Xavier Basagaña1, Bénédicte Jacquemin2, Angeliki Karanasiou3, Bart Ostro4, Xavier Querol3, David Agis5, Ester Alessandrini6, Juan Alguacil7, Begoña Artiñano8, Maria Catrambone9, Jesús D de la Rosa10, Julio Díaz11, Annunziata Faustini6, Silvia Ferrari12, Francesco Forastiere6, Klea Katsouyanni13, Cristina Linares14, Cinzia Perrino9, Andrea Ranzi12, Isabella Ricciardelli12, Evangelia Samoli13, Stefano Zauli-Sajani12, Jordi Sunyer15, Massimo Stafoggia6. 1. Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain. Electronic address: xbasagana@creal.cat. 2. Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; INSERM U1018, CESP-Centre for Research in Epidemiology and Population Health, UMRS U1018, Respiratory and Environmental Epidemiology Team, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif, France; University Paris Sud, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif, France. 3. Institute of Environmental Assessment and Water Research (IDAEA-CSIC), C/Jordi Girona 18-26, 08034 Barcelona, Spain. 4. Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Air Pollution Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay St 16th floor, 94612 Oakland, CA, USA. 5. Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain. 6. Department of Epidemiology, Lazio Region Health Service, Via di Santa Costanza 53, 00198 Rome, Italy. 7. CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Center of Research on Environmental Health (CYSMA), University of Huelva, Campus de El Carmen, 21007 Huelva, Spain. 8. Departamento de Medio Ambiente, CIEMAT, C/Complutense 40, 28040 Madrid, Spain; CSIC-IDAEA/CIEMAT Associate Unit on Atmospheric Pollution, Spain. 9. C.N.R. Institute of Atmospheric Pollution Research, Via Salaria Km 29, 300 Montelibretti, Rome, Italy. 10. Associate Unit CSIC-University of Huelva "Atmospheric Pollution", Centre of Research of Sustainable Chemistry (CIQSO), Campus of Excellence CEIA3, University of Huelva, Edificio Robert H Grubbs, Campus de El Carmen, 21007 Huelva, Spain. 11. National School of Public Health, Carlos III Health Institute, C/Sinesio Delgado 6, 28029 Madrid, Spain. 12. Environmental Protection Agency of Emilia-Romagna, Via F. Rocchi, 19, Via Triachini, 17, 40138 Bologna, Italy. 13. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75, Goudi, GR-11527 Athens, Greece. 14. CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain; National School of Public Health, Carlos III Health Institute, C/Sinesio Delgado 6, 28029 Madrid, Spain. 15. Centre for Research in Environmental Epidemiology (CREAL), C/Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), C/Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), C/Doctor Aiguader 88, 08003 Barcelona, Spain; IMIM (Hospital del Mar Research Institute), C/Doctor Aiguader 88, 08003 Barcelona, Spain.
Abstract
BACKGROUND: Few recent studies examined acute effects on health of individual chemical species in the particulate matter (PM) mixture, and most of them have been conducted in North America. Studies in Southern Europe are scarce. The aim of this study is to examine the relationship between particulate matter constituents and daily hospital admissions and mortality in five cities in Southern Europe. METHODS: The study included five cities in Southern Europe, three cities in Spain: Barcelona (2003-2010), Madrid (2007-2008) and Huelva (2003-2010); and two cities in Italy: Rome (2005-2007) and Bologna (2011-2013). A case-crossover design was used to link cardiovascular and respiratory hospital admissions and total, cardiovascular and respiratory mortality with a pre-defined list of 16 PM10 and PM2.5 constituents. Lags 0 to 2 were examined. City-specific results were combined by random-effects meta-analysis. RESULTS: Most of the elements studied, namely EC, SO4(2-), SiO2, Ca, Fe, Zn, Cu, Ti, Mn, V and Ni, showed increased percent changes in cardiovascular and/or respiratory hospitalizations, mainly at lags 0 and 1. The percent increase by one interquartile range (IQR) change ranged from 0.69% to 3.29%. After adjustment for total PM levels, only associations for Mn, Zn and Ni remained significant. For mortality, although positive associations were identified (Fe and Ti for total mortality; EC and Mg for cardiovascular mortality; and NO3(-) for respiratory mortality) the patterns were less clear. CONCLUSIONS: The associations found in this study reflect that several PM constituents, originating from different sources, may drive previously reported results between PM and hospital admissions in the Mediterranean area.
BACKGROUND: Few recent studies examined acute effects on health of individual chemical species in the particulate matter (PM) mixture, and most of them have been conducted in North America. Studies in Southern Europe are scarce. The aim of this study is to examine the relationship between particulate matter constituents and daily hospital admissions and mortality in five cities in Southern Europe. METHODS: The study included five cities in Southern Europe, three cities in Spain: Barcelona (2003-2010), Madrid (2007-2008) and Huelva (2003-2010); and two cities in Italy: Rome (2005-2007) and Bologna (2011-2013). A case-crossover design was used to link cardiovascular and respiratory hospital admissions and total, cardiovascular and respiratory mortality with a pre-defined list of 16 PM10 and PM2.5 constituents. Lags 0 to 2 were examined. City-specific results were combined by random-effects meta-analysis. RESULTS: Most of the elements studied, namely EC, SO4(2-), SiO2, Ca, Fe, Zn, Cu, Ti, Mn, V and Ni, showed increased percent changes in cardiovascular and/or respiratory hospitalizations, mainly at lags 0 and 1. The percent increase by one interquartile range (IQR) change ranged from 0.69% to 3.29%. After adjustment for total PM levels, only associations for Mn, Zn and Ni remained significant. For mortality, although positive associations were identified (Fe and Ti for total mortality; EC and Mg for cardiovascular mortality; and NO3(-) for respiratory mortality) the patterns were less clear. CONCLUSIONS: The associations found in this study reflect that several PM constituents, originating from different sources, may drive previously reported results between PM and hospital admissions in the Mediterranean area.
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