@article{3049884,
    title = "Short-term effects of air pollution on hospital admissions of
respiratory diseases in Europe: A quantitative summary of APHEA study
results",
    author = "Spix, C and Anderson, HR and Schwartz, J and Vigotti, MA and LeTertre, A and and Vonk, JM and Touloumi, G and Balducci, F and Piekarski, T and and Bacharova, L and Tobias, A and Ponka, A and Katsouyanni, K",
    journal = "ARCHIVES OF ENVIRONMENTAL HEALTH",
    year = "1998",
    volume = "53",
    number = "1",
    pages = "54-64",
    publisher = "Heldref Publications",
    issn = "0003-9896",
    doi = "10.1080/00039899809605689",
    abstract = "The Air Pollution and Health: a European Approach (APHEA) project is a
coordinated study of the short-term effects of air pollution on
mortality and hospital admissions. Five West European cities (i.e.,
London, Amsterdam, Rotterdam, Paris, Milano) contributed several years
of hospital admissions data for all respiratory causes. In the current
study, the authors describe the results obtained from the quantitative
pooling (meta-analysis) of local analyses. The diagnostic group was
defined by ICD 460-519. The age groups studied were 15-64 y (i.e.,
adults) and 65 + y (elderly). The air pollutants studied were sulfur
dioxide; particles (i.e., Black Smoke or total suspended particles);
ozone; and nitrogen dioxide. The pollutants were obtained from existing
fixed-site monitors in a standardized manner. We used Poisson models and
standardized confounder models to examine the associations between daily
hospital admissions and air pollution. We conducted quantitative pooling
by calculating the weighted means of local regression coefficients. We
used a fixed-effects model when no heterogeneity could be detected;
otherwise, we used a random-effects model. When possible, the authors
investigated the factors correlated with heterogeneity. The most
consistent and strong finding was a significant increase of daily
admissions for respiratory diseases (adults and elderly) with elevated
levels of ozone. This finding was stronger in the elderly, had a rather
immediate effect (same or next day), and was homogeneous over cities.
The elderly were affected more during the warm season. The Sulfur
dioxide daily mean was available in all cities, and it was not
associated consistently with an adverse effect. Effects were present in
areas in which more than one station was used in the assessment of daily
exposure. Some significant associations were observed, although no
conclusion that related to an overall particle effect could be drawn.
The effect of Black Smoke was significantly stronger with high nitrogen
dioxide levels on the same day, but nitrogen dioxide itself was not
associated with admissions. The ozone results were in good agreement
with the results of similar U.S. studies. The coherence of the results
of this study and other results gained under different conditions
strengthens the argument for causality."
}