Fine particulate air pollution and all-cause mortality within the Harvard Six-Cities Study: variations in risk by period of exposure.

PURPOSE: We used Poisson regression methods to examine the relation between temporal changes in the levels of fine particulate air pollution (PM(2.5)) and the risk of mortality among participants of the Harvard Six Cities longitudinal study.
METHODS: Our analyses were based on 1430 deaths that occurred between 1974 and 1991 in a cohort that accumulated 105,714 person-years of follow-up. For each city, indices of PM(2.5) were derived using daily samples. Individual level data were collected on several risk factors including: smoking, education, body mass index (BMI), and occupational exposure to dusts. Time-dependent indices of PM(2.5) were created across 13 calendar periods (< 1979, 1979, 1980, em leader, 1989, >/= 1990) to explore whether recent or chronic exposures were more important predictors of mortality.
RESULTS: The relative risk (RR) of mortality calculated using Poisson regression based on average city-specific exposures that remained constant during follow-up was 1.31 [95% confidence interval (CI) = 1.12-1.52] per 18.6 microg/m(3) of PM(2.5). This result was similar to the risk calculated using the Cox model (RR = 1.26, 95% CI = 1.08-1.46). The RR of mortality was attenuated when the Poisson regression model included a time-dependent estimate of exposure (RR = 1.19, 95% CI = 1.04-1.36). There was little variation in RR across time-dependent indices of PM(2.5).
CONCLUSIONS: The attenuated risk of mortality that was observed with a time-dependent index of PM(2.5) is due to the combined influence of city-specific variations in mortality rates and decreasing levels of air pollution that occurred during follow-up. The RR of mortality associated with PM(2.5) did not depend on when exposure occurred in relation to death, possibly because of little variation between the time-dependent city-specific exposure indices.