Short-term effects of particulate matter constituents on daily hospitalizations and mortality in five South-European cities: Results from the MED-PARTICLES project
Introduction
Dozens of studies link increases in daily particulate matter (PM) levels to increases in mortality and hospital admissions (Brook et al., 2010, Brunekreef and Holgate, 2002), some in the Mediterranean area (Samoli et al., 2013, Stafoggia et al., 2013). However, particulate matter is a location- and season-dependent complex mixture of different components with potentially different toxicity. Several recent investigations have also examined the relationship between concentrations of individual chemical species and mortality or hospital admissions (Bell et al., 2009, Bell et al., 2014, Burnett et al., 2000, Franklin et al., 2008, Ito et al., 2011, Lall et al., 2011, Levy et al., 2012, Lippmann et al., 2006, Mar et al., 2000, Ostro et al., 2007, Ostro et al., 2010, Ostro et al., 2011, Peng et al., 2009, Sarnat et al., 2008, Son et al., 2012, Zanobetti et al., 2009, Zhou et al., 2011). Most of these studies were conducted in North America, while studies in other parts of the world, where chemical composition may be different, are still limited. In Europe, such studies are scarce and only included one city Ostro et al., 2011, Andersen et al., 2007, Atkinson et al., 2010. While it seems that some elements such as elemental carbon, nickel, and silicon are among the components most commonly associated with adverse health, the main conclusion derived from existing studies is that there is no sufficient evidence to identify the constituents more closely related to health outcomes (Environmental Protection Agency, 2009, Rohr and Wyzga, 2012, WHO (World Health Organization), 2013).
In this study, we examine the relationship between PM constituents and hospitalizations and mortality in five cities in Southern Europe, a region characterized by high vehicle and population densities, a high proportion of diesel cars, high sea traffic and peculiar meteorology with intense solar radiation, low precipitation and stagnation of regional air masses. These patterns confer to PM distinctive grain size and chemical patterns that are characterized by an important fraction of coarse (2.5–10 μm) PM into PM10 and relatively high proportions of mineral (anthropogenic and natural) dust and sulfate (Querol et al., 2009).
Section snippets
Study population and data
This study, within the context of the MED-PARTICLES project, included five cities, three in Spain (Barcelona, Madrid and Huelva) and two in Italy (Rome and Bologna) (Fig. A.1). City characteristics are provided in the Appendix. The overall period of study was from January 2003 to April 2013, although the different cities contributed to different periods according to data availability. Daily mortality counts for all non-external causes [International Classification of Diseases, 9th Revision
Results
Table 1 summarizes the daily number cardiovascular and respiratory hospital admissions and of deaths by natural, cardiovascular and respiratory causes in the five participating cities. Madrid, Rome and Barcelona are large cities with a high number of events, while Bologna and Huelva had lower numbers. Rome and Barcelona were the cities contributing most days to the analyses for PM10 and PM2.5, respectively.
The concentrations of PM10 and PM2.5 and of their selected constituents in the five
Discussion
This study investigated the relationship between PM10 and PM2.5 constituents and hospital admissions and mortality in five South-European cities. Several individual PM components showed increased percent changes in hospital admissions and/or mortality. More consistent results were found for hospital admissions, which had increased power due to a greater frequency of the outcome. The highest effects were found for EC and Ni but many other species showed increased percent changes. For mortality,
Conflict of interest statement
The authors have no conflicts of interest to disclose.
Acknowledgments
The research described in this article was conducted under the grant agreement European Commission, Environment LIFE10/IT/327. We thank the Instituto Nacional de Estadística and the Agència de Salut Pública de Barcelona for providing the mortality data, the Consorci Sanitari de Barcelona (Cat-Salut) for providing hospitalization data for Barcelona and the Agencia Estatal de Meteorologia (Ministerio de Agricultura, Alimentación y Medio Ambiente) for providing the weather data for Spain.
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Both authors contributed equally to this work.
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MED-PARTICLES Study group. Italy: E. Alessandrini, P. Angelini, G. Berti, L. Bisanti, E. Cadum, M. Catrambone, M. Chiusolo, M. Davoli, F. de' Donato,M. Demaria, M. Gandini, M. Grosa, A. Faustini, S. Ferrari, F. Forastiere, P. Pandolfi, R. Pelosini, C. Perrino, A. Pietrodangelo, L. Pizzi, V. Poluzzi, G. Priod, G. Randi, A. Ranzi, M. Rowinski, C. Scarinzi, M. Stafoggia, E. Stivanello, S. Zauli-Sajani; Greece: K. Dimakopoulou, K. Elefteriadis, K. Katsouyanni, A. Kelessis, T. Maggos, N. Michalopoulos, S. Pateraki, M. Petrakakis, S. Rodopoulou, E. Samoli, V. Sypsa; Spain: D. Agis, J. Alguacil, B. Artiñano, J. Barrera-Gómez, X. Basagaña, J. de la Rosa, J. Diaz, R. Fernandez, B. Jacquemin, A. Karanasiou, C. Linares, B. Ostro, N. Perez, J. Pey, X. Querol, P. Salvador, AM Sanchez, J. Sunyer, A. Tobias; France: M. Bidondo, C. Declercq, A. Le Tertre, P. Lozano, S. Medina, L. Pascal, and M. Pascal.