@article{3140282,
    title = "Acute Effects of Ambient Particulate Matter on Mortality in Europe and
North America: Results from the APHENA Study",
    author = "Samoli, Evangelia and Peng, Roger and Ramsay, Tim and Pipikou, Marina and and Touloumi, Giota and Dominici, Francesca and Burnett, Rick and Cohen, and Aaron and Krewski, Daniel and Samet, Jon and Katsouyanni, Klea",
    journal = "Environmental Health Perspectives",
    year = "2008",
    volume = "116",
    number = "11",
    pages = "1480-1486",
    publisher = "US DEPT HEALTH HUMAN SCIENCES PUBLIC HEALTH SCIENCE",
    issn = "0091-6765, 1552-9924",
    doi = "10.1289/ehp.11345",
    keywords = "air pollution; effect modification; heterogeneity; meta-regression;
mortality; natural splines; particulate matter; penalized splines;
time-series analysis",
    abstract = "BACKGROUND: The APHENA (Air Pollution and Health: A Combined European
and North American Approach) study, is a collaborative analysis of
multicity time-series data on the effect of air pollution on population
health, bringing together data from the European APHEA (Air Pollution
and Health: A European Approach) and U.S. NMMAPS (National Morbidity,
Mortality and Air pollution Study) projects, along with Canadian data.
OBJECTIVES: The main objective of APHENA was to assess the coherence of
the findings of the multicity studies carried out in Europe and North
America, when analyzed with a common protocol, and to explore sources of
possible heterogeneity. We present APHENA results on the effects of
particulate matter (PM) <= 10 mu m in aerodynamic diameter (PM10) on the
daily number of deaths for all ages and for those < 75 and >= 75 years
of age. We explored the impact of potential environmental and
socioeconomic factors that may modify this association.
METHODS: In the first stage of a two-stage analysis, we used Poisson
regression models, with natural and penalized splines, to adjust for
seasonality, with various degrees of freedom. In the second stage, we
used meta-regression approaches to combine time-series results across
cites and to assess effect modification by selected ecologic covariates.
RESULTS: Air pollution risk estimates were relatively robust to
different modeling approaches. Risk estimates from Europe and United
States were similar, but those from Canada were substantially higher.
The combined effect of PM10 on all-cause mortality across all ages for
cities with daily, air pollution data ranged front 0.2% to 0.6% for a
10-mu g/m(3) increase in ambient PM10 concentration. Effect modification
by other pollutants and climatic variables differed in Europe and the
United States. In both of these regions, a higher proportion of older
people and higher unemployment were associated with increased air
pollution risk.
CONCLUSIONS: Estimates of the increased mortality associated with PM air
pollution based on the APHENA study were generally comparable with
results of previous reports. Overall, risk estimates were similar in
Europe and in the United States but higher in Canada, However, PM10
effect modification patterns were somewhat different in Europe and the
United States."
}