Determinants of personal and indoor PM2.5 and absorbance among elderly subjects with coronary heart disease.

Epidemiological studies have established an association between outdoor levels of fine particles (PM2.5) and cardiovascular health. However, there is little information on the determinants of PM2.5 exposures among persons with cardiovascular disease, a potentially susceptible population group. Daily outdoor, indoor and personal PM2.5 and absorbance (proxy for elemental carbon) concentrations were measured among elderly subjects with cardiovascular disease in Amsterdam, the Netherlands, and Helsinki, Finland, during the winter and spring of 1998-1999 within the framework of the ULTRA study. There were 37 non-smoking subjects in Amsterdam and 47 in Helsinki. In Amsterdam, where there were enough exposure events for analyses, exposure to environmental tobacco smoke (ETS) indoors was a major source of between-subject variation in PM2.5 exposures, and a strong determinant of PM2.5 and absorbance exposures. When the days with ETS were excluded, within-subject variation accounted for 89% of the total variation in personal PM2.5 and 97% in absorbance in Amsterdam. The respective figures were 66% and 61% in Helsinki. In both cities, outdoor levels of PM2.5 and absorbance were major determinants of personal and indoor levels. Traffic was also an important determinant of absorbance: living near a major street increased exposure by 22%, and every hour spent in a motor vehicle by 13% in Amsterdam. The respective increases were 37% and 9% in Helsinki. Cooking was associated with increased levels of both absorbance and PM2.5. Our results demonstrate that by using questionnaires in connection with outdoor measurements, exposure estimation of PM2.5 and its combustion originating fraction can be improved among elderly persons with compromised health.