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/m³) 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.