Daily respiratory mortality and PM10 pollution in Mexico City: importance of considering place of death.

Significant associations have been reported between particles with a 50% cut-off aerodynamic diameter of 10 mm (PM10) and ozone ambient concentrations, and daily number of deaths from respiratory causes. The aim of the present study was to assess such associations among elderly (> or =65 yrs) residents of Mexico City. Ambient air pollution data were provided by the Metropolitan Monitoring Network. During the study period, the average daily PM10 ranged 23.4-175.3 microg x m(-3), and ozone 1 h daily maximums ranged 39.4-216.7 ppb. Information was compiled on the primary and underlying causes of death. The analyses were conducted separately according to place of death (within or out of a hospital unit) using time-series methodology. The total number of deaths from all respiratory causes and mortality for chronic obstructive pulmonary diseases (COPD) were significantly related to PM10 over different lags: an increase of 10 microg x m(-3) was related to a 2.9% (95% (CI): 0.9-4.9%) increase and to a 4.1% (95% CI: 1.3%-6.9%) increase with a 3-day lag when death occurred out of medical units, respectively. For deaths occurring in medical units, a longer lag and smaller risk estimate was observed. An interactive effect between PM10 and ozone was detected. This study confirms that there is an important impact of PM10 on respiratory morbidity among elderly subjects. It also indicates that accounting for primary and underlying causes of death, and considering place of death may reduce misclassification and provide more accurate estimates of the adverse impact of PM10 on mortality.