Annunziata Faustini1, Ester R Alessandrini1, Jorge Pey2, Noemi Perez3, Evangelia Samoli4, Xavier Querol3, Ennio Cadum5, Cinzia Perrino6, Bart Ostro7, Andrea Ranzi8, Jordi Sunyer7, Massimo Stafoggia1, Francesco Forastiere1. 1. Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy. 2. Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona, Spain Aix Marseille Université, CNRS, Marseille, France. 3. Institute of Environmental Assessment and Water Research, IDAEA-CSIC, Barcelona, Spain. 4. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece. 5. Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, Italy. 6. Institute of Atmospheric Pollution, National Research Council, Rome, Italy. 7. Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. 8. Regional Centre for Environment and Health, Regional Agency for Environmental Protection of Emilia-Romagna, Modena, Italy.
Abstract
BACKGROUND: An association between occurrence of wildfires and mortality in the exposed population has been observed in several studies with controversial results for cause-specific mortality. In the Mediterranean area, forest fires usually occur during spring-summer, they overlap with Saharan outbreaks, are associated with increased temperature and their health effects are probably due to an increase in particulate matter. AIM AND METHODS: We analysed the effects of wildfires and particulate matter (PM10) on mortality in 10 southern European cities in Spain, France, Italy and Greece (2003-2010), using satellite data for exposure assessment and Poisson regression models, simulating a case-crossover approach. RESULTS: We found that smoky days were associated with increased cardiovascular mortality (lag 0-5, 6.29%, 95% CIs 1.00 to 11.85). When the effect of PM10 (per 10 µg/m(3)) was evaluated, there was an increase in natural mortality (0.49%), cardiovascular mortality (0.65%) and respiratory mortality (2.13%) on smoke-free days, but PM10-related mortality was higher on smoky days (natural mortality up to 1.10% and respiratory mortality up to 3.90%) with a suggestion of effect modification for cardiovascular mortality (3.42%, p value for effect modification 0.055), controlling for Saharan dust advections. CONCLUSIONS: Smoke is associated with increased cardiovascular mortality in urban residents, and PM10 on smoky days has a larger effect on cardiovascular and respiratory mortality than on other days. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: An association between occurrence of wildfires and mortality in the exposed population has been observed in several studies with controversial results for cause-specific mortality. In the Mediterranean area, forest fires usually occur during spring-summer, they overlap with Saharan outbreaks, are associated with increased temperature and their health effects are probably due to an increase in particulate matter. AIM AND METHODS: We analysed the effects of wildfires and particulate matter (PM10) on mortality in 10 southern European cities in Spain, France, Italy and Greece (2003-2010), using satellite data for exposure assessment and Poisson regression models, simulating a case-crossover approach. RESULTS: We found that smoky days were associated with increased cardiovascular mortality (lag 0-5, 6.29%, 95% CIs 1.00 to 11.85). When the effect of PM10 (per 10 µg/m(3)) was evaluated, there was an increase in natural mortality (0.49%), cardiovascular mortality (0.65%) and respiratory mortality (2.13%) on smoke-free days, but PM10-related mortality was higher on smoky days (natural mortality up to 1.10% and respiratory mortality up to 3.90%) with a suggestion of effect modification for cardiovascular mortality (3.42%, p value for effect modification 0.055), controlling for Saharan dust advections. CONCLUSIONS: Smoke is associated with increased cardiovascular mortality in urban residents, and PM10 on smoky days has a larger effect on cardiovascular and respiratory mortality than on other days. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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