Skip to main content
NCBI home page
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2002 Mar;110(3):221–228. doi: 10.1289/ehp.02110221

A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project.

Marc Saez 1, Ferran Ballester 1, Maria Antònia Barceló 1, Santiago Pérez-Hoyos 1, Juan Bellido 1, José María Tenías 1, Ricardo Ocaña 1, Adolfo Figueiras 1, Federico Arribas 1, Nuria Aragonés 1, Aurelio Tobías 1, Lluís Cirera 1, Alvaro Cañada 1; EMECAM1
PMCID: PMC1240760  PMID: 11882471

Abstract

In recent years, some epidemiologic studies have attributed adverse effects of air pollutants on health not only to particles and sulfur dioxide but also to photochemical air pollutants (nitrogen dioxide and ozone). The effects are usually small, leading to some inconsistencies in the results of the studies. Furthermore, the different methodologic approaches of the studies used has made it difficult to derive generic conclusions. We provide here a quantitative summary of the short-term effects of photochemical air pollutants on mortality in seven Spanish cities involved in the EMECAM project, using generalized additive models from analyses of single and multiple pollutants. Nitrogen dioxide and ozone data were provided by seven EMECAM cities (Barcelona, Gijón, Huelva, Madrid, Oviedo, Seville, and Valencia). Mortality indicators included daily total mortality from all causes excluding external causes, daily cardiovascular mortality, and daily respiratory mortality. Individual estimates, obtained from city-specific generalized additive Poisson autoregressive models, were combined by means of fixed effects models and, if significant heterogeneity among local estimates was found, also by random effects models. Significant positive associations were found between daily mortality (all causes and cardiovascular) and NO(2), once the rest of air pollutants were taken into account. A 10 microg/m(3) increase in the 24-hr average 1-day NO(2)level was associated with an increase in the daily number of deaths of 0.43% [95% confidence interval (CI), -0.003-0.86%] for all causes excluding external. In the case of significant relationships, relative risks for cause-specific mortality were nearly twice as much as that for total mortality for all the photochemical pollutants. Ozone was independently related only to cardiovascular daily mortality. No independent statistically significant relationship between photochemical air pollutants and respiratory mortality was found. The results in this study suggest that, given the present levels of photochemical pollutants, people living in Spanish cities are exposed to health risks derived from air pollution.

Full Text

The Full Text of this article is available as a PDF (1.9 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ballester Díez F., Sáez Zafra M., Alonso Fustel M. E., Taracido Trunk M., Ordóez Iriarte J. M., Aguinaga Ontoso I., Daponte Codina A., Bellido Blasco J., Guillén Pérez J. J., Pérez Boíllos M. J. El proyecto EMECAM: Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad. Antecedentes, participantes, objetivos y métodología. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):165–175. [PubMed] [Google Scholar]
  2. Borja-Aburto V. H., Loomis D. P., Bangdiwala S. I., Shy C. M., Rascon-Pacheco R. A. Ozone, suspended particulates, and daily mortality in Mexico City. Am J Epidemiol. 1997 Feb 1;145(3):258–268. doi: 10.1093/oxfordjournals.aje.a009099. [DOI] [PubMed] [Google Scholar]
  3. Braun-Fahrländer C., Ackermann-Liebrich U., Schwartz J., Gnehm H. P., Rutishauser M., Wanner H. U. Air pollution and respiratory symptoms in preschool children. Am Rev Respir Dis. 1992 Jan;145(1):42–47. doi: 10.1164/ajrccm/145.1.42. [DOI] [PubMed] [Google Scholar]
  4. Bremner S. A., Anderson H. R., Atkinson R. W., McMichael A. J., Strachan D. P., Bland J. M., Bower J. S. Short-term associations between outdoor air pollution and mortality in London 1992-4. Occup Environ Med. 1999 Apr;56(4):237–244. doi: 10.1136/oem.56.4.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Burnett R. T., Dales R. E., Raizenne M. E., Krewski D., Summers P. W., Roberts G. R., Raad-Young M., Dann T., Brook J. Effects of low ambient levels of ozone and sulfates on the frequency of respiratory admissions to Ontario hospitals. Environ Res. 1994 May;65(2):172–194. doi: 10.1006/enrs.1994.1030. [DOI] [PubMed] [Google Scholar]
  6. Castellsague J., Sunyer J., Sáez M., Antó J. M. Short-term association between air pollution and emergency room visits for asthma in Barcelona. Thorax. 1995 Oct;50(10):1051–1056. doi: 10.1136/thx.50.10.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Daniels M. J., Dominici F., Samet J. M., Zeger S. L. Estimating particulate matter-mortality dose-response curves and threshold levels: an analysis of daily time-series for the 20 largest US cities. Am J Epidemiol. 2000 Sep 1;152(5):397–406. doi: 10.1093/aje/152.5.397. [DOI] [PubMed] [Google Scholar]
  8. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2. [DOI] [PubMed] [Google Scholar]
  9. Forsberg B., Stjernberg N., Falk M., Lundbäck B., Wall S. Air pollution levels, meteorological conditions and asthma symptoms. Eur Respir J. 1993 Sep;6(8):1109–1115. [PubMed] [Google Scholar]
  10. Hackney J. D., Linn W. S., Avol E. L., Shamoo D. A., Anderson K. R., Solomon J. C., Little D. E., Peng R. C. Exposures of older adults with chronic respiratory illness to nitrogen dioxide. A combined laboratory and field study. Am Rev Respir Dis. 1992 Dec;146(6):1480–1486. doi: 10.1164/ajrccm/146.6.1480. [DOI] [PubMed] [Google Scholar]
  11. Hazucha M. J., Folinsbee L. J., Seal E., Jr Effects of steady-state and variable ozone concentration profiles on pulmonary function. Am Rev Respir Dis. 1992 Dec;146(6):1487–1493. doi: 10.1164/ajrccm/146.6.1487. [DOI] [PubMed] [Google Scholar]
  12. Hoek G., Brunekreef B., Meijer R., Scholten A., Boleij J. Indoor nitrogen dioxide pollution and respiratory symptoms of schoolchildren. Int Arch Occup Environ Health. 1984;55(1):79–86. doi: 10.1007/BF00378070. [DOI] [PubMed] [Google Scholar]
  13. Hoek G., Schwartz J. D., Groot B., Eilers P. Effects of ambient particulate matter and ozone on daily mortality in Rotterdam, The Netherlands. Arch Environ Health. 1997 Nov-Dec;52(6):455–463. doi: 10.1080/00039899709602224. [DOI] [PubMed] [Google Scholar]
  14. Katsouyanni K., Zmirou D., Spix C., Sunyer J., Schouten J. P., Pönkä A., Anderson H. R., Le Moullec Y., Wojtyniak B., Vigotti M. A. Short-term effects of air pollution on health: a European approach using epidemiological time-series data. The APHEA project: background, objectives, design. Eur Respir J. 1995 Jun;8(6):1030–1038. [PubMed] [Google Scholar]
  15. Kinney P. L., Ozkaynak H. Associations of daily mortality and air pollution in Los Angeles County. Environ Res. 1991 Apr;54(2):99–120. doi: 10.1016/s0013-9351(05)80094-5. [DOI] [PubMed] [Google Scholar]
  16. Lee J. T., Shin D., Chung Y. Air pollution and daily mortality in Seoul and Ulsan, Korea. Environ Health Perspect. 1999 Feb;107(2):149–154. doi: 10.1289/ehp.99107149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Loomis D., Castillejos M., Gold D. R., McDonnell W., Borja-Aburto V. H. Air pollution and infant mortality in Mexico City. Epidemiology. 1999 Mar;10(2):118–123. [PubMed] [Google Scholar]
  18. McDonnell W. F., Muller K. E., Bromberg P. A., Shy C. M. Predictors of individual differences in acute response to ozone exposure. Am Rev Respir Dis. 1993 Apr;147(4):818–825. doi: 10.1164/ajrccm/147.4.818. [DOI] [PubMed] [Google Scholar]
  19. Morgan G., Corbett S., Wlodarczyk J., Lewis P. Air pollution and daily mortality in Sydney, Australia, 1989 through 1993. Am J Public Health. 1998 May;88(5):759–764. doi: 10.2105/ajph.88.5.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Neas L. M., Dockery D. W., Ware J. H., Spengler J. D., Speizer F. E., Ferris B. G., Jr Association of indoor nitrogen dioxide with respiratory symptoms and pulmonary function in children. Am J Epidemiol. 1991 Jul 15;134(2):204–219. doi: 10.1093/oxfordjournals.aje.a116073. [DOI] [PubMed] [Google Scholar]
  21. Ostro B., Sanchez J. M., Aranda C., Eskeland G. S. Air pollution and mortality: results from a study of Santiago, Chile. J Expo Anal Environ Epidemiol. 1996 Jan-Mar;6(1):97–114. [PubMed] [Google Scholar]
  22. Pérez-Hoyos S., Sáez Zafra M., Barceló M. A., Cambra C., Figueiras Guzmán A., Ordóez J. M., Guillén Grima F., Ocaña R., Bellido J., Cirera Suárez L. Protocolo EMECAM: análisis del effecto a corto plazo de la contaminacion atmosférica sobre la mortalidad. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):177–185. [PubMed] [Google Scholar]
  23. Pönkä A., Savela M., Virtanen M. Mortality and air pollution in Helsinki. Arch Environ Health. 1998 Jul-Aug;53(4):281–286. doi: 10.1080/00039899809605709. [DOI] [PubMed] [Google Scholar]
  24. Saez M., Figueiras A., Ballester F., Pérez-Hoyos S., Ocaña R., Tobías A. Comparing meta-analysis and ecological-longitudinal analysis in time-series studies. A case study of the effects of air pollution on mortality in three Spanish cities. J Epidemiol Community Health. 2001 Jun;55(6):423–432. doi: 10.1136/jech.55.6.423. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Saez M., Pérez-Hoyos S., Tobias A., Saurina C., Barceló M. A., Ballester F. Métodos de series temporales en los estudios epidemiológicos sobre contaminación atmosférica. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):133–143. [PubMed] [Google Scholar]
  26. Samet J. M., Lambert W. E., Skipper B. J., Cushing A. H., Hunt W. C., Young S. A., McLaren L. C., Schwab M., Spengler J. D. Nitrogen dioxide and respiratory illnesses in infants. Am Rev Respir Dis. 1993 Nov;148(5):1258–1265. doi: 10.1164/ajrccm/148.5.1258. [DOI] [PubMed] [Google Scholar]
  27. Sartor F., Demuth C., Snacken R., Walckiers D. Mortality in the elderly and ambient ozone concentration during the hot summer, 1994, in Belgium. Environ Res. 1997 Feb;72(2):109–117. doi: 10.1006/enrs.1996.3694. [DOI] [PubMed] [Google Scholar]
  28. Schwartz J. Air pollution and daily mortality in Birmingham, Alabama. Am J Epidemiol. 1993 May 15;137(10):1136–1147. doi: 10.1093/oxfordjournals.aje.a116617. [DOI] [PubMed] [Google Scholar]
  29. Schwartz J. Air pollution and daily mortality: a review and meta analysis. Environ Res. 1994 Jan;64(1):36–52. doi: 10.1006/enrs.1994.1005. [DOI] [PubMed] [Google Scholar]
  30. Schwartz J., Ballester F., Saez M., Pérez-Hoyos S., Bellido J., Cambra K., Arribas F., Cañada A., Pérez-Boillos M. J., Sunyer J. The concentration-response relation between air pollution and daily deaths. Environ Health Perspect. 2001 Oct;109(10):1001–1006. doi: 10.1289/ehp.011091001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Schwartz J. Lung function and chronic exposure to air pollution: a cross-sectional analysis of NHANES II. Environ Res. 1989 Dec;50(2):309–321. doi: 10.1016/s0013-9351(89)80012-x. [DOI] [PubMed] [Google Scholar]
  32. Schwartz J. What are people dying of on high air pollution days? Environ Res. 1994 Jan;64(1):26–35. doi: 10.1006/enrs.1994.1004. [DOI] [PubMed] [Google Scholar]
  33. Schwartz J., Zanobetti A. Using meta-smoothing to estimate dose-response trends across multiple studies, with application to air pollution and daily death. Epidemiology. 2000 Nov;11(6):666–672. doi: 10.1097/00001648-200011000-00009. [DOI] [PubMed] [Google Scholar]
  34. Simpson R. W., Williams G., Petroeschevsky A., Morgan G., Rutherford S. Associations between outdoor air pollution and daily mortality in Brisbane, Australia. Arch Environ Health. 1997 Nov-Dec;52(6):442–454. doi: 10.1080/00039899709602223. [DOI] [PubMed] [Google Scholar]
  35. Sunyer J., Castellsagué J., Sáez M., Tobias A., Antó J. M. Air pollution and mortality in Barcelona. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s76–s80. doi: 10.1136/jech.50.suppl_1.s76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Tenías Burillo J. M., Ballester Díez F., Medina S., Daponte Codina A. Revisión de los trabajos originales que analizan los effectos de la contaminación atmosférica en la mortalidad, 1994-1998. Rev Esp Salud Publica. 1999 Mar-Apr;73(2):145–164. [PubMed] [Google Scholar]
  37. Tobías Garcés A., Sunyer Deu J., Castellsagué Piqué J., Sáez Zafra M., Antó Boqué J. M. Impacto de la contaminación atmosférica sobre la mortalidad y las urgencias por enfermedad pulmonar obstructiva crónica y asma en Barcelona. Gac Sanit. 1998 Sep-Oct;12(5):223–230. doi: 10.1016/s0213-9111(98)76476-3. [DOI] [PubMed] [Google Scholar]
  38. Touloumi G., Katsouyanni K., Zmirou D., Schwartz J., Spix C., de Leon A. P., Tobias A., Quennel P., Rabczenko D., Bacharova L. Short-term effects of ambient oxidant exposure on mortality: a combined analysis within the APHEA project. Air Pollution and Health: a European Approach. Am J Epidemiol. 1997 Jul 15;146(2):177–185. doi: 10.1093/oxfordjournals.aje.a009249. [DOI] [PubMed] [Google Scholar]
  39. Touloumi G., Pocock S. J., Katsouyanni K., Trichopoulos D. Short-term effects of air pollution on daily mortality in Athens: a time-series analysis. Int J Epidemiol. 1994 Oct;23(5):957–967. doi: 10.1093/ije/23.5.957. [DOI] [PubMed] [Google Scholar]
  40. Verhoeff A. P., Hoek G., Schwartz J., van Wijnen J. H. Air pollution and daily mortality in Amsterdam. Epidemiology. 1996 May;7(3):225–230. doi: 10.1097/00001648-199605000-00002. [DOI] [PubMed] [Google Scholar]
  41. Whitehead A., Whitehead J. A general parametric approach to the meta-analysis of randomized clinical trials. Stat Med. 1991 Nov;10(11):1665–1677. doi: 10.1002/sim.4780101105. [DOI] [PubMed] [Google Scholar]
  42. Zmirou D., Schwartz J., Saez M., Zanobetti A., Wojtyniak B., Touloumi G., Spix C., Ponce de León A., Le Moullec Y., Bacharova L. Time-series analysis of air pollution and cause-specific mortality. Epidemiology. 1998 Sep;9(5):495–503. [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES