Short-term effects of air pollution on total and cardiovascular mortality: The confounding effect of influenza epidemics

Giota Touloumi, Evangelia Samoli, Philippe Quenel, A. Páldy, Ross H. Anderson, Dennis Zmirou, Igancio Galan, Bertil Forsberg, Christian Schindler, Joel Schwartz, Klea Katsouyanni

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Air pollution is associated with total mortality. This association may be confounded by uncontrolled time-varying risk factors such as influenza epidemics. Methods: We analyzed independent data on influenza epidemics from 7 European cities that also had data on mortality associated with particulates (PM10). We used 10 methods to control for epidemics (5 derived from influenza data and 5 from respiratory mortality series) and compared those results with analyses that did not control for these epidemics. Results: Adjustment for influenza epidemics increased the PM10 effect estimate in most cases (% change in the pooled regression coefficient: -1.9 to 38.9 for total mortality and 1.3 to 25.5 for cardiovascular mortality). A 10-μg/m3 increase in PM10 concentrations (lag 0-1) was associated with a 0.48% (95% confidence interval = 0.27-0.70%) increase in daily mortality unadjusted for influenza epidemics, whereas under the various methods to control for epidemics the increase ranged from 0.45% (0.26-0.69%) to 0.67% (0.46-0.89%). The corresponding figures for cardiovascular mortality were 0.85% (0.53-1.18%) with no adjustment and from 0.86% (0.53-1.19%) to 1.06% (0.74-1.39%) with the methods of control. Conclusions: The association between air pollution and mortality is not weakened by control for influenza epidemic irrespective of the method used. To adjust for influenza epidemics, one can use methods based on respiratory mortality counts instead of counts of influenza cases if the latter are not available. However, adjustment for influenza by any method tested did not markedly alter the air pollution effect estimate.

Original languageEnglish
Pages (from-to)49-57
Number of pages9
JournalEpidemiology
Volume16
Issue number1
DOIs
Publication statusPublished - Jan 2005

Fingerprint

Air Pollution
Human Influenza
Mortality
Confidence Intervals

ASJC Scopus subject areas

  • Epidemiology

Cite this

Short-term effects of air pollution on total and cardiovascular mortality : The confounding effect of influenza epidemics. / Touloumi, Giota; Samoli, Evangelia; Quenel, Philippe; Páldy, A.; Anderson, Ross H.; Zmirou, Dennis; Galan, Igancio; Forsberg, Bertil; Schindler, Christian; Schwartz, Joel; Katsouyanni, Klea.

In: Epidemiology, Vol. 16, No. 1, 01.2005, p. 49-57.

Research output: Contribution to journalArticle

Touloumi, G, Samoli, E, Quenel, P, Páldy, A, Anderson, RH, Zmirou, D, Galan, I, Forsberg, B, Schindler, C, Schwartz, J & Katsouyanni, K 2005, 'Short-term effects of air pollution on total and cardiovascular mortality: The confounding effect of influenza epidemics', Epidemiology, vol. 16, no. 1, pp. 49-57. https://doi.org/10.1097/01.ede.0000142152.62400.13
Touloumi, Giota ; Samoli, Evangelia ; Quenel, Philippe ; Páldy, A. ; Anderson, Ross H. ; Zmirou, Dennis ; Galan, Igancio ; Forsberg, Bertil ; Schindler, Christian ; Schwartz, Joel ; Katsouyanni, Klea. / Short-term effects of air pollution on total and cardiovascular mortality : The confounding effect of influenza epidemics. In: Epidemiology. 2005 ; Vol. 16, No. 1. pp. 49-57.
@article{58a437a2227740a5b21ea94ec2643b40,
title = "Short-term effects of air pollution on total and cardiovascular mortality: The confounding effect of influenza epidemics",
abstract = "Background: Air pollution is associated with total mortality. This association may be confounded by uncontrolled time-varying risk factors such as influenza epidemics. Methods: We analyzed independent data on influenza epidemics from 7 European cities that also had data on mortality associated with particulates (PM10). We used 10 methods to control for epidemics (5 derived from influenza data and 5 from respiratory mortality series) and compared those results with analyses that did not control for these epidemics. Results: Adjustment for influenza epidemics increased the PM10 effect estimate in most cases ({\%} change in the pooled regression coefficient: -1.9 to 38.9 for total mortality and 1.3 to 25.5 for cardiovascular mortality). A 10-μg/m3 increase in PM10 concentrations (lag 0-1) was associated with a 0.48{\%} (95{\%} confidence interval = 0.27-0.70{\%}) increase in daily mortality unadjusted for influenza epidemics, whereas under the various methods to control for epidemics the increase ranged from 0.45{\%} (0.26-0.69{\%}) to 0.67{\%} (0.46-0.89{\%}). The corresponding figures for cardiovascular mortality were 0.85{\%} (0.53-1.18{\%}) with no adjustment and from 0.86{\%} (0.53-1.19{\%}) to 1.06{\%} (0.74-1.39{\%}) with the methods of control. Conclusions: The association between air pollution and mortality is not weakened by control for influenza epidemic irrespective of the method used. To adjust for influenza epidemics, one can use methods based on respiratory mortality counts instead of counts of influenza cases if the latter are not available. However, adjustment for influenza by any method tested did not markedly alter the air pollution effect estimate.",
author = "Giota Touloumi and Evangelia Samoli and Philippe Quenel and A. P{\'a}ldy and Anderson, {Ross H.} and Dennis Zmirou and Igancio Galan and Bertil Forsberg and Christian Schindler and Joel Schwartz and Klea Katsouyanni",
year = "2005",
month = "1",
doi = "10.1097/01.ede.0000142152.62400.13",
language = "English",
volume = "16",
pages = "49--57",
journal = "Epidemiology",
issn = "1044-3983",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Short-term effects of air pollution on total and cardiovascular mortality

T2 - The confounding effect of influenza epidemics

AU - Touloumi, Giota

AU - Samoli, Evangelia

AU - Quenel, Philippe

AU - Páldy, A.

AU - Anderson, Ross H.

AU - Zmirou, Dennis

AU - Galan, Igancio

AU - Forsberg, Bertil

AU - Schindler, Christian

AU - Schwartz, Joel

AU - Katsouyanni, Klea

PY - 2005/1

Y1 - 2005/1

N2 - Background: Air pollution is associated with total mortality. This association may be confounded by uncontrolled time-varying risk factors such as influenza epidemics. Methods: We analyzed independent data on influenza epidemics from 7 European cities that also had data on mortality associated with particulates (PM10). We used 10 methods to control for epidemics (5 derived from influenza data and 5 from respiratory mortality series) and compared those results with analyses that did not control for these epidemics. Results: Adjustment for influenza epidemics increased the PM10 effect estimate in most cases (% change in the pooled regression coefficient: -1.9 to 38.9 for total mortality and 1.3 to 25.5 for cardiovascular mortality). A 10-μg/m3 increase in PM10 concentrations (lag 0-1) was associated with a 0.48% (95% confidence interval = 0.27-0.70%) increase in daily mortality unadjusted for influenza epidemics, whereas under the various methods to control for epidemics the increase ranged from 0.45% (0.26-0.69%) to 0.67% (0.46-0.89%). The corresponding figures for cardiovascular mortality were 0.85% (0.53-1.18%) with no adjustment and from 0.86% (0.53-1.19%) to 1.06% (0.74-1.39%) with the methods of control. Conclusions: The association between air pollution and mortality is not weakened by control for influenza epidemic irrespective of the method used. To adjust for influenza epidemics, one can use methods based on respiratory mortality counts instead of counts of influenza cases if the latter are not available. However, adjustment for influenza by any method tested did not markedly alter the air pollution effect estimate.

AB - Background: Air pollution is associated with total mortality. This association may be confounded by uncontrolled time-varying risk factors such as influenza epidemics. Methods: We analyzed independent data on influenza epidemics from 7 European cities that also had data on mortality associated with particulates (PM10). We used 10 methods to control for epidemics (5 derived from influenza data and 5 from respiratory mortality series) and compared those results with analyses that did not control for these epidemics. Results: Adjustment for influenza epidemics increased the PM10 effect estimate in most cases (% change in the pooled regression coefficient: -1.9 to 38.9 for total mortality and 1.3 to 25.5 for cardiovascular mortality). A 10-μg/m3 increase in PM10 concentrations (lag 0-1) was associated with a 0.48% (95% confidence interval = 0.27-0.70%) increase in daily mortality unadjusted for influenza epidemics, whereas under the various methods to control for epidemics the increase ranged from 0.45% (0.26-0.69%) to 0.67% (0.46-0.89%). The corresponding figures for cardiovascular mortality were 0.85% (0.53-1.18%) with no adjustment and from 0.86% (0.53-1.19%) to 1.06% (0.74-1.39%) with the methods of control. Conclusions: The association between air pollution and mortality is not weakened by control for influenza epidemic irrespective of the method used. To adjust for influenza epidemics, one can use methods based on respiratory mortality counts instead of counts of influenza cases if the latter are not available. However, adjustment for influenza by any method tested did not markedly alter the air pollution effect estimate.

UR - http://www.scopus.com/inward/record.url?scp=20844440876&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=20844440876&partnerID=8YFLogxK

U2 - 10.1097/01.ede.0000142152.62400.13

DO - 10.1097/01.ede.0000142152.62400.13

M3 - Article

C2 - 15613945

AN - SCOPUS:20844440876

VL - 16

SP - 49

EP - 57

JO - Epidemiology

JF - Epidemiology

SN - 1044-3983

IS - 1

ER -