Atmospheric circulation types and daily mortality in Athens, Greece.

We investigated the short-term effects of synoptic and mesoscale atmospheric circulation types on mortality in Athens, Greece. The synoptic patterns in the lower troposphere were classified in 8 a priori defined categories. The mesoscale weather types were classified into 11 categories, using meteorologic parameters from the Athens area surface monitoring network; the daily number of deaths was available for 1987-1991. We applied generalized additive models (GAM), extending Poisson regression, using a LOESS smoother to control for the confounding effects of seasonal patterns. We adjusted for long-term trends, day of the week, ambient particle concentrations, and additional temperature effects. Both classifications, synoptic and mesoscale, explain the daily variation of mortality to a statistically significant degree. The highest daily mortality was observed on days characterized by southeasterly flow [increase 10%; 95% confidence interval (CI), 6.1-13.9% compared to the high-low pressure system), followed by zonal flow (5.8%; 95% CI, 1.8-10%). The high-low pressure system and the northwesterly flow are associated with the lowest mortality. The seasonal patterns are consistent with the annual pattern. For mesoscale categories, in the cold period the highest mortality is observed during days characterized by the easterly flow category (increase 9.4%; 95% CI, 1.0-18.5% compared to flow without the main component). In the warm period, the highest mortality occurs during the strong southerly flow category (8.5% increase; 95% CI, 2.0-15.4% compared again to flow without the main component). Adjusting for ambient particle levels leaves the estimated associations unchanged for the synoptic categories and slightly increases the effects of mesoscale categories. In conclusion, synoptic and mesoscale weather classification is a useful tool for studying the weather-health associations in a warm Mediterranean climate situation.