1 7 Cancer 4 16 Northeast Bavaria Total mortality(b) 12 31 Cardiovascular diseases(b) 6 19 (a) n = 4,748. (b) n = 4,723. During the early 1980s, air pollution concentrations were high in the coal basin as well as in the rural northern Bavarian region (Figure 1). [SO.sub.2] concentrations repeatedly exceeded 500 [micro]g/[m.sup.3], but concentrations were on average higher in the coal basin than in northeast Bavaria (Table 2). Concentrations of [SO.sub.2] and TSP decreased during the study period (Figure 1). Carbon monoxide carbon monoxide, chemical compound, CO, a colorless, odorless, tasteless, extremely poisonous gas that is less dense than air under ordinary conditions. It is very slightly soluble in water and burns in air with a characteristic blue flame, producing carbon dioxide; concentrations decreased over time and nitric oxide nitric oxide or nitrogen monoxide, a colorless gas formed by the combustion of nitrogen and oxygen as given by the reaction: energy + N2 + O2 → 2NO; m.p. −163.6°C;; b.p. −151.8°C;. concentrations remained the same in the rural area in Germany (data not shown). For the coal basin, [NO.sub.2], [PM.sub.10], and [PM.sub.2.5] measurements were performed during the last 2 years of the study (1993-1994). [PM.sub.10] concentrations exceeded 165 [micro]g/[m.sup.3] on 6.4% of the days and [PM.sub.2.5] concentrations were [is greater than] 65 [micro]g/[m.sup.3] on 22% of the days. On average, 68% of the TSP was [PM.sub.10], and most of the [PM.sub.10] was [PM.sub.2.5] (75%). During the study period, [SO.sub.2] and TSP showed a correlation of approximately 0.7 both in the coal basin and in Bavaria (Table 3). Whereas both [NO.sub.2] and CO were moderately correlated with [SO.sub.2] and TSP in Bavaria, [NO.sub.2] was highly correlated with [SO.sub.2] and TSP in the coal basin (Table 3). [PM.sub.10] and [PM.sub.2.5] were highly correlated (r = 0.98) with each other and with TSP (Table 3). [Figure 1 ILLUSTRATION OMITTED] Table 2. Distribution of daily concentrations of air pollutants and meteorologic me·te·or·ol·o·gy n. The science that deals with the phenomena of the atmosphere, especially weather and weather conditions. [French météorologie, from Greek variables in the two study regions between 1982 and 1994. Pollutant/variable No. Mean SD Coal basin [SO.sub.2] ([micro]g/[m.sup.3]) 4,748 99.7 89.4 TSP ([micro]g/[m.sup.3]) 4,725 121.2 85.3 [NO.sub.2] ([micro]g/[m.sup.3])(a) 1,013 33.6 13.6 CO (mg/[m.sup.3])(b) 496 0.58 0.39 [O.sub.3] ([micro]g/[m.sup.3])(b) 585 40.3 25.0 [PM.sub.10] ([micro]g/[m.sup.3])(b) 391 65.9 79.8 [PM.sub.2,5] ([micro]g/[m.sup.3])(b) 400 51.0 70.6 Temperature ([degrees] C) 4,748 8.8 8.1 Relative humidity (%) 4,748 73.6 12.1 Northeast Bavaria [SO.sub.2] ([micro]g/[m.sup.3]) 4,709 41.4 58.9 TSP ([micro]g/[m.sup.3]) 4,698 51.6 34.1 [NO.sub.2] ([micro]g/[m.sup.3]) 4,437 25.2 11.3 CO (mg/[m.sup.3]) 4,303 0.88 0.69 [O.sub.3] ([micro]g/[m.sup.3]) 4,353 38.2 21.9 Temperature ([degrees] C) 4,715 8.02 7.92 Relative humidity (%) 4,719 77.0 11.0 Pollutant/variable Minimum Median Maximum Coal basin [SO.sub.2] ([micro]g/[m.sup.3]) 9 73 987 TSP ([micro]g/[m.sup.3]) 17 99 940 [NO.sub.2] ([micro]g/[m.sup.3])(a) 6 32 156 CO (mg/[m.sup.3])(b) -0.1 0.52 2.88 [O.sub.3] ([micro]g/[m.sup.3])(b) 1 38 140 [PM.sub.10] ([micro]g/[m.sup.3])(b) 10 45 832 [PM.sub.2,5] ([micro]g/[m.sup.3])(b) 2 32 780 Temperature ([degrees] C) -19.5 9.1 28.7 Relative humidity (%) 35 74 99 Northeast Bavaria [SO.sub.2] ([micro]g/[m.sup.3]) 2 20 630 TSP ([micro]g/[m.sup.3]) 5 44 333 [NO.sub.2] ([micro]g/[m.sup.3]) 4 23.7 104 CO (mg/[m.sup.3]) 0.1 0.6 6.2 [O.sub.3] ([micro]g/[m.sup.3]) 0 38 149 Temperature ([degrees] C) -18.0 8.1 27.1 Relative humidity (%) 40 79 99 (a) Time period 1992-1994. (b) Time period 1993-1994. Table 3. The Pearson correlation coefficients for the two study regions.
Czech Republic
Northeast Bavaria [SO.sub.2] TSP [NO.sub.2](a)
[SO.sub.2] 0.70 0.66
TSP 0.70 0.80
[NO.sub.2] 0.37 0.46
CO 0.37 0.37 0.32
Temperature -0.46 -0.12 -0.30
Rel humidity 0.13 -0.09 0.05
[O.sub.3] -0.28 -0.12 -0.35
Czech Republic
Northeast Bavaria CO(b) Temperature Rel humidity
[SO.sub.2] 0.33 -0.60 0.38
TSP 0.49 -0.35 0.21
[NO.sub.2] 0.61 -0.41 0.31
CO -0.49 0.44
Temperature -0.25 -0.52
Rel humidity 0.15 -0.55
[O.sub.3] -0.37 0.58 -0.63
Czech Republic
Northeast Bavaria [O.sub.3](b) [PM.sub.10](b) [PM.sub.2.5](b)
[SO.sub.2] -0.34 0.77 0.73
TSP -0.21 0.93 0.92
[NO.sub.2] -0.45 0.84 0.82
CO -0.57 0.44 0.42
Temperature 0.57 -0.38 -0.38
Rel humidity -0.75 0.23 0.21
[O.sub.3] -0.23 -0.22
Rel, relative. (a) Time period 1992-1994. (b) Time period 1993-1994. Regression regression, in psychology: see defense mechanism. regression In statistics, a process for determining a line or curve that best represents the general trend of a data set. analyses of daily mortality counts showed a general downward trend of 0.4%/year in Bavaria and 0.2%/year in the coal basin. Sine and cosine functions showed the maximal max·i·mal adj. 1. Of, relating to, or consisting of a maximum. 2. Being the greatest or highest possible. mortality in February and the minimal mortality in August. Cold temperature (daily averages [is less than] 10 [degrees] C) on the preceding days was associated with an increase in mortality in both locations. Evidence for an increase in mortality at hot temperatures (daily averages [is greater than] 15 [degrees] C) were found in both locations. A day-of-the-week pattern with a reduced mortality on Sundays as compared to Wednesdays was observed in the rural German study region but not in the coal basin. Increases in acute respiratory infections were a powerful predictor of mortality in the Czech Republic. The strongest effects were seen with a lag of 1 week. An influenza epidemic was defined as [is greater than] 10,000 acute respiratory events/week in the five districts and was associated with a 21.5% increase in all-cause mortality (CI, 15.9-27.4%). There was an association between the logarithm logarithm (lŏg`ərĭthəm) [Gr.,=relation number], number associated with a positive number, being the power to which a third number, called the base, must be raised in order to obtain the given positive number. of TSP and all-cause mortality for the coal basin, when TSP concentrations were lagged 1 or 2 days (Table 4). Nonparametric smooths also were consistent, with a logarithmic logarithmic pertaining to logarithm. logarithmic relationship when the logs of two variables plotted against each other create a straight line. transformation of the TSP concentrations (Figure 2). [SO.sub.2] showed lightly weaker associations (Table 4). Estimates for 2-day lags were statistically significant for both TSP and [SO.sub.2]. Joint analyses of TSP and [SO.sub.2] in one model showed an increased risk of 3.3% in association with 100 [micro]g/[m.sup.3] TSP (CI, -0.5-7.2%) and a risk of 1.0% in association with 100 [micro]g/[m.sup.3] [SO.sub.2] (CI, -3.0-5.2%). The exclusion of days with [SO.sub.2] concentrations [is greater than] 200 [micro]g/[m.sup.3] (excluding 8.8% of all observations) resulted in an increased risk of 3.2% for 100 [micro]g/[m.sup.3] TSP (CI,-1.0-7.5%). Similarly, the exclusion of days with TSP concentrations [is greater than] 200 [micro]g/[m.sup.3] (excluding 11.6% of all observations) led to risk estimations of 3.0% for 100 [micro]g/[m.sup.3] TSP (CI, -1.5-7.7%). [Figure 2 ILLUSTRATION OMITTED] Table 4. Associations between mortality and the logarithm of air pollutants for the coal basin in the Czech Republic.
Log (air pollutant) Unit(a)
1982-1994
[SO.sub.2] same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
TSP same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
1992-1994
TSP(b) same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
[PM.sub.10](b) same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
[PM.sub.2.5](b) same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
[NO.sub.2](c) same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
CO(b) same day 1 mg/[m.sup.3]
Lagged 1 day 1 mg/[m.sup.3]
Lagged 2 day 1 mg/[m.sup.3]
Lagged 3 day 1 mg/[m.sup.3]
[O.sub.3](b) same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
All-cause mortality
Log (air pollutant) RR CI
1982-1994
[SO.sub.2] same day 0.991 0.958-1.026
Lagged 1 day 1.028 0.994-1.063
Lagged 2 day 1.032(**) 1.000-1.065
Lagged 3 day 1.005 0.975-1.036
TSP same day 0.993 0.964-1.023
Lagged 1 day 1.019 0.989-1.051
Lagged 2 day 1.038(**) 1.008-1.069
Lagged 3 day 1.008 0.979-1.037
1992-1994
TSP(b) same day 1.063 0.983-1.150
Lagged 1 day 1.095(**) 1.012-1.185
Lagged 2 day 1.062 0.983-1.146
Lagged 3 day 0.992 0.922-1.068
[PM.sub.10](b) same day 1.041 0.955-1.136
Lagged 1 day 1.098(**) 1.007-1.197
Lagged 2 day 0.996 0.918-1.079
Lagged 3 day 1.031 0.954-1.114
[PM.sub.2.5](b) same day 0.987 0.914-1.065
Lagged 1 day 1.059 0.980-1.144
Lagged 2 day 0.979 0.908-1.055
Lagged 3 day 1.006 0.936-1.081
[NO.sub.2](c) same day 1.066 0.967-1.176
Lagged 1 day 1.057 0.957-1.167
Lagged 2 day 1.026 0.935-1.125
Lagged 3 day 1.045 0.954-1.144
CO(b) same day 1.016(*) 0.998-1.035
Lagged 1 day 1.016(*) 0.998-1.034
Lagged 2 day 1.013 0.996-1.030
Lagged 3 day 1.012 0.995-1.028
[O.sub.3](b) same day 0.982 0.905-1.065
Lagged 1 day 1.052 0.950-1.164
Lagged 2 day 1.078 0.982-1.184
Lagged 3 day 1.025 0.938-1.121
RR, relative risk. Adjusted for trend, season, influenza influenza or flu, acute, highly contagious disease caused by a virus; formerly known as the grippe. There are three types of the virus, designated A, B, and C, but only types A and B cause more serious contagious infections. , temperature, and relative humidity using a generalized additive model. (a) Of increase. (b) Time period 1993-1994. (c) Time period 1992-1994. (*) p < 0.1. (**) p < 0.05. [PM.sub.10] and [PM.sub.2.5] were both associated with all-cause mortality in 1993-1994 with a lag of 1 day (Table 4). TSP concentrations showed stronger effects during the 2 last years than during the whole study period (Table 4). [PM.sub.10] and [PM.sub.2.5] were only measured in Teplice, the central district of the coal basin. Analyses with the TSP concentrations as measured in Teplice confirmed the results for 1993 and 1994 [7.9% increase for 100 [micro]g/[m.sup.3] TSP (CI, 1.5-15.0%)]. [NO.sub.2] showed a positive association with mortality, but did not achieve statistical significance (Table 4). No association was observed between CO and all-cause mortality. A positive, but not statistically significant, association was observed between TSP (lagged 2 days) and mortality of cardiovascular or respiratory causes (Table 5). However, we observed associations between cancer mortality and TSP. Table 5. Associations between mortality and the logarithm of TSP for the coal basin in the Czech Republic in 1982-1994.
Cardiovascular
disease mortality
Log (TSP) Unit of increase RR CI
TSP same day 100 [micro]g/[m.sup.3] 0.967(*) 0.929-1.005
Lagged 1 day 100 [micro]g/[m.sup.3] 1.007 0.967-1.048
Lagged 2 day 100 [micro]g/[m.sup.3] 1.020 0.982-1.061
Lagged 3 day 100 [micro]g/[m.sup.3] 1.004 0.966-1.042
Respiratory
disease mortality Cancer mortality
Log (TSP) RR CI RR CI
TSP same day 1.027 0.897-1.176 1.030 0.971-1.091
Lagged 1 day 0.960 0.836-1.103 1.066(**) 1.005-1.131
Lagged 2 day 1.063 0.929-1.216 1.086(**) 1.025-1.150
Lagged 3 day 1.033 0.906-1.177 1.051(**) 0.994-1.112
RR, relative risk. Adjusted for trend, season, influenza, temperature, and relative humidity using a generalized additive model. (*) p < 0.1. (**) p < 0.05. We did not observe associations between elevated levels of TSP or [SO.sub.2] and the all-cause mortality in the Bavarian study region (Table 6). In addition, we found no evidence that associations with a lag of [is greater than] 3 days was present. The linearity assessment of the associations confirmed a linear but weak association for all pollutants; neither the nonlinear A system in which the output is not a uniform relationship to the input. nonlinear - (Scientific computation) A property of a system whose output is not proportional to its input. nor the linear terms of the locally weighted least squares estimator achieved statistical significance. Increases in CO on the previous day were associated with an increase in all-cause mortality. Table 6. Associations between mortality and air pollutants for the rural study area in Northeast Bavaria in 1982-1994.
Pollutant Unit of increase
[SO.sub.2] same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
TSP same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
[NO.sub.2] same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
CO same day 1 mg/[m.sup.3]
Lagged 1 day 1 mg/[m.sup.3]
Lagged 2 day 1 mg/[m.sup.3]
Lagged 3 day 1 mg/[m.sup.3]
[O.sub.3] same day 100 [micro]g/[m.sup.3]
Lagged 1 day 100 [micro]g/[m.sup.3]
Lagged 2 day 100 [micro]g/[m.sup.3]
Lagged 3 day 100 [micro]g/[m.sup.3]
All-cause mortality
Pollutant RR CI
[SO.sub.2] same day 1.009 0.988-1.030
Lagged 1 day 1.009 0.989-1.030
Lagged 2 day 1.003 0.983-1.023
Lagged 3 day 1.011 0.992-1.030
TSP same day 1.016 0.989-1.045
Lagged 1 day 1.009 0.982-1.038
Lagged 2 day 1.004 0.977-1.031
Lagged 3 day 1.016 0.989-1.043
[NO.sub.2] same day 1.011 0.919-1.112
Lagged 1 day 0.997 0.908-1.094
Lagged 2 day 1.022 0.933-1.118
Lagged 3 day 0.997 0.913-1.090
CO same day 1.014 0.994-1.034
Lagged 1 day 1.023(**) 1.005-1.041
Lagged 2 day 1.013 0.995-1.031
Lagged 3 day 1.003 0.985-1.021
[O.sub.3] same day 1.082(**) 1.004-1.167
Lagged 1 day 0.999 0.933-1.069
Lagged 2 day 0.960 0.899-1.025
Lagged 3 day 0.918 0.862-0.977
Cardiovascular
disease mortality
Pollutant RR CI
[SO.sub.2] same day 1.001 0.974-1.029
Lagged 1 day 0.988 0.961-1.015
Lagged 2 day 0.987 0.961-1.014
Lagged 3 day 0.985 0.960-1.010
TSP same day 1.015 0.977-1.054
Lagged 1 day 0.988 0.951-1.026
Lagged 2 day 0.983 0.947-1.020
Lagged 3 day 0.980 0.945-1.016
[NO.sub.2] same day 1.055 0.927-1.200
Lagged 1 day 1.005 0.885-1.143
Lagged 2 day 1.028 0.908-1.164
Lagged 3 day 0.960 0.850-1.083
CO same day 1.018 0.994-1.044
Lagged 1 day 1.012 0.987-1.038
Lagged 2 day 1.016 0.991-1.041
Lagged 3 day 1.004 0.980-1.029
[O.sub.3] same day 1.061 0.963-1.170
Lagged 1 day 0.982 0.894-1.077
Lagged 2 day 0.971 0.888-1.063
Lagged 3 day 0.940 0.862-1.025
Adjusted for trend, season, temperature, relative humidity, and day-of-the-week effects using a generalized additive model, 1982-1994. (**) p < 0.05. Discussion In the coal basin there was an increase in mortality in association with elevated levels of TSP lagged 2 days. Analyses using the [PM.sub.10] and [PM.sub.2.5] data, which were available during the last 2 years of the study, confirmed the association between particulate matter and mortality. In January 1993, a major air pollution episode occurred (6) that might explain the stronger associations for TSP observed during the last 2 years of study as compared to the entire study period. A logarithmic transformation fit better than a linear parameterization of the particle particle /par·ti·cle/ (pahr´ti-k'l) a tiny mass of material. Dane particle an intact hepatitis B viral particle. concentrations, indicating that less consistent effects were observed at TSP concentrations [is greater than] 400 [micro]g/[m.sup.3]. At these concentrations spatial variation might have been high or the contribution of coarse mass might have reduced the health effects observed per microgram microgram /mi·cro·gram/ (µg) (mi´kro-gram) one millionth (10-6) of a gram. mi·cro·gram n. Abbr. per cubic meter Noun 1. cubic meter - a metric unit of volume or capacity equal to 1000 liters cubic metre, kiloliter, kilolitre metric capacity unit - a capacity unit defined in metric terms TSP (9). A logarithmic transformation also fit better in analyses of data from Erfurt, in the former East Germany East Germany: see Germany. , between 1980 and 1989 (10). The pollution situation in the former GDR might be comparable to the coal basin, although [SO.sub.2] concentrations were nearly twice as high in Erfurt as compared to the coal basin during the mid-1980s. Associations between mortality and air pollution were studied in 12 locations in 9 European countries as part of the APHEA project (4). The APHEA central European sites were Bratislava in Slovakia and four cities in Poland (Cracow, Lodz, Poznan, and Wroclaw). In Bratislava, a small but non-significant association was observed with TSP (11). There was a positive association between all-cause mortality and black smoke in two of the four cities in Poland (12). A combined analysis estimated an increase of 0.6%, which was statistically significant for 50 [micro]g/[m.sup.3] black smoke (5). The increase was substantially smaller than the 3.2% combined effect of 50 [micro]g/[m.sup.3] black smoke in the western cities. A recent meta-analysis estimated an 0.8% increase associated with 10 [micro]g/[m.sup.3] [PM.sub.10] (13). To compare the results, the black smoke could be considered equal to [PM.sub.10] (13). Therefore, the results for the coal basin seem to be comparable to the APHEA results (we estimated that an increase from 10 to 60 [micro]g/[m.sup.3] [PM.sub.10] was associated with a 3.7% increase in mortality) and the recent meta-analyses (we estimated that an increase from 20 to 30 [micro]g/[m.sup.3] [PM.sub.10] was associated with a 0.8% increase in mortality). The strongest association in the coal basin was observed between mortality caused by cancer and TSP. Other causes of death such as respiratory or cardiovascular diseases, which were associated with exposure to ambient Surrounding. For example, ambient temperature and humidity are atmospheric conditions that exist at the moment. See ambient lighting. particles in previous studies (1), were positively associated but did not achieve statistical significance. Lung cancer lung cancer, cancer that originates in the tissues of the lungs. Lung cancer is the leading cause of cancer death in the United States in both men and women. Like other cancers, lung cancer occurs after repeated insults to the genetic material of the cell. is prevalent in the coal basin and is mentioned as an underlying disease on the death certificates of 35 and 10% of men and women, respectively. Associations between particulate air pollution and pneumonia pneumonia (n  mōn`yə), acute infection of one or both lungs that can be caused by a bacterium, usually Streptococcus pneumoniae (a common
complication complication /com·pli·ca·tion/ (kom?pli-ka´shun)1. disease(s) concurrent with another disease. 2. occurrence of several diseases in the same patient. com·pli·ca·tion n. in lung cancer patients) have been noted in Philadelphia, Pennsylvania (14), and in the Six Cities Study (15). In addition, a consistent association has been observed between hospital admissions for pneumonia and [PM.sub.10] in five cities in the United States (16). Therefore, the association between cancer mortality and air pollution might reflect the exacerbation ex·ac·er·ba·tion n. An increase in the severity of a disease or in any of its signs or symptoms. ex·ac of a chronic disease by air pollution. No association was observed between elevated concentrations of [SO.sub.2] or TSP and mortality in the rural Bavarian study region, although the air pollution concentrations were not low during the mid-1980s and the five stations showed a high correlation between each other throughout the study period. There is a possibility that none of the pollutants might be a good indicator for fine particles Fine particles are an air pollutant mainly produced by cars running on diesel. Other sources are the combustion of fossil fuels in power plants and various industrial processes. under the circumstances CIRCUMSTANCES, evidence. The particulars which accompany a fact. 2. The facts proved are either possible or impossible, ordinary and probable, or extraordinary and improbable, recent or ancient; they may have happened near us, or afar off; they are public or in Germany. Unfortunately no [PM.sub.10] measurements were available; therefore it is not known which fraction of the TSP consists of inhalable particles. The German study region is a rural area and sources for TSP might be different as compared to an industrialized region such as the coal basin. In particular, windblown dust might play a larger role in a rural than in an industrialized area. We found an association for CO, which might be a traffic-related indicator pollutant pol·lut·ant n. Something that pollutes, especially a waste material that contaminates air, soil, or water. and which was increasing over time in the study region. In the APHEA project, the results for Cologne Cologne (kəlōn`), Ger. Köln, city (1994 pop. 962,500), North Rhine–Westphalia, W Germany, on the Rhine River. It is a commercial, financial, and industrial center, a rail and road junction, and a river port. , Germany, ranked in the lower third of all study results (5). Extensive attempts have been made to model season and meteorologic variables with nonparametric functions; therefore, it is unlikely that confounding confounding when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies. confounding factor might have obscured the effect. However, the effect estimates are within the confidence bounds of the overall APHEA study results and therefore might be considered consistent with the APHEA study, although they did not achieve statistical significance by themselves. The data presented here show an increase in mortality associated with the concentration of particulate matter in a highly polluted setting in central Europe that is consistent with the associations observed in other western European cities and in the United States (1,3,5). REFERENCES AND NOTES (1.) Dockery DW, Pope CA. Acute respiratory effects of particulate air pollution. Annu Rev Public Health 15:107-132 (1994). (2.) Schwartz J. Air pollution and daily mortality: a review and meta analysis. Environ Res 64:36-52 (1994). (3.) Bascom R, Bromberg PA, Costa DA, Devlin R, Dockery DW, Frampton MW, Lambert W, Samet JM, Speizer FE, Utell M. Health effects of outdoor air pollution. Am J Respir Crit Care Med 153:3-50 (1996). (4.) Katsouyanni K, Zmirou D, Spix C, Sunyer J, Schouten JP, Ponka A, Anderson HR, Le Moullec Y, Wojtyniak B, Vigotti MA, et al. Short-term effects of air pollution on health: a European approach using epidemiological epidemiological emanating from or pertaining to epidemiology. epidemiological associations the associative relationships between the frequency of occurrence of a disease and its determinants, its predisposing and precipitating time-series data. The APHEA project: background, objectives, design. Eur Respir J 8(6):1030-1038 (1995). (5.) Katsouyanni K, Touloumi G, Spix C, Schwartz J, Balducci F, Medina S, Rossi 6, Wojtyniak B, Sunyer J, Bacharova L, et al. Short term effects of ambient sulphur dioxide sulphur dioxide Noun Chem a strong-smelling colourless soluble gas, used in the manufacture of sulphuric acid and in the preservation of foodstuffs Noun 1. and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Br Med J 314:1658-1663 (1997). (6.) Pinto pinto Spotted horse, also called paint, piebald, skewbald, and other terms to describe variations in colour and markings. The American Indian ponies of the western U.S. were often pintos. Most pure-breed associations refuse to register horses with pinto colouring. JP, Stevens RK, Willis RD, Kellogg R, Mamane Y, Nowak J, Santroch J, Benes I, Bures V, Lenicek J. Czech air quality monitoring and receptor receptor /re·cep·tor/ (-ter) 1. a molecule on the surface or within a cell that recognizes and binds with specific molecules, producing a specific effect in the cell; e.g. modeling study. Environ Sci Technol 32:843-854 (1998). (7.) Schwartz J, Spix C, Touloumi G, Bacharova L, Barumamdzadeh T, Letertre A, Piekarksi T, Deleon AP, Ponka A, Rossi G, et al. Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health 50:S3-S11 (1996). (8.) Chamber JM, Hastie TJ. Statistical Models in S. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of :Chapman & Hall, 1993. (9.) Schwartz J, Norris G, Larson T, Sheppard L, Claiborne C, Koenig JQ. Episodes of high coarse particle concentrations are not associated with increased mortality. Environ Health Perspect 107(5):339-342 (1999). (10.) Spix C, Heinrich J, Dockery DW, Schwartz J, Volksch G, Schwinkowski K, Collen C, Wichmann HE. Air pollution and daily mortality in Erfurt, East Germany, 1980-1989. Environ Health Perspect 101:518-526 (1993). (11.) Bacharova L, Fandakova K, Bratinka J, Budinska M, Bachar J, Gudaba M. The association between air poilution and the daily number of deaths: findings from the Slovak Republic contribution to the APHEA project. J Epidemiol Community Health 50:S19-S21 (1996). (12.) Wojtyniak B, Piekarski T. Short term effect of air pollution on mortality in Polish urban populations--what is different? J Epidemiol Community Health 50:S36-S41 (1996). (13.) Pope CA III CA III Challenge Athena version III (Navy SATCOM link) , Dockery DW, Holgate ST, Samet JM, Koren HS, Maynard RL, eds. Air Pollution and Health. Epidemiology of Particle Effects. San Diego San Diego (săn dēā`gō), city (1990 pop. 1,110,549), seat of San Diego co., S Calif., on San Diego Bay; inc. 1850. San Diego includes the unincorporated communities of La Jolla and Spring Valley. Coronado is across the bay. , CA:Academic Press, 1999;31,673-705. (14) Schwartz J, Dockery DW. Increased mortality in Philadelphia associated with daily air pollution concentrations. Am Rev Respir Dis 145:600-604 (1992). (15.) Schwartz J, Dockery DW, Neas LM. Is daily mortality associated specifically with fine particles? J Air Waste Manage Assoc 46:927-939 (1996). (16.) Schwartz J. Air pollution and hospital admissions for respiratory disease. Epidemiology 7(1):20-28 (1996). Address correspondence to A. Peters, GSF-National Research Center for Environment and Health, Institute of Epidemiology, Postfach 1129, 85758 Neuherberg, Germany. Telephone: 49 89 3187 4566. Fax: 49 89 3187 3380. E-mail: peters@gsf.de We thank the Institute of Health Statistics and the Hydrometeorological hy·dro·me·te·or·ol·o·gy n. The branch of meteorology that deals with the occurrence, motion, and changes of state of atmospheric water. hy Institute (Prague, Czech Republic), as well as the Bayerisches Landesamt fur Statistik und Datenverarbeitung and the Bayerisches Landesamt fur Umweltschutz (Munich, Germany) for providing data. We thank K. Honig-Blum for the data management and H. Wei[Beta]gerber for support and discussions during the project. The study was funded by the Bayerisches Staatsministerium fur Landesentwicklung und Umweltfragen and the Fund for Regional Development of the European Union European Union (EU), name given since the ratification (Nov., 1993) of the Treaty of European Union, or Maastricht Treaty, to the European Community . Received 18 May 1999; accepted 30 September 1999. Annette Peters,(1) Jiri Skorkovsky,(2) Frantisek Kotesovec,(3) Jaromir Brynda,(2) Claudia Spix,(1) H. Erich Wichmann,(1) and Joachim Heinrich,(1) (1) GSF-National Research Center for Environment and Health, Neuherberg, Germany (2) Institute of Hygiene, Teplice, Czech Republic (3) Institute of Experimental Medicine, Academy of Science of the Czech Republic, Prague, Czech Republic |
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